Atypical antipsychotics, maternal and child outcomes: A critical review

Introduction Atypical antipsychotics are increasingly prescribed for women suffering affective and non-affective psychoses during the antenatal and postnatal period. The level of evidence for psychopharmacological treatment during pregnancy with these agents is generally poor, especially on maternal, foetal and infant outcomes. The aim is to summarize the current evidence on the use of atypical antipsychotics during pregnancy, and to evaluate the known maternal, foetal and neonatal outcomes related to maternal treatment with atypical antipsychotic during the antenatal period. Materials and methods A comprehensive literature search was undertaken by using various electronic databases to identify published studies reporting on safety of atypical antipsychotics in human pregnancy up to March 2014. We inspected all references of all identified studies and hand searched for key journals. The selected studies were reviewed, summarised, and synthesised. Results Atypical antipsychotics are known to be associated with maternal weight gain, which can increase risks of maternal gestational diabetes, metabolic syndrome, and foetal neural tube defects. Single cases of obstetrical complications and perinatal adverse reactions associated with exposure to atypical agents during pregnancy have also been reported. Conversely, there is no conclusive evidence of their structural teratogenicity. Conclusion The rapid development in pharmacotherapy has resulted in a growing number of women of childbearing age being treated with atypical antipsychotic drugs. The major challenge for healthcare professionals is to achieve an optimal balance between minimizing foetal and neonatal exposure whilst avoiding the potentially harmful consequences of maternal mental illnesses. Due to the limitation of the research and the potential public health implications, further evidence on maternal, obstetric and infant outcomes of mother treated with atypical antipsychotics is urgently needed.