Psychotropics in pregnancy: safety and other considerations.

INTRODUCTION: Perinatal psychiatric disorders are important because of their adverse effects on pregnancy outcomes. The aim of this review is investigate psychotropic drugs in the management of antenatal psychiatric disorders with emphasis on the risk of harmful effects.
METHOD: A systematic review of published electronic literature between January 2000 and August 2011 was conducted using the following keywords: pregnancy, pregnancy complications, neonatal complications, congenital anomalies, infant/child development, antidepressants, antipsychotics, and lithium. The search was conducted for each class of psychotropic agents. Further hand searches were conducted. Anticonvulsants were excluded.
RESULTS: Antidepressants are associated with increased risk of spontaneous abortions, stillbirths, preterm deliveries, respiratory distress, endocrine and metabolic disturbance. There is evidence of discontinuation syndrome and of increased risk of cardiac defects. Antipsychotics are associated with increased gestational weight and diabetes and with increased risk of preterm birth. The effects of antipsychotics on birth weight are inconclusive. In addition, the findings in relation to malformations are inconclusive. Lithium is associated with increased birth complications such as polyhydramnios, pre-eclampsia, respiratory distress syndrome, hypotonia, and preterm birth. Lithium has previously been associated with markedly increased risk of Ebstein's anomaly. However, recent re-evaluation of the data casts doubt on the previous estimates. There is evidence that lithium is associated with cardiac septal defects.
CONCLUSION: Psychotropic drugs remain an important treatment option during pregnancy to properly manage symptoms of psychiatric diseases. Clinicians need to remain aware of the potential risk of adverse effects associated with psychotropic drug treatment.