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The Safety of Psychotropic Drug Use During Pregnancy: A Review

Authors: Adrienne Einarson, RNFaculty and Disclosures


Abstract and Background


A substantial number of women of childbearing age are prescribed psychotropic drugs, and because nearly 50% of pregnancies are unplanned, many women are still taking them upon becoming pregnant. This article reviews the various classes of psychotropic drugs that are commonly used to treat psychiatric disorders -- antidepressants, benzodiazepines, antipsychotics, antiepileptics, lithium and monoamine oxidase (MAO) inhibitors -- in terms of their safety during pregnancy. Evidence-based information from epidemiologic studies indicates that most psychotropic drugs are relatively safe for use during pregnancy. There is also an increasingly large body of evidence-based information in the literature indicating that it may be more harmful to both the mother and her baby if she is not treated appropriately when suffering from a severe psychiatric disorder. Therefore, it is important for women with psychiatric disorders and their healthcare providers to have access to evidenced-based information about the safety of these drugs when taken during pregnancy to ensure that women make an informed decision as to whether they should continue with the pharmacotherapy they have been using to treat their condition.


Psychiatric disorders are common among women of childbearing age, and affected women are frequently prescribed psychotropic drugs. However, despite the fact that most recent studies have documented the relative safety of these medications during pregnancy, there remains a high level of anxiety regarding their safety among patients and healthcare providers alike. For every pregnancy, the baseline risk of a major congenital malformation is 1% to 3% of the population, so chance alone would account for a substantial number of children born with birth defects whose mothers consumed medications in early pregnancy. This concept is often misunderstood and, consequently, many of these birth defects have been attributed to the consumption of drugs.[1]

In addition, some women believe that psychotropic drugs must be more harmful to take during pregnancy than other drugs because they act on the brain.[2] Moreover, the media tend to exacerbate women's fears by frequently stressing positive associations between drug treatment and birth defects while ignoring the results of studies that show negative associations.[3] Because of these factors as well as others -- such as well-meaning friends and family who advise women not to take any drugs during pregnancy[2] -- it is not surprising that either their own fears or the advice of well-intentioned healthcare providers lead some women to decide to discontinue their psychotropic medications upon diagnosis of a pregnancy.[4]

The objective of this review is to examine all of the information in the literature regarding the use of psychotropic drugs during pregnancy. This will provide women and their healthcare providers with evidence-based information about the safety of these drugs during pregnancy and help women make an empowered decision regarding pharmacotherapy during pregnancy.

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