Psychiatric Medications and Pregnancy

We often think of pregnancy as a joyful and happy time, but many pregnant women actually develop severe mood disorders and anxiety during pregnancy. Pregnancy can also be complicated by a previous psychiatric illness, such as bipolar disorder. Psychiatric medications can provide wonderful relief from symptoms and allow women to enjoy their lives again. But how safe is it to take psychiatric medication during pregnancy? Can these medications affect the development of your baby? If you are taking psychiatric medications and are pregnant or thinking about becoming pregnant, it is important to speak with your doctor about the safety of medications during pregnancy.

Psychiatric Disorders in Pregnancy
20% of women suffer from some type of psychiatric disorder during their pregnancy. From depression and anxiety to bipolar disorder and schizophrenia, pregnant women can suffer from the same illness as women who are not pregnant. Doctors used to be very hesitant to prescribe psychiatric medications to pregnant women. In fact, most pregnant women were discouraged from taking any type of medication for fear drugs and pregnancy would not mix well. Today, more information is available on the effects that various psychiatric medications have on a fetus and, as a result, more pregnant women are able to keep up with treatments for their illnesses.

If you are currently taking a psychiatric medication and are pregnant, or thinking about becoming pregnant, speak with your health care provider. Some prescription medications have few or no side effects during pregnancy and are safe to take. Others however, are associated with increased pregnancy risks including congenital birth defects, behavioral disorders, and perinatal syndromes, and are medications to avoid during pregnancy. All psychiatric medications cross the placenta during pregnancy, though in small amounts.

Measuring the Risk of Psychiatric Medicines During Pregnancy
All medicines are at some point tested for use during pregnancy. There is less data available about the effect of newer “atypical” psychiatric medicines on pregnancy because there has not been sufficient time to perform large enough trials. However, there are ample amounts of information on older, “typical” psychiatric medications for doctors to assess their effects during pregnancy.

When testing a psychiatric medication’s effects on pregnancy, doctor’s look for three things: the occurrence of birth defects (structural teratogenesis), the occurrence of behavioral problems (behavioral teratogenesis), and the occurrence of unusual symptoms directly after birth (perinatal syndromes). The rates of these three things are then compared to those rates found in pregnancies without psychiatric medication.

The following is a list of the major psychiatric medications used to treat depression, anxiety disorders, bipolar disorder, and schizophrenia, and the known effects of these drugs on pregnancy. Do not take any psychiatric medications during pregnancy without first consulting your health care provider.

Antidepressant Medications

  • Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are relatively new depression medications. Among others, they include Prozac, Celexa, Zoloft, and Paxil. Of the SSRIs, only Prozac has been widely tested in pregnant women. Prozac does not appear to increase the risk of any birth complications in baby. The other SSRIs also show no increased risks of major fetal malformations after preliminary studies and are assumed safe medications for pregnancy. There are some suggestions that SSRIs taken around the time of delivery may increase the possibility of prenatal syndromes including tremor, restlessness, and increased crying.
  • Tricyclics: Tricyclic anti-depressant medications, like Tofranil and Pamelor, have been widely tested in pregnant women. They are among the safest to use during pregnancy, with no adverse effects on baby.
  • Monoamine Oxidase Inhibitors: MAOIs, like Parnate and Nardil, are commonly prescribed for depression and anxiety disorders. They should not be used during pregnancy as they commonly react with other medications. Some research suggests that MAOIs may increase the risk of fetal malformation in the first trimester.

Anti-Anxiety Medications

  • Benzodiazepines: Benzodiazepines are commonly prescribed to people suffering from anxiety disorders. Older studies suggest that benzodiazepines may increase the risk of cleft lip and palate in babies by 0.78%. However, this information is highly debated. Benzodiazepines are also associated with prenatal syndrome, including feeding problems, hypothermia, and deficiency in baby’s muscle tone.

Mood Stabilizers

  • Lithium: Lithium is a known tetragen (tetragens interfere with the development of a baby’s major organs, which occurs during the first trimester). Taken in the first trimester, Lithium increases the risk for Ebstein’s Anomaly, a defect in the heart, by 10 times. It is also associated with perinatal syndrome when taken around the time of birth, including a bluish discoloration of the skin and decreased muscle tone.
  • Valproic Acid: Valproic Acid is a known tetragen. Taken during the first trimester, it can increase the risk of fetal malformation by up to 4%.

Antipsychotic Medications

  • High-Potency Antipsychotics: High-potency antipsychotics, like Haldol, are effective schizophrenia and bipolar medications. They are associated with no increased risk to fetus or baby, and are recommended for use during pregnancy in high-risk patients.
  • Low-Potency Anti-Psychotics: Low-potency antipsychotics, such as Thorazine, are also used in the treatment of schizophrenia. They are not recommended for use during pregnancy, as they may increase the risk of fetal malformation.
  • Atypical Antipsychotics: Atypical antipsychotics have recently been introduced to the market and include risperidone, olanzapine, ziprasidone, and quetiapine. There is not enough data to accurately identify the effects that these medications may have on baby. A switch to a high-potency antipsychotic like Haldol is usually recommended.

Things To Consider
If you are pregnant and taking a psychiatric medication, you should speak with your health care provider. Find out about the risks and benefits of continuing with the medication during pregnancy. In some instances, the risk to your baby may be too great to warrant the continuation of the medication.

However, if the medication is necessary to your well-being, it may actually be better for your baby if you continue taking the medication. Medication often prevents behavior that may put your baby at risk, including: alcohol and drug abuse, exposure to sexually transmitted diseases, and lack of prenatal care.

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