Psychotropic Medications In Pregnant And Breast-Feeding Women: A Review Of The Literature And Treatment Guidelines
Marie-Paule Austin and Philip B Mitchell
Presenting author: Marie-Paule Austin MBBS, FRANZCP. Staff Specialist in Liaison Psychiatry, Prince of Wales Hospital and Conjoint Lecturer, School of Psychiatry, University of New South Wales, Sydney.
phone: (02) 93822796; fax: (02) 93822177; email: m.austin@unsw.edu.au
Objectives:
To review all studies and case reports examining the impact of psychotropic medications taken during pregnancy and breast-feeding, on infant outcome.
To provide clinicians with clinical guidelines for the use of psychotropes in pregnancy and breast-feeding, both acutely and prophylactically.
Results:
a) Pregnancy: Several hundred infants exposed to SSRIs and TCAs have now been studied in a small number of prospective, controlled, non-randomised, studies. Findings suggest that neither the SSRIs nor the TCAs cause major congenital anomalies. Conversely, results from small, often less methodologically rigorous studies suggest that benzodiazepines, lithium, anticonvulsants and chlorpromazine do lead to an increased rate of congenital anomalies. Studies of longer-term neurobehavioural sequelae are very limited but at present do not indicate any adverse effects.
b) Breast-feeding: on the basis of findings from a small number of prospective controlled studies, the use of SSRIs, TCAs, carbamazepine, sodium valproate and short-acting benzodiazepines in breast-feeding is relatively safe. High dose antipsychotics should be avoided as they may be associated with developmental delays. The potential for neonatal toxicity with lithium is significant.
Conclusions:
The use of psychotropes in the perinatal period remains complex. While the available data suggest that antidepressants used in pregnancy and breast-feeding are relatively safe, other psychotropes used in pregnancy are associated with a small risk of congenital anomalies and perinatal complications. Furthermore the long-term sequelae of psychotrope use in pregnancy and breast-feeding is virtually unknown.
Conversely, mental illness per se, may also be associated with an adverse outcome in the infant. Clearly, the risks to both mother and infant need to be carefully weighed and discussed with the parents before a decision about medication can be made. Finally, clinicians need to bear in mind the importance of prophylactic psychotrope use in the early post-partum period in women at high risk of relapse.
