Background: When a pregnant or lactating woman is treated with an antipsychotic drug, the maternal need of antipsychotics must be weighed against possible risks to the fetus/infant.
Material and methods: Published articles on the use of antipsychotics during pregnancy and lactation were identified by Medline and Embase searches. An overview is presented.
Results: Available data do not indicate a clinically significant increased risk of congenital malformations after use of first-generation antipsychotics in pregnancy. However, use in the third trimester increases the risk of extrapyramidal symptoms in the newborn. Epidemiological studies do not indicate long-term effects on psychomotor development or cognitive abilities. For second-generation antipsychotics, data are generally very sparse. The excretion in breast milk of first-generation high potency antipsychotics is generally low and no negative effects have been documented after use in monotherapy. For second-generation antipsychotics, data are sparse or lacking.
Interpretation: First-generation antipsychotics do not appear to be teratogenic. If antipsychotics are used in the third trimester, the neonate should be observed for extrapyramidal symptoms. When the use of a first-generation antipsychotic is indicated in a lactating woman, the favourable effects of lactation will most likely in the majority of cases exceed the theoretical risk of detrimental drug effects in the infant. Nevertheless, efforts should always be made to minimise drug exposure to the fetus or suckling infant.