The FDA classifies medications for use during pregnancy into five major categories: A, B, C, D, and X.
Class A drugs: There are sufficient
controlled studies have failed to demonstrate that the use of this class of drugs in the first trimester of pregnancy poses a risk to the fetus.
The FDA classifies drugs into five categories: A, B, C, D, and X.
Class B drugs: Adequate animal studies have failed to demonstrate that these drugs pose a risk to the fetus.
Adequate animal studies have failed to demonstrate fetal risk for these drugs.
The drugs in category B: Adequate animal trials have failed to demonstrate fetal risk, but there are no adequate controlled human studies.
Class C drugs.
Animal studies have demonstrated adverse effects on the fetus.
The potential benefits support the use of these drugs during pregnancy, although animal studies have demonstrated adverse fetal effects and there are no adequate controlled human studies.
The potential benefits support the use of these drugs during pregnancy, despite the potential risks.
There are potential risks.
Class D drugs: Human trials have demonstrated adverse fetal effects.
The potential benefits support their use during pregnancy despite the potential risks.
The potential benefits support the use of these drugs during pregnancy despite the potential risks.
The potential benefits support their use during pregnancy despite the potential risks.
Class X drugs: Animal and human studies have demonstrated the adverse effects of these drugs on the fetus.
This class of drugs has been shown to cause adverse effects in the fetus in both animal and human trials.
The risks of using these drugs during pregnancy clearly outweigh the potential benefits.
They are contraindicated during pregnancy because the risks of their use during pregnancy significantly outweigh the potential benefits.
The vast majority of antipsychotics are classified as Class B or C drugs by the FDA pregnancy safety classification for commonly used psychiatric drugs. The effects of mood stabilizers and benzodiazepines on
fetal malformations and behavioral effects are more closely related and are mostly
They are classified as Class D and require more caution when used during pregnancy and lactation.
The FDA pregnancy safety classification for psychotropic medications FDA Pregnancy Safety Classification for Psychotropic Drugs
Safety Classification Psychiatric Drugs
A (none)
B Clozapine, buspirone, bupropion, maprotiline, zolpidem
C olanzapine, paliperidone, risperidone, quetiapine, ziprasidone, aripiprazole, chlorpromazine
C Olanzapine, haloperidol, fluoxetine, sertraline, escitalopram
Citalopram, fluvoxamine, duloxetine, venlafaxine, mirtazapine, doxepin, trazodone, doxorubicin
Serpine, Trazodone, Donepezil, Gabapentin
D valproate, carbamazepine, lithium, diazepam, alprazolam, lorazepam
Diazepam, Clorazepam
Nitrazepam, midazolam, paroxetine, amitriptyline, promethazine, mipramine
X triazolam, eszopiclone
N/A sulpiride, amisulpride
Adaptive physiological changes in maternal systems during pregnancy that
also have a relationship with psychiatric relapse and treatment. Pregnancy
Estrogen increases during pregnancy and is mainly produced by the corpus luteum in early gestation.
After 10 weeks of gestation, it is mainly synthesized by the feto-placental unit.
By the end of pregnancy, estriol is 1000 times greater than that of non-pregnant women
By the end of pregnancy, estradiol and estrone are 100 times greater than in non-pregnant women. Estrogen
estrogen has antidopaminergic effects and may reduce the risk of schizophrenia relapse.
The risk of recurrence of schizophrenia is reduced. However, after delivery, estrogen decreases abruptly, dopamine
rebound increases and the rate of schizophrenia relapse increases sharply.
This change should be noted in treatment.
(ii) Before pregnancy
Women with schizophrenia who have recovered from treatment and have been on low-dose consolidation therapy for
Women who have been treated for schizophrenia for more than 2 years can consider stopping medication for pregnancy.
Pregnancy. Do a risk assessment for medication discontinuation. Carefully review the medical history and
Review medical history and response to treatment. If medication is discontinued, inform patients
and their families of the personal risks associated with discontinuation, evidence of the safety of antipsychotic use during pregnancy Establish a
Establish a schedule for tapering off the medication and have the patient follow it.
Advise family members to closely monitor the patient for early signs of relapse and to seek prompt
Advise family members to monitor the patient closely for signs of early relapse and to seek prompt medical attention.
If the patient agrees to continue using medications that have a tendency to elevate prolactin secretion, it is recommended that he or she be monitored.
If the patient agrees to continue using medications that have a tendency to elevate prolactin production, monitoring of plasma prolactin is recommended. If
is too high, it may affect fertility and a change in treatment may be considered.
(iii) During pregnancy (iii) During pregnancy
Give psychological support to the patient. Prenatal administration of vitamins
and folic acid to reduce the risk of neural tube abnormality.
If the patient continues antipsychotic medication, give the lowest effective dose and split doses.
If patients continue antipsychotic treatment, they should be given the lowest effective dose and divided doses. The dose administered will need to be adjusted as weight, metabolism, excretion and body size change during pregnancy.
The dose administered needs to be adjusted as weight, metabolism, excretion and body size change during pregnancy. Avoid diuretics and low-salt diets and
Avoid combination medications. Routine monitoring of gestational diabetes to avoid
Avoid excessive weight gain. Avoid treatment with long-acting antipsychotics.
Avoid treatment with long-acting antipsychotics.
During pregnancy, the psychiatrist should work closely with the obstetrician
work closely with the obstetrician to ensure that the patient does not abandon treatment and completes
The patient should be monitored as appropriate. All indicators of physical and mental health are routinely followed up during pregnancy.
health status and mental health indicators. Patients are advised to attend
Patients are advised to attend prenatal classes to help prepare for delivery. Assess the patient’s
The patient’s ability to care for the newborn is assessed. For patients with impaired caregiving capacity
patients with impaired caregiving skills, start family education sessions early to establish
(iv) Pre-birth
(iv) Pre-delivery
Obstetricians should be vigilant about the use of antipsychotic medications for maternal
The obstetrician should be vigilant about the use of antipsychotic medications in labor. If it is a typical antipsychotic medication
The neonate should be monitored for extrapyramidal reactions in the first few days of life. If the mother is taking clozapine, then
The neonate’s blood neutrophils need to be reviewed.
(v) Postpartum and lactation
The risk of recurrence of psychiatric symptoms in the postpartum period is high and the original medication needs to be continued.
The risk of recurrence of psychiatric symptoms in the postpartum period is high, and the original medication needs to be continued and restarted if the medication is discontinued.
(v) Postpartum and lactation
When a mother takes antipsychotic medication, the medication passes into her breast milk, but the concentration is much lower than in the mother.
However, the concentration will be much lower than the maternal concentration, less than 10% of the mother’s
The concentration of the drug in the mother’s breast milk is much lower, less than 10% of the mother’s concentration, resulting in dose-related adverse events in the infant.
It is unlikely that the infant will experience dose-related adverse events and breastfeeding can be considered.
The infant’s level of alertness needs to be monitored. However, it is best to avoid breastfeeding when taking clozapine.
However, breastfeeding is best avoided for those taking clozapine. Some mothers delay the start of drug therapy until after breastfeeding for absolute safety.
However, this can lead to a high risk of recurrence.
Women with schizophrenia are less fertile, and if
decide to become pregnant, the risk of relapse is greater if medication is stopped than if
continuing treatment. For patients who choose to become pregnant, it is important to make them fully
them aware of the benefits and risks of medication. For the
The clinical management of pregnant women with schizophrenia is closely linked to the early intervention of the obstetrician to reduce the potential risks of pregnancy.
Early intervention by the obstetrician to reduce the risks that may arise during pregnancy
The risks and benefits of medication options are discussed with the obstetrician.
and discuss with the obstetrician the risks and benefits of medication options, and provide adequate psychosocial support during pregnancy and before and after delivery to
From the latest edition of the treatment guidelines