Aripiprazole (Abilify) Use During Pregnancy
Aripiprazole can be continued during pregnancy when the benefits of treating serious mental illness outweigh potential risks, as untreated schizophrenia or bipolar disorder poses significant dangers to both mother and fetus, though neonates require monitoring for withdrawal and extrapyramidal symptoms in the immediate postpartum period. 1
Risk-Benefit Framework
The decision to use aripiprazole during pregnancy must weigh maternal psychiatric stability against fetal exposure risks:
Maternal Risks of Untreated Illness
- Untreated schizophrenia significantly increases risk of relapse, hospitalization, and suicide 1
- Schizophrenia itself is associated with adverse perinatal outcomes including preterm birth, though it remains unclear whether this stems directly from the illness or comorbid factors 1
- Women who discontinue psychotropic medications during pregnancy face substantially higher relapse rates compared to those who continue treatment 1
Fetal and Neonatal Considerations
- Available epidemiologic data do not establish a clear association between aripiprazole and major birth defects 1, 2
- A retrospective Medicaid database study of 9,258 women exposed to antipsychotics during pregnancy found no overall increased risk for major birth defects 1
- Neonates exposed to aripiprazole during the third trimester are at risk for extrapyramidal and/or withdrawal symptoms including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorders 1
- These neonatal symptoms vary in severity—some infants recover within hours to days without treatment, while others require prolonged hospitalization 1
Clinical Management Algorithm
Preconception and Early Pregnancy
- Discuss continuation versus discontinuation based on illness severity, prior relapse history, and patient preference 1
- Register patients in the National Pregnancy Registry for Atypical Antipsychotics (1-866-961-2388) to contribute to safety data 1
- Consider monotherapy at the lowest effective dose if treatment is necessary 2
During Pregnancy
- Continue aripiprazole if psychiatric stability requires it, as the risks of maternal decompensation typically exceed theoretical medication risks 2, 3
- Monitor for metabolic complications including hyperglycemia, as aripiprazole can cause blood sugar elevations 1
- Avoid abrupt discontinuation without consulting the prescriber, as this can precipitate psychiatric decompensation 1
Peripartum Period
- Alert the neonatal team about third-trimester aripiprazole exposure to ensure appropriate monitoring 1
- Monitor neonates for extrapyramidal symptoms, withdrawal symptoms, respiratory distress, and feeding difficulties 1
- Manage neonatal symptoms supportively; duration and intensity vary considerably 1
Evidence Quality and Limitations
The available safety data, while not definitive, are increasingly reassuring:
- No randomized controlled trials exist (for ethical reasons), but relatively large prospective studies and database analyses provide meaningful safety information 2
- Animal studies showed developmental toxicity at doses 10 times the maximum recommended human dose, including delayed fetal development, decreased fetal weight, and skeletal abnormalities 1
- Recent systematic reviews conclude that newer safety data are relatively reassuring, and in many cases the benefits outweigh the risks for women with serious mental illness 2
- The evidence base for aripiprazole is stronger than for many other antipsychotics due to its relatively frequent use in women of childbearing age 2
Critical Pitfalls to Avoid
- Do not withhold necessary antipsychotic treatment due to pregnancy concerns alone—untreated psychosis poses substantial risks to maternal and fetal wellbeing 1, 2
- Failing to inform patients about the pregnancy registry represents a missed opportunity to contribute to safety knowledge 1
- Do not discontinue aripiprazole abruptly without psychiatric consultation, as this dramatically increases relapse risk 1
- Neglecting to communicate third-trimester exposure to the neonatal team prevents appropriate monitoring for withdrawal symptoms 1