2005 issue 4


Volume 21, issue 4


Psychopharmacologic management with woman with affective disorders during pregnancy

Małgorzata Rzewuska1
1. Samodzielna Pracownia Farmakoterapii Instytutu Psychiatrii i Neurologii w Warszawie
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 301-314
Keywords: major depression and bipolar disorder, pregnancy, pharmacotherapy


Psychopharmacologic management decisions with newer agents represent controversial aspect of treating pregnancy women with affective disorders. Most antipsychotic drugs, mood stabilizers and antidepressants have been identified by FDA as category C (i.e. human teratogenicity cannot be ruled out) or category D (i.e. positive risk of human fetal teratogenicity has been demonstrated), most existing information about pregnancy outcomes derives from small registries, in patients with another diagnosis (epilepsya, schizophrenia).
With most psychotropics, decisions about unknown relative risks must be balanced on individual data about psychopathology, and risk associated with course and untreated illness. Major congenital malformations are in the general population in 2-3% offsprings regardless of psychotropic drug use.
Moreover, the possibility exists that some disorders, including affective, may confer elevation of risk for complications during pregnancy.
Specific pharmacologic management may vary during first, second and third trimesters, and risk of relapse is various. All these factors must be carefully consider, before decision. This review summarized current information about safety of use of psychotropic medication during pregnancy. Recommendations are presented for clinical management.