What is schizophrenia?
Schizophrenia is a psychotic disorder, meaning a disorder in which the biggest feature is psychosis, disruptions in thoughts and emotions such that the person is out of touch with reality. Symptoms include delusions and hallucinations. A delusion is a belief or idea that a person maintains, even in the face of evidence that the belief is false, or when it is different from what is accepted by people as a whole. There are different categories of delusions. Paranoid delusions, for instance, are delusions in which the belief is that everyone else is part of a conspiracy organized against them. Hallucinations are perceptions within a persons mind of things that are not really there and they can involve any of the senses. Visual hallucinations, for instance, are the person thinking they see something that is not there. Auditory hallucinations are the person thinking they hear something that isn’t there, for instance a voice. Typically in schizophrenia, hallucinations are auditory. Other psychotic features include disorganized speech and disorganized behavior.
How common is schizophrenia in pregnancy?
Psychotic disorders, of which schizophrenia is the most common type, affect approximately 3.5 percent of people worldwide. Younger men and people of color are affected by schizophrenia more commonly. However, young and middle-aged women can also develop the condition, and so pregnancy can happen to women with schizophrenia. Furthermore, a growing number of women with schizophrenia are getting pregnant.
How is schizophrenia diagnosed?
Schizophrenia diagnosis is made clinically, by way of a psychiatric evaluation that includes your history and demonstration of symptoms such as hallucinations, delusions, disorganized speech, or disorganized behavior. These are assessed in terms of criteria that are listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Based on the presence of psychotic symptoms for more than six months and the amount that the condition affects your function, an examiner can determine if you meet the requirements for schizophrenia as opposed to a different disorder such as brief psychotic disorder with postpartum onset, what used to be called post-partum psychosis.
Does schizophrenia cause problems during pregnancy?
Schizophrenia during pregnancy increases the risk that the mother will experience problems such as a need for cesarean delivery, induction of labor, or bleeding (hemorrhage) before or after delivery. One possible cause of hemorrhage before delivery is a serious condition called placental abruption, in which the placenta detaches from the wall of the uterus, thereby cutting off blood flow to the developing baby, but also causing the mother to lose a lot of blood.
Does schizophrenia cause problems for the baby?
Schizophrenia in the mother increases the risk of poor growth of the baby, fetal distress (the developing baby is not doing well, usually because the placenta is not receiving enough blood flow or oxygen), premature rupture of membranes (water breaking too early), stillbirth, infant death, preterm delivery, low birth weight, birth defects due to reduced blood flow in the uterus, placental abruption, and other problems.
What to consider about taking medications when you are pregnant:
- The risks to yourself and your baby if you do not treat the schizophrenia
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat schizophrenia during pregnancy?
Drugs used for treating schizophrenia are characterized into different groups based on how they are thought to work and based on how old or how new they are. Older drugs, known as first-generation antipsychotic agents, include phenothiazines and butyrophenones, which have been used to treat not just schizophrenia, but also nausea during pregnancy including a severe condition of nausea and vomiting called hyperemesis gravidarum. One powerful, commonly used butyrophenone called haloperidol has been subject to controversy as to whether it increases the risk of birth defects; there was a report that when given during the first trimester the drug caused abnormalities in the limb of babies, but this was contradicted by studies involving larger numbers of pregnancies, leading researchers to conclude that haloperidol is probably relatively safe in pregnancy. There also is some concern that a commonly used, lower-potency phenothiazine called chlorpromazine may slightly increase the risk of birth defects when given during the first trimester. There is some concern that exposure to chlorpromazine, haloperidol, or other first-generation antipsychotic drugs in the womb may cause temporary problems for the baby involving movement, feeding, the intestines, or jaundice (yellowing of the skin). Some concern also surrounds second-generation antipsychotic agents, which include olanzapine, risperidone, clozapine, amisulpride, aripiprazole, and ziprasidone, but more studies are needed to understand the risks.
Who should NOT stop taking medication for schizophrenia during pregnancy?
If your doctors decide that you require an antipsychotic drug to treat schizophrenia during or after pregnancy, you are better off continuing with the treatment. While there has been some concern about effects in the baby, the risks are not fully understood but are thought to be low, whereas the problems connected with untreated schizophrenia are very severe.
What should I know about choosing a medication for schizophrenia in pregnancy?
You may find Pregistrys expert reports about the individual medications to treat schizophrenia here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for schizophrenia when I am breastfeeding?
Tiny amounts of antipsychotic medication entering breastmilk are not thought to be dangerous to full-term infants, although safety limits still need to be established. Mothers with preterm infants should be more careful with such medications since we don’t know how easily the drugs enter breastmilk. To be absolutely safe, if you are on antipsychotic medication, you can avoid any risk, regardless of the maturity of your infant, by not breastfeeding and choosing an infant formula under the direction of your pediatrician.
What alternative therapies besides medications are there to treat schizophrenia during pregnancy?
Antipsychotic medications are the gold standard for treating schizophrenia, but a procedure called electroconvulsive therapy (ECT) can be effective sometimes, both for schizophrenia and for short term psychotic conditions. Usually, this is the choice only after medication proves to be inadequate, so ECT is not really an alternative to medication.
What can I do for myself and my baby when I have schizophrenia during pregnancy?
It is very important to follow the
instructions of your physician and therapist, attend your counseling sessions, and take your medications as instructed.
Resources for schizophrenia during pregnancy:
For more information about schizophrenia during pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles: