A review of the use of psychotropic medication in pregnancy

There is increasing awareness within obstetric services of the importance of treating maternal mental illness due to the association with increased maternal mortality, morbidity and poorer child outcomes. However, there is limited research on the risks and benefits of pharmacological treatment of women in pregnancy. This review is focused on studies published in the past 18 months.

Antidepressants and antiepileptic mood stabilizers are the most frequently studied of the pharmacological treatments for mental illness. There are clear risks of neonatal serotonin discontinuation symptoms associated with antenatal antidepressant use. It remains unclear whether there is an elevated risk of malformations, persistent pulmonary hypertension of the newborn, prematurity, low birth weight and negative child developmental outcomes. Mood stabilizers have been associated with an increased malformation risk and some are associated with poorer neonatal and child developmental outcomes. There are available only limited studies on antipsychotics in pregnancy.

Given the limited research on psychotropic medication in pregnancy, each woman, in collaboration with her clinician, needs to consider the risks in the context of her individual circumstances. However, any consideration of the risks of pharmacological treatment must be considered in relation to the risks associated with untreated mental illness.