Discontinuation of Antipsychotics in Pregnancy Raises Relapse Risk among women with psychosis: JAMA

A new cohort study published in the Journal of the American Medical Association found that women with psychotic disorders who discontinued antipsychotic treatment during pregnancy had a higher risk of severe relapse, with a possible increased risk also seen in those who stopped treatment before pregnancy. In contrast, results for women with bipolar disorder were inconclusive. These findings emphasize on the need for prospective studies to better assess the effectiveness of antipsychotics in preventing both severe and non-severe relapses during the perinatal period.

Antipsychotic use in the perinatal period is becoming more common, despite limited evidence about their safety and effectiveness during pregnancy. Clinicians and patients often face difficult decisions, in balancing the potential risks of medication exposure to the fetus against the dangers of untreated mental illness.

This research analyzed national birth and health registry data from Denmark and Sweden, which covered pregnancies from 1998 through 2022. The study focused on women diagnosed with primary psychotic disorders or bipolar disorder who had been actively treated with antipsychotic medications prior to pregnancy. A total of over 3,200 women were included.

The primary question was whether discontinuing antipsychotic treatment in the perinatal was associated with an increased risk of severe psychiatric relapse. Relapse was defined as requiring inpatient psychiatric care during pregnancy or within 3 months after childbirth.

The findings revealed that those who stopped taking antipsychotics during pregnancy faced a significantly higher risk of severe relapse when compared to those who continued treatment. Discontinuation during pregnancy was associated with a 60% increased risk of relapse. Women who stopped medication before pregnancy also showed a higher relapse risk.

In women with bipolar disorder, the results were inconclusive. While some data suggested no increased risk or even a reduced risk, the sample size was too limited to draw firm conclusions.

For women with psychotic disorders, continuing medication during pregnancy may reduce the risk of severe relapse often resulting in serious consequences for both mother and child. However, treatment decisions must still consider the medical history, symptom severity, and preferences of every patient. Overall, the findings of this study stress the importance of individualized care.

Source:

Liu, X., Smout, S., Mahjani, B., Munk-Olsen, T., Blæhr, E. E., Robakis, T. K., & Bergink, V. (2026). Risk of relapse in psychotic and bipolar disorders after prenatal antipsychotic discontinuation. JAMA Network Open, 9(3), e260682. https://doi.org/10.1001/jamanetworkopen.2026.0682