title: A Systematized Review of Atypical Antipsychotics in Pregnant Women: Balancing Between Risks of Untreated Illness and Risks of Drug-Related Adverse Effects.
abstract: OBJECTIVE
  To summarize risks related to (1) illness and (2) second-generation antipsychotic (SGA) treatment in pregnant women and their offspring. Concerning illness-related risks, we focused on bipolar disorder and schizophrenia, psychiatric disorders for which SGAs are preferentially prescribed.
  
  
  METHODS
  PubMed, Ovid, Scopus, PsycINFO, and Cochrane Library were searched from the date of the first available article to October 2015 using the following key terms: pregnancy OR gestation OR bipolar disorder OR schizophrenia. We also included cross-references from identified articles.
  
  
  METHODS
  We included 49 English-language articles regarding illness-related and SGA-related risks in bipolar disorder and schizophrenia. First, searches were done for epidemiologic or experimental studies (from January 2000 to October 2015), then for systematic reviews and meta-analyses.
  
  
  METHODS
  Data were extracted independently, after removing duplicates and studies that were not relevant or not pertinent.
  
  
  RESULTS
  Abrupt discontinuation of treatment-exposed mothers with bipolar disorder or schizophrenia led to a high risk of relapses during pregnancy. Both bipolar disorder and schizophrenia were linked to a slightly increased risk of obstetric complications for mothers (schizophrenia) and the newborn (bipolar disorder and schizophrenia), although data on drug exposure during pregnancy were not given in the majority of studies. Maternal morbidity (schizophrenia but not bipolar disorder) may be associated with the worst neonatal outcomes (stillbirth, neonatal or infant deaths, and intellectual disability). Untreated bipolar disorder and schizophrenia may be considered independent risk factors for congenital malformations, while SGAs were not associated with increased recurring defects in fetuses. Evidence regarding the potential effects of SGAs on child neurodevelopment remains reassuring.
  
  
  CONCLUSIONS
  After taking into account the parents' will and after they provide informed consent, the most reasonable and less harmful choice for treating future mothers with bipolar disorder or schizophrenia appears to be maintaining them at the safest minimum dosage.
authors.affiliation: Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico GB Rossi, Ple LA Scuro 10, 37134 Verona (VR), Italy. sarah.tosato@univr.it.|Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tosato
authors.affiliation: Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy, and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Albert
authors.affiliation: Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Tomassi
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Odontostomatology, University "Federico II" of Naples, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Iasevoli
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Carmassi
authors.affiliation: Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ferrari
authors.affiliation: Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Italy.
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Nanni
authors.affiliation: Institute of Psychiatry, University of Sassari, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nivoli
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Volpe
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Atti
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fiorillo
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000139:chemically induced; D066087:Perinatal Death; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011256:Pregnancy Outcome; D012008:Recurrence; D012306:Risk; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D050497:Stillbirth
chemical_list: D014150:Antipsychotic Agents