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Clozapine Safety in Pregnancy: A Clinical Study
Jayashri Kulkarni1, Adam De Chellis1, Heather Gilbert1
1HER Centre Australia, Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Australia.
Schizophrenia Bulletin
|July 20, 2024
Summary
Pregnant women using clozapine had higher risks of miscarriage, gestational diabetes, and lower birth weight compared to quetiapine users or those drug-free. Neonatal outcomes were similar across groups.
Area of Science:
- Perinatal psychiatry
- Reproductive toxicology
- Maternal-fetal medicine
Background:
- Clozapine is an antipsychotic used for schizophrenia, but its safety during pregnancy is not well-established.
- Understanding clozapine's risks in pregnancy is crucial for managing persistent schizophrenia in expectant mothers.
Purpose of the Study:
- To assess pregnancy outcomes in women with schizophrenia treated with clozapine during the first trimester.
- To compare outcomes with quetiapine treatment and no medication during pregnancy.
Main Methods:
- A nested case-control study using the National Register of Antipsychotic Medication in Pregnancy (NRAMP) database.
- Compared pregnancy outcomes of 14 women on clozapine with 53 on quetiapine and 24 drug-free women.
Main Results:
- Higher miscarriage rates were observed in the clozapine group.
- Increased prevalence of gestational diabetes and lower birth weight were noted with clozapine use.
- Vaginal delivery rates were higher, but neonatal outcomes (gestational age, Apgar scores) were similar across groups.
Conclusions:
- Clozapine use in pregnancy is associated with increased risks of adverse maternal and infant outcomes.
- Key risks include miscarriage, maternal gestational diabetes, and lower birth weight.
- Despite these risks, critical neonatal indicators like gestational age and Apgar scores were comparable.
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