Safety of Quetiapine During Pregnancy

Ms. A, a 33-year-old woman, experienced a first episode of psychosis that was initially treated with risperidone, 4 mg/day. After 2 weeks, her medication was switched to quetiapine because of a combination of higher prolactin levels (1997 mU/liter; <550 is the normal maximum) and poor clinical response. Pregnancy was diagnosed during week 4 of the 39-week gestation, after 2 weeks of quetiapine treatment. Conception took place despite hyperprolactinemia.

A collaborative decision was reached to have Ms. A continue taking quetiapine throughout pregnancy because of the level of risk and family history of psychosis. We found no reports of complications during pregnancy or teratogenicity in the medical literature or manufacturer’s database regarding quetiapine. Clinical improvement was monitored by using various clinical rating scales at baseline and at the 6-week, 3-month, and 9-month time points. Ms. A’s scores on the Brief Psychiatric Rating Scale were 21, 0, 4, 0, and 1; her Global Assessment Scale (2) scores were 35, 84, 81, 91, and 89. Her side effects were negligible. Her initial maintenance dose of 300 mg/day was reduced to 200 mg/day at week 21. This dose remained stable until 4 weeks before Ms. A’s estimated due date, when her quetiapine dose was reduced by 50 mg/day each week to enable breast-feeding after birth. Ms. A remained in remission throughout pregnancy and at week 39 gave birth to a healthy girl. The baby weighed 3.61 kg. Her Apgar score in the first minute was 8, and after 5 minutes, it was 9. No problems developed in the first month postpartum. There was no exacerbation of psychosis, and successful breast-feeding was initiated.