Women with a history of serious psychotic disorders are at increased risk of disease relapse during pregnancy. Long-acting injectable (LAI) antipsychotics have been widely used to improve adherence and prevent relapse in patients with various severe psychotic disorders, but there is a lack of high-quality data from previous research on the safety of LAI antipsychotics during pregnancy.

To summarize relevant data on maternal, pregnancy, neonatal, and developmental outcomes from published cases of LAI antipsychotic use in pregnancy.

A literature search was performed through November 11, 2023, using three online databases: PubMed/MEDLINE, Scopus, and Web of Science. Case reports or case series that reported information about the outcomes of pregnancy in women who used LAI antipsychotics at any point in pregnancy, with available full texts, were included. Descriptive statistics, narrative summation, and tabulation of the extracted data were performed.

A total of 19 publications satisfied the inclusion criteria: 3 case series, 15 case reports, and 1 conference abstract. They reported the outcomes of LAI antipsychotic use in 74 women and 77 pregnancies. The use of second-generation LAI antipsychotics was reported in the majority (n = 47; 61.0%) of pregnancies. First-generation LAI antipsychotics were administered during 30 pregnancies (39.0%). Most of the women (approximately 64%) had either satisfactory control of symptoms or no information about relapse, while approximately 12% of them had developed gestational diabetes mellitus. A minority of cases reported adverse outcomes such as stillbirth, spontaneous abortion, preterm birth, low birth weight, congenital anomalies, and neurological manifestations in newborns. However, there were no reports of negative long-term developmental outcomes.

Currently available data seem reassuring, but further well-designed studies are required to properly evaluate the risks and benefits of LAI antipsychotic use during pregnancy.

Psychiatric illness may develop or relapse during pregnancy, and understanding best practices is paramount. In 2017, the British Association for Psychopharmacology (BAP) consensus guidance on the use of psychotropic medication preconception, in pregnancy, and postpartum was released. The BAP guidelines provide concise evidence and additional insight and flexibility for use of psychiatric medication. Key takeaways of these guidelines are highlighted serving as a concise reference for practitioners. Additionally, practice points, such as recommendations for rapid tranquilization and the role of long-acting injectable antipsychotic medications as well as additional insights to the growing body of literature associated with psychiatric medications in pregnancy since 2017 are summarized. Providers are strongly encouraged to stay up to date to provide optimal care for pregnant patients and their babies.

The antipsychotic drug, olanzapine, is prescribed for postpartum psychosis. Possible adverse effects on fertility of offspring are unclear. We investigated the effects of administering olanzapine via lactation on testicular development and endocrine function of prepuberal male rats. Olanzapine was administered to mothers at 2.5, 5 or 10 mg/kg. We found in male offspring increased body weight, decreased gonadosomatic index, testicular weight and epididymal weight. The volume of seminiferous tubules, seminiferous epithelium, Leydig cells, intertubule tissue and lymphatic space was reduced in rat pups exposed to olanzapine. Tubule diameter and length, seminiferous epithelium height, Leydig cell size and nuclear diameter also were reduced. Testosterone levels were reduced in the groups exposed to olanzapine, while prolactin levels were increased. We observed histopathology in testes of animals whose mothers had been treated with 2.5 mg/kg olanzapine; more severe pathology was observed in offspring whose mothers were administered higher doses. Administration of olanzapine to mothers during lactation produced testicular and endocrine pathology in prepuberal rats in a dose-dependent manner.

Our study aimed to examine pregnancy, neonatal and psychosocial outcomes for women treated with LAIs at tertiary maternity hospital. A retrospective review of all women who were treated with LAIs between 1999 and 2017. Cases were identified via the hospital dispensary system and outcome data were extracted case notes as well as the midwifery notification system. Measures included sociodemographic data, smoking, alcohol and illicit substance use, pregnancy complications such as gestational diabetes, and neonatal outcomes. Psychosocial profiles such as psychiatric admission during pregnancy and statutory child protection involvement were also assessed. Where available, outcomes were compared with state population data. The study found 38 pregnancies to 36 women, who had LAI treatment. Two congenital malformations (5.7%) were recorded. Compared to general population data, pregnant women treated with LAIs were more likely to have obstetric complications including gestational diabetes and pregnancy hypertension and special care nursery admission for their babies. They also had elevated rates of psychiatric admissions during pregnancy and statutory child protection involvement. Outcomes were similar first and second generation LAIs exposure. As women on LAI have limited options for treatment of their psychotic disorders, the findings point towards a need for enhanced multidisciplinary pregnancy care for this vulnerable cohort.

Long-acting injectable antipsychotic medications (LAIs) are an evidence-based treatment option for people with severe mental illness. While women with severe mental illness who are prescribed LAIs can become pregnant, there is a dearth of research examining the safety of these medication formulations during pregnancy.

This article summarizes available literature on the use of LAIs in pregnancy to help inform clinical decisions and guide future research.

PubMed literature searches were completed using combinations of keywords including "antipsychotic" and "long-acting injectable" or "depot," or generic or brand names of LAIs with "pregnancy." Pregnancy outcomes were compared across studies.

Twelve relevant case reports of 13 pregnancies were identified. Six cases did not report any negative birth or infant outcomes, including prematurity, infants being born small for gestational age, congenital anomalies, and extrapyramidal symptoms. No cases reported abnormal Apgar scores, infants being born large for gestational age, or negative long-term developmental outcomes after exposure to LAIs during pregnancy. Cesarean section rate was comparable to the general population. Specific adverse outcomes included one infant with multiple congenital anomalies, 3 infants with minor congenital anomalies, and one infant with possible extrapyramidal symptoms. One infant was born prematurely, one infant was born small for gestational age, and 2 infants were born both prematurely and small for gestational age.

There is little research specifically examining the use of LAIs in pregnancy, so risks must be extrapolated from studies on oral antipsychotics in pregnancy. While the few published case reports examining LAIs in pregnancy somewhat align with research examining oral antipsychotics, these findings are inconclusive due to the inherently limited nature of case reports. Further investigation into the use of LAIs in pregnancy is warranted.

Introduction: Pregnant women and fetuses are more likely than ever to be exposed to antipsychotic drugs (APs) during pregnancy and postpartum period. Second-generation APs (SGA) are increasingly used among women in reproductive age. Key outcomes (i.e., congenital malformations, pregnancy and maternal outcomes, neonatal/infant risks, and developmental/long-term outcomes) following the exposure to APs remain limited in number and size and yield of inconsistent findings overall, particularly regarding long-acting injectable AP (LAI-APs) formulations.Areas covered: The review aims at providing a summary of current knowledge on potential risks and safety profile of LAI-APs during pregnancy and breastfeeding, specifically focusing on SGA.Expert opinion: The management of safety and tolerability of long-acting injectable AP (LAI-APs) is far from having solid scientific evidence. In fact, due to ethical reasons, there is a lack of randomized clinical trials that limits the reliability and generalizability of the available data on LAI-APs safety profile during the perinatal period, being limited in the scientific literature only to isolated case reports. Therefore, it seems to be important for the future pathways to perinatal mental health care, providing a network of specialized clinicians and systematically collecting data of pregnant/puerperal women on oral and/or LAI APs-therapy about mother and infant outcomes.

Antipsychotic long-acting formulations (LAI-AP) have emerged as a new therapeutic choice to treat patients presenting a severe mental disorder. Despite that, to date, there is a lack of safety data and studies regarding the use of LAI-AP formulations in pregnant women. Here we present the first six-case series of pregnant women with schizophrenia treated with aripiprazole-LAI reported in the literature. All patients remained psychopathologically stable through pregnancy and the postpartum period, and all of them were in treatment with aripiprazole-LAI. To date, all infants remain healthy with normal developmental milestones, without the presence of congenital malformations or adverse effects. Lack of information on safety data regarding the use of new antipsychotic formulations remains important in treating women with mental illness who desire to become pregnant. Further studies in this clinical population with a larger number of patients included remains necessary.