Safety of antipsychotic drugs for pregnant and breastfeeding women with non-affective psychosis

doi:10.1136/bmj.329.7472.933

BMJ 2004;329:933-934 (23 October), doi:10.1136/bmj.329.7472.933

Editorial

Safety of antipsychotic drugs for pregnant and breastfeeding women with non-affective psychosis

Multicentre cohort studies are needed as randomised trials areimpractical

The first 150 words of the full text of this article appear below.

Around 2% of women develop a non-affective psychotic disorder,and more than half of them have children.¹ ² Women with nonaffectivepsychoses are less fertile than controls, partly because of hyperprolactinaemia secondary to antipsychotic drugs.³ ⁴ Theuse of atypical drugs such as clozapine and olanzapine, whichdo not have this effect, may increase fertility rates. Weighingrisks against benefits in treating pregnant and breastfeedingwomen with antipsychotics requires assessment of clinical effectivenessversus risk of toxicity to mother, fetus, newborn, and the developingchild. Withholding antipsychotic treatment may expose motherand fetus to more harm than benefit as, in addition to behaviouraldisturbance which may put both at risk, physiological changesassociated with psychosis could affect fetoplacental integrityand development of the central nervous system. Subsequently,poor clinical outcomes for mothers may result in poorer interactionbetween mother and infant.⁵ But the impact of antipsychoticmedication on the fetus is also . . . [Full text of this article]

Louise Howard, senior lecturer

Health Services Research Department, Institute of Psychiatry, London SE5 8AF (l.howard@iop.kcl.ac.uk)

Roger Webb, research fellow

(r.webb@man.ac.uk)

Kathryn Abel, senior lecturer

(kathryn.m.abel@man.ac.uk) Centre for Women's Mental Health Research, University of Manchester, Manchester M13 9PL

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