Long-Acting Injectable Aripiprazole in High-Risk Pregnancy: A Case Report on Relapse Prevention, Obstetric Outcomes, and Infant Development

Abstract

Pregnancy in women with bipolar disorder is high risk, with significant relapse rates. Medication nonadherence and teratogenicity concerns complicate treatment. Long-acting injectable antipsychotics offer improved adherence but are underutilized in pregnancy due to limited safety data. A 30-year-old woman with bipolar disorder and attention-deficit hyperactivity disorder, stable atomoxetine, and discontinued lithium pre-conception, resulting in mania requiring hospitalization. She was stabilized on oral aripiprazole, then transitioned to monthly LAI aripiprazole. She got pregnant two months later and chose to continue LAI throughout. The patient maintained mood stability throughout pregnancy with no manic, psychotic, or depressive episodes. Regular monitoring revealed no teratogenic effects. At 39 weeks, she delivered a healthy infant (APGAR 9, no malformations). Postpartum, she had paranoia (Young mania rating scale score increased to 14 from 8 during pregnancy), leading to increased LAI aripiprazole to 720 mg every 4 weeks. The infant continued normal development at 18 months and had no symptoms of autism or neuroatypicality. This case demonstrates the successful use of LAI aripiprazole throughout prepartum, antepartum, and postpartum periods in a high-risk pregnant woman with bipolar disorder. It maintained euthymia in the mother, prevented relapse-related hospitalization, and resulted in a healthy infant. Despite the development of gestational diabetes and postpartum exacerbation requiring dose adjustment, the case supports considering LAI antipsychotics in pregnant bipolar disorder patients with adherence difficulty, but it still warrants further research.