USE OF QUETIAPINE IN PREGNANCY

Quetiapine is an atypical antipsychotic used in the treatment of schizophrenia, bipolar disorder, other psychoses, and major depressive disorder.

The considerable data regarding first trimester exposure to quetiapine do not suggest an overall increased risk of congenital malformation. More limited data do not support an association between quetiapine exposure and small for gestational age or preterm delivery. A large study of neurodevelopment in children exposed to quetiapine gestationally did not identify an increased risk of any clinical diagnosis of neurodevelopmental delay. A single study has suggested an increased risk of miscarriage, while no studies have investigated the risk of intrauterine death following in utero exposure to quetiapine specifically. Studies of antipsychotics as a class have presented conflicting findings for all of these outcomes.

Use of antipsychotics throughout pregnancy or near delivery has been associated with withdrawal symptoms in the neonate and/or poor neonatal adaptation syndrome (PNAS). These symptoms may vary in severity and duration but are likely to be more severe in infants exposed in utero to more than one CNS-acting drug. Three studies have reported higher rates of symptoms for quetiapine exposure in comparison to other antipsychotics. Delivery should be planned in a unit with facilities to monitor exposed neonates.

There is evidence that atypical antipsychotic use in pregnancy increases the risk of gestational diabetes mellitus. Studies have identified an increased risk of large for gestational age among antipsychotic-exposed infants; therefore, additional maternal, fetal and neonatal monitoring is recommended.

It is important to ensure that maternal mental health is treated appropriately. Where a patient is stabilised on quetiapine, either prior to conception or during pregnancy, the risk of discontinuing or changing medication, or reducing the dose, should be carefully weighed against the risk of relapse of the maternal condition. Where clinically appropriate, clinicians are encouraged to discuss the advantages and disadvantages of continued quetiapine use during pregnancy with the patient. Where the benefit of continued treatment is considered to outweigh any potential or known risks, quetiapine may be prescribed for use in pregnancy.