Effects of antimanic mood-stabilizing drugs on fetuses, neonates, and nursing infants

Pregnancy presents a special problem to the clinician treating bipolar diso rders in women. Since the first episode of mania typically occurs before th e age of 30, many women in their prime childbearing years may be exposed to potentially teratogenic mood-stabilizing agents. This exposure may also co ntinue for the nursing infant during lactation. Pregnancy itself can exacer bate bipolar symptoms and also alter the pharmacokinetics of mood-stabilizi ng drug. Risks to mother and fetus can be reduced with a number of simple s trategies, including monotherapy with the lowest effective dose of a drug f or the shortest period necessary, periconceptional use of multivitamins wit h folate, prescription of drugs with established safety records, and avoida nce of exposure to antimanic agents during the first trimester of pregnancy In this article, we review existing evidence on the risks to fetuses and n ursing infants of mothers taking specific mood-stabilizing agents, and we p resent appropriate management guidelines designed to minimize these risks.