Korean J Psychopharmacol.  2013 Jul;24(3):102-114.

Psychopharmacotherapy for Pregnant Women

Affiliations
  • 1Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
  • 2Department of Psychiatry, Gangnam CHA Hospital, School of Medicine, CHA University, Seoul, Korea.
  • 3Department of Psychiatry, School of Medicine, Ewha Women's University, Seoul, Korea.
  • 4Department of Psychiatry, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea. noveltier@gmail.com

Abstract

Authors reviewed the risk of psychopharmacotherapies during pregnancy. Psychopharmaotherapy in pregnants should be determined by considering the risk of disease recurrence in the mother and the impacts on the fetus. The American College of Obstetricians and Gynecologists does not recommend the routine use of antipsychotics in pregnancy, but risk-benefit assessments may indicate that such use is appropriate. Generally, antipsychotics are indicated for severe mental disorder, the benefits to the mother appear to outweigh the unknown risk. Folate (4 mg/day) has been recommended for women taking atypical antipsychotics because they may have a high risk of neural tube defects due to inadequate folate intake and obesity. Mood stabilizers should be avoided during pregnancy because of their potential teratogenicity. Lamotrigine or topiramate are relatively safe and combination with folate could be reduced the risk of neural tube defects. Antidepressants have been used in pregnant women with relative safety, but we should be considered the risk of major defects and neonatal syndrome. Especially, prenatal eochocardiography is recommended if it has been exposed in the first trimester of pregnancy. Paroxetine should be avoided in the first trimester of pregnancy due to the risk of congenital anomalies. There are many controversies in causal association between benzodiazepine and congenital defects. But, if the maternal condition requires the use of benzodiazepine during pregnancy, the lowest possible dose should be taken. Although no congenital malformation have been reported, data are too limited to confirm the risk of zolpidem for pregnancy, further evaluation are needed.

Keyword

Psychopharmacotherapy; Pregnancy; Congenital anomaly

MeSH Terms

Antidepressive Agents
Antipsychotic Agents
Benzodiazepines
Congenital Abnormalities
Female
Fetus
Folic Acid
Fructose
Humans
Mental Disorders
Mothers
Neural Tube Defects
Obesity
Paroxetine
Pregnancy
Pregnancy Trimester, First
Pregnant Women
Pyridines
Recurrence
Risk Assessment
Triazines
Antidepressive Agents
Antipsychotic Agents
Benzodiazepines
Folic Acid
Fructose
Paroxetine
Pyridines
Triazines
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