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

Dr. Parinda Parikh¹, Kanuja Sood², Himani J Suthar³, Arnesh Shukla⁴, Parthiv Pansuriya⁵, Shaurya Kumar Singh⁶, Zoe Gellert⁷, Sahia Manepalli⁸, Mahiya Buddhavarapu⁹, Arushi Kaushik Chandra¹⁰, Anika Shrivastava¹¹, Dr. Mina Oza¹²

1. Department of Psychiatry, Weill Cornell Medical School, White Plains, USA
2. SGT Medical College, Hospital and Research Institute, Gurugram, India
3. GMERS Medical College and Civil Hospital, Gandhinagar, India
4. St. Martinus University, Willemstad, Curaçao
5. Government Medical College Surat, India
6. Pravara Institute of Medical Sciences, Loni, Maharashtra, India
7. Tulane University, New Orleans, USA
8. University of South Florida, Tampa, USA
9. University of Pittsburgh, Pennsylvania, USA
10. NYU Steinhardt School, New York, USA
11. Cassady School, Oklahoma City, USA
12. 2nd Arc Associates, White Plains, New York, USA

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PUBLISHED: 31 August 2025

CITATION: Parikh, P., 2025. Long-Acting Injectable Aripiprazole in High-Risk Pregnancy: A Case Report on Relapse Prevention, Obstetric Outcomes, and Infant Development. Medical Research Archives, [online] 13(8).
https://doi.org/10.18103/mra.v13i8.6905

COPYRIGHT © 2025 European Society of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI https://doi.org/10.18103/mra.v13i8.6905

ISSN 2375-1924

ABSTRACT

Pregnancy in women with bipolar disorder (BD) is considered high-risk due to various clinical and pharmacotherapeutic factors. The administration of pharmacological treatment during pregnancy requires a thorough evaluation of the exposure to psychotropic drugs and the risk of BD relapses. According to a recent systematic review published in the American Journal of Psychiatry, 37% of patients with a history of bipolar disorder relapsed during pregnancy. Failure to address bipolar disorder during pregnancy can lead to adverse outcomes for both the mother and the infant. This case report aims to explore the utilization of long-acting injectable aripiprazole (LAI) in a pregnant woman, to maintain stability and prevent relapse, while also considering the safety of the fetus. The patient experienced significant psychiatric symptoms, including mania and depression. Subsequently, throughout the 6 months of her pregnancy, the medication was adjusted to ensure optimal management of her bipolar disorder. Ultimately, the patient delivered a healthy baby boy via cesarean section at 39 weeks, weighing 9 lbs and 7 oz, and exhibiting an APGAR score of 9. The findings suggest that LAIs can be a viable option for managing bipolar disorder in pregnant women.

Keywords

Bipolar disorder, pregnancy, long-acting injectable aripiprazole, relapse prevention, obstetric outcomes

Introduction

Pregnancy in women with bipolar disorder (BD) is considered high-risk due to various clinical and pharmacotherapeutic factors. The administration of pharmacological treatment during pregnancy requires a thorough evaluation of the exposure to psychotropic drugs and the risk of BD relapses. According to a recent systematic review published in the American Journal of Psychiatry, 37% of patients with a history of bipolar disorder relapsed during pregnancy. Failure to address bipolar disorder during pregnancy can lead to adverse outcomes for both the mother and the infant.

This case report aims to explore the utilization of long-acting injectable aripiprazole (LAI) in a pregnant woman, to maintain stability and prevent relapse, while also considering the safety of the fetus.

Case Report

A 28-year-old female with a history of manic, psychotic, or depressive episodes. Her monthly Young Mania rating scale (YMRS) ranged from the range of 4-8. In addition to her primary treatment, the patient reported experiencing anxiety regarding her pharmacological needs. Regular monitoring by a multidisciplinary team, comprising her psychiatrist and obstetrician, revealed ongoing manic symptoms and no teratogenic effects on the growing fetus. Notably, the patient experienced a weight gain of 45 lbs within the initial trimester and subsequently developed gestational diabetes in the 8th month, necessitating insulin therapy. In this period, she reported an overall sense of well-being and good mood. The patient delivered a healthy baby boy via cesarean section at 39 weeks, weighing 9 lbs and 7 oz, and exhibiting an APGAR score of 9.

Discussion

Long-acting injectable (LAI) antipsychotics play a crucial role in enhancing adherence among clinicians regarding medication adherence, reduced risk of overdose, and improved, standardized interaction between clinicians and patients. In contrast to oral antipsychotics, LAIs have demonstrated greater efficacy in preventing psychiatric hospitalization. Additional advantages of LAIs include heightened awareness among clinicians regarding medication adherence, reduced risk of overdose, and improved, standardized interaction between clinicians and patients. The majority of available data suggest that the adverse effects of LAIs during pregnancy are comparable to those of oral counterparts, except for long-acting injectable, which necessitates a three-hour observation period following injection.

Conclusion

In the case of long-acting injectable antipsychotics (LAIs), there is a greater tendency for clinicians not to begin or discontinue LAI prescriptions during pregnancy. Given the prevalence of significant psychiatric conditions and their associated risks of decompensation during the perinatal period, healthcare providers must be at ease with the use of antipsychotic medications during pregnancy. While acknowledging the limited safety data on long-acting injectable (LAI) formulations during pregnancy, we recommend transcending apprehensions related to prescribing LAIs to pregnant women when substantial risks of psychiatric decompensation outweigh the absence of data.

References