PHARMACOLOGICAL MANAGEMENT OF PSYCHIATRIC-ILLNESS DURING PREGNANCY - DILEMMAS AND GUIDELINES

Objective: Given concerns about use of psychotropic medication during pregnancy, the authors reviewed the literature regarding the effects o f prenatal exposure to psychotropic medications on fetal outcome. Meth od: A MEDLINE search of all articles written in English from 1966 to 1 995 was performed to review information on the effects of psychotropic drug use during pregnancy on fetal outcome. Where sufficient data wer e available and when methodologically appropriate, meta-analyses were performed to assess risk of fetal exposure by psychotropic medication class. Results: Three primary effects are associated with medication u se during pregnancy: 1) teratogenicity, 2) perinatal syndromes (neonat al toxicity), and 3) postnatal behavioral sequelae. For many drug clas ses there are substantial data regarding risk for teratogenicity. Tric yclic antidepressants do not seem to confer increased risk for organ d ysgenesis. The available data indicate that first-trimester exposure t o low-potency phenothiazines, lithium, certain anticonvulsants, and be nzodiazepines may increase the relative risk for congenital anomalies. However, the absolute risk of congenital malformations following pren atal exposure to most psychotropics is low. Conclusions: Exposure to c ertain psychotropic drugs in utero may increase the risk for some spec ific congenital anomalies, but the rate of occurrence of these anomali es even with the increased risk remains low. Use of psychotropic medic ations during pregnancy is appropriate in many clinical situations and should include thoughtful weighing of risk of prenatal exposure versu s risk of relapse following drug discontinuation. The authors present disorder-based guidelines for psychotropic drug use during pregnancy a nd for psychiatrically ill women who wish to conceive.