Atypical Antipsychotics for Schizophrenia and/or Bipolar Disorder in Pregnancy: Current Recommendations and Updates in the NICE Guidelines.

BACKGROUND The gold standard pharmacological agents used to treat schizophrenia and bipolar disorder in adults are antipsychotics. Atypical or second-generation antipsychotics have superseded or used as alternatives to typical first-generation antipsychotics due to better tolerability and safety profile. However the efficacy and safety of these drugs are severely limited in pregnancy and/or women of childbearing potential. There are very few guidelines to guide the clinical management of schizophrenia and/or bipolar disorder in this subgroup. AIM We aimed to review current evidence of atypical antipsychotics used in pregnancy where available, with considerations to its efficacy and safety to both the mother and fetus, in conjunction with the recently updated NICE guidelines. METHODS The latest NICE CG192 guidelines on antenatal and postnatal mental health, published in December 2014 was reviewed and summarized, and the BNF-approved list of atypical antipsychotics were identified. Clinically relevant MEDLINE-linked publications were searched and selected where available using the PubMed search engine to identify evidence for or against the use of atypical antipsychotics in pregnancy. RESULTS AND CONCLUSIONS NICE CG192 improved clarity on the prediction, support and holistic management of mental illness in pregnancy and puerperium; however there were no specific recommendations in terms of pharmacological agents used to treat schizophrenia and/or bipolar disorder in this subgroup. Evidence from the literature on atypical antipsychotics yielded discordant results. Nonetheless, our report presents preliminary findings of certain antipsychotics which appear to be effective and safe in pregnancy. Future research would benefit from larger, prospective randomized controlled trials, and perhaps include newer atypical antipsychotics for consideration in this subgroup.