Schizophrenia During Pregnancy and Lactation

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Schizophrenia is a psychotic disorder. This means a condition in which psychosis is the most prominent feature. Psychosis features disrupt thoughts and emotions to the point that you are out of touch with reality. The disconnection with reality shows up as symptoms, particularly delusions and hallucinations. A delusion is an idea or belief that the affected person has, even if the idea or belief is not logical or is rejected by everybody else in the person’s society. Delusions fall into different categories, such as paranoid delusions, which are delusions in which the underlying disconnection from reality is that everyone else is part of a conspiracy organized against the person.

Hallucinations are perceptions of things within the mind that are not really there. Hallucinations fall into different categories based on the senses involved:

  • Visual hallucinations: These are false perceptions that the person is seeing something that is not there.
  • Auditory hallucination: These are false perceptions that the person is hearing something, for instance a voice. Typically in schizophrenia, hallucinations are auditory.

Other psychotic features include disorganized speech and disorganized behavior.

The most common psychotic disorder is schizophrenia , which affect approximately 3.5 percent of people around the world. Schizophrenia is most common in younger men and racial and ethnic minorities, but young and middle aged women can develop it as well. This means that schizophrenia can coexist with pregnancy , and actually a growing number of women with schizophrenia are becoming pregnant.

Mental health professionals diagnose schizophrenia clinically, through psychiatric evaluation that includes the person’s history and demonstration of features, such as delusions, hallucinations, disorganized speech, or disorganized behavior. Assessment is based on criteria that are listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Psychotic features must be present for more than six months. The diagnosis also is influenced by the degree to which the condition affects your function. The doctor can determine if you meet the criteria for schizophrenia or for a different disorder, such as “brief psychotic disorder with postpartum onset” (in the past, this was called “post-partum psychosis”).

If you suffer from schizophrenia during pregnancy, there is an increased risk of problems, such as a need for cesarean section (surgical birth) or induction of labor, or hemorrhage (bleeding) before or after delivery. One possible cause of hemorrhage prior to delivery is called placental abruption. This is a condition in which the placenta disconnects from the wall of the uterus, thus preventing blood from flowing to the fetus. Since the mother herself loses a lot of blood, she too is in danger. Maternal schizophrenia also increases the risk of fetal distress (the fetus is not doing well, usually because the placenta is not receiving enough blood flow, or oxygen), poor fetal growth, premature rupture of membranes (“water breaking” too early) stillbirth (child is born dead), infant death, preterm delivery, low birth weight, and birth defects.

Schizophrenia is treated with a variety of medications classified into different groups based on how new or old they are and on how scientists think they work against psychosis. Older drugs, called first generation antipsychotic agents, include phenothiazines and butyrophenones; doctors have been used these drugs to treat schizophrenia, as well as nausea during pregnancy, including a severe condition of nausea and vomiting called hyperemesis gravidarum. Controversy surrounds whether a common and very powerful butyrophenone called haloperidol increases the risk of birth defects. One report suggested that haloperidol given during the first trimester causes abnormalities in the baby’s limbs; however, other studies involving larger numbers or pregnancies have led researchers to conclude that haloperidol is probably relatively safe in pregnancy. There also is some concern that a lower-potency phenothiazine called chlorpromazine may increase the risk of birth defects slightly if administered during the first trimester, and that exposure to chlorpromazine, haloperidol, or other first generation antipsychotic drugs may lead to temporary problems for the baby involving feeding, movement, the intestines, or jaundice (yellowing of the skin). Additionally, there is a concern that second generation antipsychotic agents (including olanzapine, risperidone, clozapine, amisulpride, aripiprazole, and ziprasidone), may be harmful, but more studies are required to understand the risks.

Although antipsychotic medications are the principal treatment for schizophrenia, a procedure called electroconvulsive therapy (ECT) can be helpful sometimes in women with schizophrenia or with short-term psychotic conditions, when medication fails.

Small amounts of antipsychotic medication can get into breast milk, but doctors do not think that such amounts are dangerous to full-term infants. If you have a preterm infant, however, you should take more caution with such medications, as there are many unknowns when it comes to drugs and breastmilk. To be on the safe side, if you are on antipsychotic drugs, you should avoid breastfeeding, whether to a mature or immature newborn. Instead, you can choose an infant formula with the help of your pediatrician.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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