Stopping during pregnancy raises relapse risk in psychosis — stopping before may too
STUDY: Liu X et al, JAMA Network Open 2026;9(3):e260682,
STUDY TYPE: Propensity score–matched cohort study
EVIDENCE GRADE: Low (5/10)
FUNDING: National Institutes of Mental Health, National Institute of Child Health and Human Development
Background
Most women on antipsychotics — over 80% in this study — stop them around conception, typically out of concern for fetal harm. Whether that decision raises their own psychiatric risk during pregnancy has been difficult to answer.
The Study
Using linked national registries from Denmark and Sweden, researchers identified 2,000 pregnant women with primary psychotic disorders and 1,292 with bipolar disorder who had been on antipsychotics before pregnancy. They compared relapse rates — defined as psychiatric hospitalization during pregnancy or within 90 days postpartum — among women who continued antipsychotics, stopped before pregnancy, or stopped during pregnancy.
Women with psychotic disorders who stopped during pregnancy had a 60% higher risk of severe relapse compared to those who continued (aHR 1.60; 95% CI, 1.01–2.54). Those who stopped before pregnancy showed a trend in the same direction, though it didn’t reach statistical significance (aHR 1.24; 95% CI, 0.82–1.90).
The sample was too small to draw conclusions about bipolar disorder.
Practice Implications
- For your patients with schizophrenia or schizoaffective disorder, this study adds meaningful weight to continuing antipsychotics through pregnancy. The risk of stopping mid-pregnancy looks real.
- Stopping before conception showed a worrying trend too — though women who planned ahead and tapered before pregnancy may have been more stable to begin with.
- Antipsychotics are not associated with teratogenicity, but some raise the risk of gestational diabetes.
- When I discuss these risks in pregnancy, I also give this brochure on lifestyle factors that improve the health of the pregnancy (including choline, which reduces risk of psychosis in offspring)
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
What’s Your Take? Share in Comments
- Are there other risks in pregnancy you are concerned about with antipsychotics?
