Jefferson Journal of Psychiatry


Concerns about medications in women of childbearing age include impact on fertility, pregnancy, neonatal outcome, breastfeeding, and behavioral teratogenesis. The objectives were to examine possible risks of clozapine on these parameters. PsycINFO and MEDLINE searches were performed and Novartis was contacted regarding their clozapine pregnancy registry. Since prolactin levels are not elevated with clozapine as they are with typical antipsychotics, there is not interference with fertility. Adverse pregnancy outcomes included gestational diabetes, should dystocia, seizure, and mild floppy infant syndrome. Higher concentrations of clozapine were present in breast milk than in maternal blood. Despite a lack of case-control prospective data, available information raises some questions regarding the safety of clozapine in pregnancy. Suggestions for treatment are made. Reproductive counseling should be given to women starting on clozapine. Individual risk-benefit assessments must be performed. In pregnant women taking clozapine, the clinician should screen for gestational diabetes and advise against breastfeeding.