JAMA Netw Open
Stopping antipsychotics in pregnancy linked to higher relapse risk
Clinical takeaway: For pregnant patients with primary psychotic disorders who are stable on antipsychotics, discontinuation—especially during pregnancy—may substantially increase relapse risk; shared decision‑making, gradual tapering (if indicated), and close monitoring are essential when weighing maternal stability against fetal exposure.
This large cohort study used linked Danish and Swedish national registries to evaluate relapse risk in 3,292 pregnancies among women with primary psychotic disorders (n = 2000) or bipolar disorder (n = 1292) who were treated with antipsychotics before conception. In women with psychotic disorders, discontinuing antipsychotics during pregnancy was associated with a significantly higher risk of severe psychiatric relapse requiring inpatient treatment compared with continuation (adjusted hazard ratio [AHR], 1.60; 95% confidence interval [CI], 1.01–2.54). Discontinuation before pregnancy showed a smaller, non‑significant increase in relapse risk (AHR 1.24; 95% CI, 0.82–1.90). By contrast, among women with bipolar disorder, relapse risk estimates were not significantly elevated for prepregnancy discontinuation (AHR 0.50; 95% CI, 0.22–1.11) or pregnancy discontinuation (AHR 1.00; 95% CI, 0.48–2.10), though authors emphasized limited statistical power and wide confidence intervals.
As the investigators noted, “discontinuation during pregnancy had a higher point estimate for relapse risk compared with continuation,” highlighting pregnancy as a particularly vulnerable period for women with psychotic illness.
Source: Liu X, et al. (2026, March 27). JAMA Netw Open. Risk of Relapse in Psychotic and Bipolar Disorders After Prenatal Antipsychotic Discontinuation