Schizophrenia, Family Planning, and Pregnancy: What to Know

Medically Reviewed by Traci C. Johnson, MD on May 10, 2022
6 min read

The decision to have a baby is a big one for anyone. If you have schizophrenia and want to have a baby, you’ll have even more to think about. You and your partner or other loved ones will need to think about your mental health.

Women most often find out they have schizophrenia in their 20s or 30s. That’s later than it is for men. It means that you may find out you have schizophrenia around the same time you are thinking about having a child.

It’s important to think about what having a baby with schizophrenia might mean for you and for your future child. For some people, schizophrenia is an ongoing condition while others may have just one or a few episodes. The most common symptoms of schizophrenia include delusions, hallucinations, trouble thinking, and lack of insight. If you are having these symptoms, it may be hard for you to think through what pregnancy and having a baby would mean.

You’ll also need to consider other factors that may affect your ability to have a healthy pregnancy. Many people with schizophrenia smoke or have other substance use disorders. They also are more likely than the average person to have other health issues. For instance, people with schizophrenia are more often overweight or obese and are prone to developing diabetes. It’s a good idea for anyone thinking about pregnancy to make sure that any health conditions they have are treated and under control. This includes your schizophrenia and other physical health problems that may or may not be related to your schizophrenia.

If you have schizophrenia and want to get pregnant, it’s important that you don’t just decide on your own to stop taking your medicines. You should always talk to your doctor or psychiatrist first.

Antipsychotics are one of the most common medicines people with schizophrenia take. There are many, including:

  • Aripiprazole
  • Chlorpromazine
  • Clozapine
  • Fluphenazine
  • Haloperidol
  • Quetiapine
  • Risperidone

It can be hard to decide whether to take these medicines during pregnancy. There isn’t enough information to know where that's completely safe. You’ll want to weigh the risks and benefits for you and the baby you are thinking about having. You should consider, with your doctor’s help:

  • How often and bad your symptoms are
  • How much your medicine helps
  • How you and your future child might be affected if your symptoms got worse
  • How the medicine might affect a developing fetus

When you have a severe mental illness such as schizophrenia, any change in your medicine could cause you to get worse. Experts recommend that you should keep taking antipsychotic medicine if your symptoms will likely get worse without it. Talk to your psychiatrist or other doctor. See if you can talk to a psychiatrist who has experience with planning for pregnancy.

Your doctor can help you decide whether you should keep your medicine as it is. It’s also possible they will suggest you switch to a different medicine or change the dose. You may want to take the lowest dose of medicine that you can. You’ll want to have your doctor monitor you to make sure you’re doing well with the pregnancy and any changes to your medicines. Cognitive behavioral therapy also may help you during this time.

Most antipsychotics are considered reasonably safe to take during pregnancy. Given their importance to your mental health, it’s likely that your doctor will suggest that you stay on your medicine.

If you decide you want to stop taking your medicine and see how you’ll do, follow these steps:

  • Ask your doctor how to stop gradually. Stopping suddenly could make your symptoms worse.
  • See your psychiatrist or other health care provider often to make sure you are doing well.
  • Have a plan in place in case your symptoms get worse.

It’s possible. Some antipsychotic medicines cause a hormone called prolactin to go up. If that happens, you might have more trouble getting pregnant. Your doctor can check your prolactin levels to see if they are high. If they are and you’re having trouble getting pregnant, you could ask to switch to another medicine that’s less likely to affect prolactin.

Experts say they need more information to answer these questions. But there’s no reason to think antipsychotics make miscarriage more likely. Miscarriage is fairly common for all women. It happens in up to 1 in 5 pregnancies.

More women are taking antipsychotics during pregnancy than ever before. But there hasn’t been as much information about safety as doctors would like to have. One big study looking at antipsychotic use in early pregnancy suggests that they don’t generally lead to more birth defects. The study found a small increase in risk with risperidone, but more study is needed to be sure. If you’re taking risperidone and are worried about birth defects, ask your doctor if you could take a different medicine instead.

Antipsychotic medicines you take for schizophrenia can make you more likely to gain weight and get diabetes. If you are overweight or have diabetes, talk to your doctor about how to manage it and stay healthy during pregnancy.

Some women get diabetes during pregnancy. It’s called gestational diabetes. Some studies suggest antipsychotic medicine makes gestational diabetes more likely. But women with schizophrenia also may be more prone to diabetes and gestational diabetes even without taking medicine. Talk to your doctor about these risks and how to manage them.

The evidence on pregnancy when you have schizophrenia is limited. The data that is available suggests that women with schizophrenia more often do have pregnancy complications when compared to other women. These include:

Women with schizophrenia also have more trouble when they give birth, including:

  • Stillbirths
  • Medical abortions
  • C-sections

Babies born to mothers with schizophrenia also are more likely to be born too early. They may be smaller or weigh less than average. But keep in mind that this data includes many women who had unplanned pregnancies. Some of them weren’t getting any psychiatric care, while others were in a psychiatric hospital. That means that they likely didn’t consult a doctor ahead of time or get the care they needed before, during, or after pregnancy. Many people with schizophrenia also have other health conditions that may increase the risk for pregnancy complications.

With all this in mind, if you want to have a baby, make sure you have the support you’ll need from loved ones. See your doctor and psychiatrist to help you with the decision, and talk through any factors you need to consider. Work with them to make a plan to ensure you’ll get all the care you’ll need along the way.

Pregnancy often is a happy time. But it also can be hard on your mental health. That’s true even for women who don’t have a mental health condition such as schizophrenia. It’s even more likely that pregnancy will make your mental health worse when you have a mental illness like schizophrenia. That’s especially true if you stop taking your medicine. The chances of a relapse without your medicine are highest if you’ve had serious schizophrenia symptoms or many episodes of illness.

Your doctor or psychiatrist can help you understand how likely it is that pregnancy or changes in your medicine could worsen your schizophrenia. When you’ve had a psychotic illness, you may be at more risk for a condition called postpartum psychosis. It’s a severe mental illness that starts suddenly, soon after you have a baby. It’s most likely to happen if you have schizoaffective disorder, or symptoms of schizophrenia and another disorder such as depression or bipolar disorder. Postpartum psychosis needs emergency psychiatric care.

Talk to your doctor about your risk for making your schizophrenia symptoms worse, or for getting postpartum psychosis – and how to make it less likely. If your doctors think you are at risk, they can get you specialist care during your pregnancy. Whatever you decide to do, keep seeing your doctors for help and support with your mental health and any other health issues you may have.