Use of Clozapine in Pregnancy: A Retrospective Study From North India.

Background: There is limited information on the use of clozapine during pregnancy. This retrospective study aimed to assess pregnancy-related outcomes in women exposed to clozapine. The additional aim was to assess the outcome of the infants at the last follow-up.

Methods: Treatment records of all the female patients in the database were evaluated for conception, pregnancy, lactation-related information, and the long-term outcome of the infants.

Results: We analyzed 14 pregnancies in 12 women. Most pregnancies (71.4%) were unplanned. A small number of mothers experienced hypertension (14.3%) and gestational diabetes mellitus (7.1%) during the pregnancy. Of 14 pregnancies, 5 (35.7%) ended in miscarriage, while 9 resulted in live births, including 6 normal vaginal deliveries and 3 cesarean sections. No congenital malformations were noted. Neonatal outcomes included 1 case of fetal macrosomia and another with meconium aspiration. Breastfeeding was done in 3 out of 9 infants with no hematological or other adverse outcomes for the infants. In terms of the long-term outcome of neonates, at the mean follow-up period of 8.88 (SD: 6.33; range: 1-18) months, the growth was normal for 8 infants. Information for one infant was not available.

Conclusions: The use of clozapine in pregnancy is not associated with congenital malformations but was found to be associated with miscarriage in one-third of pregnancies. There is a need for long-term prospective studies to evaluate the impact of clozapine on pregnancy and neonatal outcomes.