How do antipsychotic medications affect pregnancy?

With increasing social pressure, the incidence of mental illness is rising year after year. Most mental illnesses develop in young adults, often in the prime of life, and many patients face key life events such as marriage and childbirth while undergoing treatment. The question of whether taking antipsychotic medication has any effect on having children is a topic that patients often consider and doctors are often asked about. Giving up medication for the sake of the child’s health may lead to a relapse; delaying childbearing for the sake of consolidating treatment may miss the “golden period of childbearing”, so whether to continue to take medication during pregnancy or whether to get pregnant while taking medication has become a dilemma. The United States was the first to classify and grade the safety of drugs for pregnancy. Divided into ABCDX five levels, in order: Class A: by clinical control observation, no damage to the fetus, is the safest class; Class B: animal testing did not see damage to the fetus and animals, but there is a lack of clinical control observation data; or animal testing was observed on the fetus and animals have damage, but the clinical control observation study failed to confirm; A, B drugs belong to the fetus and pregnant women have no or virtually no harm to the drug, and the drug can generally be used safely during pregnancy; C, B drugs can be used during pregnancy. Class C: animal experiments and clinical control observation data are not available; or animal fetal animal damage, but the lack of clinical control observation data; this type of drug selection is the most difficult, many commonly used antipsychotics belong to this category; Class D: there has been a certain amount of clinical information that the drug is harmful to the fetus, but the clinic is very important, but there is a lack of alternative medicines, at this time, can be weighed against the hazards and the severity of the clinical indications to make a decision. D: there is some clinical information that the drug is harmful to the fetus, but the clinical need is very great, and there is a lack of alternative drugs, then you can weigh the harm and the severity of the clinical indications to make a decision; C, D drugs on the fetus has a harmful effect (teratogenicity or miscarriage), but the pregnant woman is beneficial to the weighing of the pros and cons of the prudent use of the drug; X level: the results of animal experiments and clinical data indicate that the harmfulness of the fetus is great, generally beyond the therapeutic application of the beneficial benefits achieved, is a banned drug in pregnancy. Most of the drugs commonly used in psychiatry belong to class C, and some belong to class D or X (e.g., sodium valproate, lithium carbonate, alprazolam , etc.). Whether or not you can have children while taking the medication has relatively little effect on the fetus for men with or without the medication. The wife can continue to use the medication when she becomes pregnant, and there is no need to stop the medication before pregnancy if the dosage is small and the medication is safe (medications with a C rating or higher). For women, if the age of small, such as 30 years of age, it is recommended that “first treatment, after pregnancy”; older, the desire to get pregnant urgently, first consider the safety of the drug, under the guidance of the doctor to stop or switch to a lower level of safety for a higher level of safety of the drug. Discontinuation of the drug to pregnancy the shortest time recommended one month + 5 half-life of the drug (a physiological cycle + 5 drugs half-life time). If you have to use a drug with a very low safety level (e.g., X-rated), it is strongly recommended not to get pregnant, as this can cause adverse effects on the fetus and, in retrospect, even more psychological and physical damage to the pregnant woman. At the same time, would like to draw the attention of patients facing this choice to the fact that pregnancy is not recommended when mental illness is not effectively treated. This is because changes in hormone levels, living environment and rhythms of life during pregnancy may increase the psychological burden on the pregnant woman and lead to the aggravation of mental illness.