CLINICAL HANDBOOK OF SCHIZOPHRENIA

TABLE 45.1. Antipsychotic Medications in Pregnancy45. Parenting 475Medication Advantages Disadvantages Metabolic changeAripiprazole • No weight gain• No diabetes risk• Less sedation• Lack of systematic study CYP450 3A4, CYP4502D6 increased; mayneed dose increaseClozapine • Highly effective • Risk of weight gain• Risk of diabetes• Risk of sedation• Lower seizure threshold• Risk of agranulocytosis• Accumulates in fetus• Accumulates in breastfeedingbabyHaloperidolOlanzapineRisperidoneQuetiapineZiprasidone• Relatively well studied• No increased riskof physical anomalies• No adverse effectson neurodevelopment• No increased riskof physical anomalies• No increased riskof physical anomalies• Less sedation• No morphologicalteratogenicity• No weight gain• diabetes risk• Less sedation• Elevated prolactin candecrease fertility• Risk of weight gain• Risk of diabetes• Risk of sedation• Elevated prolactin candecrease fertility• Risk of sedationVariable, but CYP4501A2 (predominantenzyme) decreased; mayneed dose decreaseCYP450 3A4 increased;may need dose increaseCYP450 1A2 decreased;may need dose decreaseCYP450 2D6 increased;may need dose increaseCYP450 3A4 increased;may need dose increaseCYP450 3A4 increased;may need dose increaseto haloperidol in utero are taller and/or heavier than comparable nonexposed children.This suggests that haloperidol may have an enduring effect on fetal dopaminergic systemsthat affect growth hormone and/or appetite.FGAs may cause extrapyramidal side effects (EPS). Relatively low calcium may increasethe risk of EPS, perhaps due to effects at the neuromuscular junction. Pregnancy isa time of relatively high calcium need, and women whose diets do not contain enoughcalcium may be at heightened risk of EPS during pregnancy.Rarely, newborns can also experience a form of EPS after prolonged exposure toFGAs during pregnancy. This is posited to be withdrawal dyskinesia. Signs can includetremor, hand posturing, jerky eye movements, a shrill cry, arched back, tongue thrusting,increased tone, and hyperreflexia. These effects begin within hours to days after birth andresolve gradually over several months, with no lasting abnormalities.Pregnant women and newborns can have side effects related to the anticholinergicproperties of FGAs. Constipation can be exacerbated by intestinal slowing during pregnancy.Rarely, intestinal slowing from anticholinergic effects can result in functional intestinalobstruction in newborns. The likelihood of this side effect is increased if themother also took an anticholinergic agent to treat EPS during the pregnancy.Haloperidol has not been associated with side effects from exposure during breastfeeding. By contrast, more sedating, low-potency FGAs such as chlorpromazine havebeen observed to cause somnolence in some breast-feeding babies.