Pregnancy of patients with schizophrenia
In recent years, patients with schizophrenia have become frequently pregnant. This is due to new principles of treatment and care for such patients, as well as the use of atypical antipsychotics.
It is difficult for a psychiatrist to manage such pregnant women, and it is also difficult for gynecologists. There is a risk of complications for the mother and the fetus, and it is due to both the possibility of a relapse of schizophrenia and the effect of psychotropic drugs on the fetus.
It is known that for the first fifteen years after the onset of schizophrenia, a woman leads an active social and sexual life. And pregnancy does not protect and does not prevent the exacerbation of the disease. A woman can refuse to take psychotropic drugs, but the risk of relapse is great.
Schizophrenia can begin during pregnancy, but this is rare. Most often, personality disorders occur. But if schizophrenia occurs during pregnancy, then the further development of psychosis will be unfavorable. In such patients, preterm labor is more often recorded, and the child has a low body weight.
Schizophrenia can cause congenital anomalies and perinatal mortality. Patients with schizophrenia are advised to become pregnant one year after the onset of the disease. Hormonal drugs ( depomedroxyprogesterone ) can be a contraceptive , but relapses of schizophrenia or depression are possible while taking them.
Oral contraceptives can interact with nicotine and psychotropic drugs ( clonazepine ), increasing their serum levels. First-generation antipsychotics such as haloperidol are considered safer than atypical antipsychotics.
Cancellation of antipsychotics in the first 6-10 weeks of pregnancy can only be practiced in patients with mild forms of schizophrenia. Antipsychotics should be used at the lowest effective dose, while monitoring blood levels of the drug. When treated with olanzapine and clozapine, the CYP 1A2 activity of cytochrome P450 is reduced during pregnancy.