Management of schizophrenia in women during the perinatal period: a synthesis of international recommendations

ABSTRACT

Introduction

The perinatal period in schizophrenia is associated with high risk of psychotic relapse and pregnancy/child outcomes. The extent to which antipsychotics may potentially affect the fetus or the child development is unclear and debated. Even though guidelines have been developed, there is a lack of consensual recommendations regarding the optimal strategy to manage schizophrenia during the perinatal period.

Areas covered

This systematic review describes the current state of evidence with respect to the impact of recommended interventions for schizophrenia during the perinatal period, including childbearing age, pregnancy, and post-partum. It compares recent international treatment guidelines for this specific group of women. Last, this review presents a set of major points to be discussed with patients and relatives for shared-decision making and a summary of key recommendations from the international guidelines.

Expert opinion

Although treatment guidelines may be of significant help, discrepancies exist across them regarding the management of antipsychotics for schizophrenia women during the perinatal period. Shared decision-making and advance directives represent useful patient-centered approaches during this specific period. Further cohort-based evidence is needed to better identify maternal and fetal risks associated to antipsychotic treatment exposure.

KEYWORDS:

• Schizophrenia
• peripartum
• perinatal
• guidelines
• systematic review

Article highlights

• Women with schizophrenia have increased risk of relapse and higher rates of hospitalisation in pregnancy and early postpartum.

• Recent evidence encourages psychiatric care and mental health policies to consider specific strategies that focus on women with schizophrenia as new mothers, while optimizing healthy pregnancies.

• There is a global consensus of antipsychotics to be used during pregnancy at minimum dosage and avoiding polypharmacy, while antipsychotics during breastfeeding are not consistently recommended across guidelines.

• Multidisciplinary care involving child and adult psychiatrists, obstetrician, pediatrician, and primary care physician is recommended.

• Large cohort studies that compare schizophrenia women exposed to antipsychotics with unexposed women are needed to better identify maternal and fetal risks associated to treatment exposure, with adequate control of key confounding variables.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

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