Managing schizophrenia and pregnancy
- Individuals living with schizophrenia can have a healthy pregnancy and a healthy baby. It is important to consult with your healthcare professional regarding your medical treatment and continue using talking therapy.
- If you know someone who is pregnant and living with schizophrenia, you can be a key part of their support network just by listening to them and planning ahead.
In this section
You can have a healthy pregnancy and healthy baby if you have schizophrenia and looking after yourself can help look after your child. The first thing you should do is to talk to your doctors so you can receive the right treatment and care to manage your schizophrenia and to keep you and your baby healthy. Your doctor can provide recommendations on what is best for your situation, which may help you feel more prepared and in control. Some advice on schizophrenia and pregnancy can be found below.
I have schizophrenia and I want to have a baby
Can schizophrenia be passed down to my baby?
Although schizophrenia tends to run in families, no single gene is thought to be responsible1. It’s more likely that different combinations of genes can impact the risk of developing schizophrenia. Also, environmental factors such as stressful life events, can play just as big a role in the development of schizophrenia as genetic factors.2
Could my antipsychotic medication impact my chances of becoming pregnant?
If you are currently managing your symptoms with medication, you should discuss with your doctor the risks of treating or not treating your schizophrenia. Continuing with prescribed medication may carry risks for your unborn baby, but if you don’t take the medicine, it could leave you very unwell3.
Some antipsychotic medications may increase the levels of prolactin in the blood4. Although prolactin is helpful to prepare the body for pregnancy, too much prolactin can impact your chances of becoming pregnant and your doctor may decide to switch your medication5. Menstrual disorders
may also occur with increased prolactin levels, which can influence your libido and fertility4. It is important to discuss with your doctor which medication is most suitable for you.
How can talking therapies help?
In general, it’s always good to have someone to talk to and your support network of family, friends and peers can help with coping through the stresses during and after pregnancy as well as your schizophrenia. Talking therapies offer a more professional setting where you can talk to someone who is trained to help you manage your schizophrenia.
Specifically, Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) or arts therapies are talking therapies that you can try alongside your medication. They can help by changing the way you think and behave and therefore make the schizophrenia symptoms more manageable. These treatments may also help with postpartum psychosis, a rare but serious mental health illness that can affect a woman soon after she has a baby6.
I have schizophrenia and I am pregnant
What are the potential risks to my health if I take antipsychotic medication while I am pregnant?
Antipsychotic medications carry potential side effects to your health but there is a small increase in risk of specific complications if you are also pregnant.
A large Canadian study found that pregnant women with schizophrenia, in comparison to those without diagnosed mental illness, had slightly higher chances of7:
pre-eclampsia
deep vein thrombosis
preterm birth
small and large birthweight for gestational age
pregnancy-related diabetes
chronic hypertension
Although this meant that the women in the study had to stay in hospital more often than average, doctors are now more aware of the potential risks; therefore, appropriate risk management strategies can be developed to support women with schizophrenia who intend to be or are pregnant.
When assessing the risk/benefit of antipsychotic medication, your doctor may take into account (among others):
Risk factors for gestational diabetes and excessive weight gain.
The available safety data of these drugs in pregnancy and during the postnatal period.
Risk of relapse without medication8.
It’s important that you follow your doctor’s directions and understand the importance of managing your symptoms during your pregnancy 9,10. Ensuring that you and your doctor have open, honest conversations about the potential risks of a pregnancy and treatment switches means that you’ll have more chance of having a healthy and well-monitored pregnancy.
What are the potential risks to my unborn baby if I take antipsychotic medication while I am pregnant?
Taking antipsychotics during pregnancy is unlikely to cause any serious side effects to your unborn baby (e.g. congenital abnormalities), but it may be associated with preterm birth, low birth weight and neonatal withdrawal effects (due to exposure of medication to your baby while in the womb). However, most of the evidence comes from the use of older generation antipsychotics and not the newer (‘atypical’) antipsychotics4. Speak to your doctor if you are concerned about the health of your unborn baby while you are taking medications and they will evaluate whether you need to switch medications for the duration of your pregnancy.
What else can I do during my pregnancy to support my physical and mental health?
There are many things you can do to help maintain your wellbeing during pregnancy:
Maintain a healthy diet with physical exercise.
Take daily supplements of folic acid.1
Reduce your alcohol intake. You should stop drinking if possible.
Stop smoking.
Practice techniques to reduce stress such as muscle relaxation, meditation.
Establish good sleep patterns.
Should I continue my medication after I’ve had my baby (post-partum)?
Most antipsychotic drugs can pass into the breast milk, albeit at very low levels (<3%)1. Although there have been some reports of infant drowsiness and lethargy post-partum, the majority of reports have not found any adverse events associated with newborn babies2. To understand whether you should continue with your medication post-partum, speak to your doctor who will advise you based on your current situation.
What to do if I know someone who has schizophrenia and is pregnant?
If you are a caregiver to someone who has schizophrenia and is pregnant, the best thing to do is to support them by following three simple steps:
Listen: Being there for your friend or family member with schizophrenia during and after pregnancy can be hugely beneficial. Encourage them to voice their feelings and offer to help them in their daily life.
Plan ahead: Prepare for difficult situations that may arise during and after the pregnancy and encourage open conversations about making certain decisions ahead of time. Schizophrenic new mothers may need lots of support during the postpartum period. Close follow-up is required to watch for any return of psychotic symptoms or infant neglect which may put them at risk5.
Look after yourself: Caring for someone with schizophrenia can be stressful and major life events such as pregnancy can add to the stress. Therefore, it is important that you look after yourself and take time for your own wellbeing.
References
- https://www.nhs.uk/conditions/schizophrenia/causes/
- Brown AS. The environment and susceptibility to schizophrenia. Prog Neurobiol. 2011;93(1):23-58
- https://www.nhs.uk/conditions/pregnancy-and-baby/mental-health-problems-pregnant/
- Bargiota, et al., The Effects of Antipsychotics on Prolactin Levels and Women’s Menstruation Schizophr Res Treatment. 2013; 2013: 502697. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886401/
- Robinson, Treatment of schizophrenia in pregnancy and postpartum. The Canadian journal of clinical pharmacology 19(3):e380-6 · October 2012 https://www.researchgate.net/publication/232279872_Treatment_of_schizophrenia_in_pregnancy_and_postpartum
- https://www.nhs.uk/conditions/post-partum-psychosis/
- Vigod et al., Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based cohort study, BJOG. 2014 Apr;121(5):566-74. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/1471-0528.12567
- Using antipsychotics in pregnancy – NHS Evidence https://arms.evidence.nhs.uk/resources/hub/1047945/attachment
- Teodorescu et al., Dilemma of treating schizophrenia during pregnancy: A case series and a review of literature. BMC Psychiatry. 2017 Aug 29;17(1):311. Review. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1475-z
- Levinson. Review: women with schizophrenia have poorer pregnancy outcomes than other women, but it is unclear whether antipsychotic medications affect their infants. Evidence-Based Mental Health 2003;6:89. https://ebmh.bmj.com/content/6/3/89
- https://www.nhs.uk/common-health-questions/pregnancy/why-do-i-need-folic-acid-in-pregnancy/
- Gentile S. Infant safety with antipsychotic therapy in breast-feeding: a systematic review. J Clin Psychiatry 2000; 69:666-673
- Einarson A. Antipsychotic medication(safety/risk) during pregnancy and breastfeeding. Curr Women’s Health Rev. 2010:6:34-38.
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