Successful Use of Quetiapine in Two Successive Pregnancies

To the Editor: Ethically, it is not possible to conduct randomized, controlled trials in pregnant women; hence, most of the data with respect to use of quetiapine in pregnancy is in the form of case reports, case series, and only few studies have reported its effect on pregnancy.¹ However, there are no data with respect to use of quetiapine in successive pregnancies. We report on a patient who received quetiapine throughout two successive pregnancies.

Case Reports

A 24-year-old woman who was premorbidly well-adjusted presented with an insidious-onset illness of 3 months' duration, with symptoms of catatonic schizophrenia. Her blood count, blood biochemistry, serum electrolytes, liver function tests, renal function test, chest X-ray (PA view), computerized tomography of the brain, and ECG did not reveal any abnormality. She was initially treated with ECT and tablet risperidone. She developed severe extrapyramidal side effects with risperidone and had to be shifted to quetiapine, which was gradually increased to 250 mg/day. With quetiapine and ECT, she showed significant improvement in symptoms. We explained to the patient and her husband about the contraceptive measures to be taken while she was on quetiapine. When on quetiapine for about 6 months, the patient conceived for the first time. Throughout the pregnancy, patient received quetiapine 250 mg/day, along with folic acid and iron supplementation. She was monitored closely and underwent regular ultrasonography. At full term, she gave birth to a healthy female child weighing 2.5 kg. The patient nursed the child during the postpartum period without any complications. She conceived again after about a year and again continued taking quetiapine 250 mg/day throughout the pregnancy. As in the previous pregnancy, the patient was closely monitored and she again delivered a healthy female child, weighing 2.4 kg, and continued breast-feeding for 6 months. Both the daughters were healthy, the first one about 2 years old and the second one about 9 months at the last assessment.

Discussion

Most of data available with respect to exposure of quetiapine during pregnancy does not suggest major malformation or neonatal problems. Data maintained by the manufacturer and as reported by McKenna et al.² as of March 2005, 446 pregnancies were exposed to quetiapine, and outcome was available for 151, of which congenital malformations were seen in 8 pregnancies, all of which were different from one another. In 7 out of the 8 cases of congenital anomaly, the women were also receiving other medications during pregnancy. McKenna et al.² also reported the outcome of 36 pregnancies exposed to quetiapine and concluded that, compared with a control group of women exposed to non-teratogenic agents, quetiapine was not associated with an increase in teratogenic risk. There are limited data with respect to use of atypical antipsychotics in successive pregnancies. We could only find two case reports, one of which described exposure to clozapine,³ and another, to risperidone.⁴ Until now, no study or case report has reported successful use of quetiapine in two successive pregnancies. Our case suggests that quetiapine in low dose can be used safely in pregnancy.