It is well known that the high prevalence of schizophrenia coincides with the childbearing years, and in the face of these patients there is an inevitable need to consider their fertility. Unfortunately, even though doctors have mentioned the risks of fertility, there are still many patients in the clinic who do not listen to advice or who have unwanted pregnancies. How can psychiatrists safely administer antipsychotic medications to this special population? Let’s first look at the FDA safety classification for commonly used psychiatric drugs during pregnancy. Safety classification of psychiatric drugs A without clozapine, buspirone, bupropion, zolpidem C olanzapine, paliperidone, risperidone, quetiapine, ziprasidone, aripiprazole, fenadine, haloperidol, fluoxetine, sertraline, escitalopram, citalopram, fluvoxamine, venlafaxine, doxepin, trazodone, donepezil, gabapentin D valproate, carbamazepine, lithium, diazepam Alprazolam, lorazepam, clonazepam, midazolam, amitriptyline, promethazine, mipramine X triazolam, eszopiclone n/a sulpiride, amisulpride According to the above table, Class A: There is sufficient evidence from controlled studies that the use of these drugs in the first trimester does not pose a risk to the fetus. Class B: Animal studies confirm that these drugs do not pose a risk to the fetus, but there are no sufficient data from controlled Class C: These drugs have been shown to cause adverse fetal effects in animal studies, and there are no adequate controlled human studies to support their use during pregnancy, despite the risks. Class X: Both animal and human trials have demonstrated that these drugs can cause adverse effects on the fetus and that the risks of using these drugs during pregnancy significantly outweigh the potential benefits and should be contraindicated during pregnancy. The above table shows that most of the antipsychotic drugs are in classes C and C, so psychiatrists must be cautious in their use. Which pregnant women need antipsychotic medications? 1. Women who are taking antipsychotic drugs and intend to have children in the near future. 2.Women who are taking antipsychotic drugs and are pregnant. 3.Women who develop psychiatric disorders during pregnancy and need to use antipsychotic drugs after assessing their risks and benefits. In fact, whether it is or not, it is a very torn matter. If you use it, you will expose the fetus to risks, leading to adverse reactions such as extrapyramidal reactions and malformations; but if you don’t use it, you may cause higher risks to the mother and child. Overall, for pregnant women with schizophrenia, the benefits of taking medications outweigh their risks of not taking them. What should I be aware of when using antipsychotics during pregnancy? During the first trimester of pregnancy, it is best not to use antipsychotic medication (please take this into account), and during the second trimester, medication should also be used when necessary. Patients who require antipsychotics during pregnancy may choose clozapine and olanzapine as relatively safe medications at the lowest dose that will control the patient’s condition. Changes in the patient’s weight, metabolism, and excretion throughout pregnancy need to be considered, and the dose needs to be adjusted accordingly. In addition, there is a need to be careful in the choice of medications, avoiding long-acting antipsychotics, avoiding combination medications, and avoiding diuretics. Routine monitoring of urine sugar and weight. Blood levels and fetal tests should be reinforced during medication administration, and folic acid and vitamin K supplements should be taken to reduce the risk of neural tube abnormalities. What do I need to pay attention to after delivery? After delivery, estrogen plummets in pregnant women, and because of its antagonistic effect on dopamine, a sudden drop in levels after delivery can cause a rebound increase in dopamine, which may cause a sudden increase in the relapse rate of schizophrenia. Because of the high risk of relapse in the postpartum period, patients who discontinue medication need to restart their medication or, if the mother was taking clozapine during pregnancy, review the neutrophils of the newborn and preferably avoid breastfeeding. Due to labor and antipsychotic medications, mothers taking medication against psychosis are more likely to be obese and therefore need to pay attention to weight management.