Around 2% of women develop a non-affective psychotic disorder, and more than half of them have children.1 2 Women with nonaffective psychoses are less fertile than controls, partly because of hyperprolactinaemia secondary to antipsychotic drugs.3 4 The use of atypical drugs such as clozapine and olanzapine, which do not have this effect, may increase fertility rates. Weighing risks against benefits in treating pregnant and breastfeeding women with antipsychotics requires assessment of clinical effectiveness versus risk of toxicity to mother, fetus, newborn, and the developing child. Withholding antipsychotic treatment may expose mother and fetus to more harm than benefit as, in addition to behavioural disturbance which may put both at risk, physiological changes associated with psychosis could affect fetoplacental integrity and development of the central nervous system. Subsequently, poor clinical outcomes for mothers may result in poorer interaction between mother and infant.5 But the impact of antipsychotic medication on the fetus is also unclear as no randomised controlled trials have evaluated the use of antipsychotics in pregnancy.6

The only large controlled studies of antipsychotics in pregnancy have been conducted on …