Psychotropic Medication in Pregnancy: Focus on Child Outcomes

Abstract

Mental illness is one of the leading complications of childbirth and a leading indirect cause of maternal mortality in both the UK and Australia (Austin et al., Med J Aust 186:364–367, 2007; Oates, Br J Psychiatry 183:279–281, 2003). As identification of mental illness in pregnancy grows, attention naturally turns to a search for effective treatment, and steadily more and more this involves psychotropic medication. Both antidepressants and antipsychotics are rising in their use in adults as their role in treatment of mental disorders grows. This is probably driven in part by being simple and cost effective interventions in the developed world. The interaction between mental illness and pregnancy is complex. Many illnesses, such as bipolar affective disorder, may be exacerbated or precipitated by pregnancy. Relapses during this time pose a significant risk to mother and infant, with psychiatric-related deaths recognised as the leading cause of maternal death in developed countries (Austin et al., Med J Aust 186:364–367, 2007). Maternal mental illness is also associated with a range of pregnancy-related complications and adverse child outcomes. The effect of this evidence as it reaches the broader clinical community will be to prefer more assertive mental health care. Therefore, treatment with these medications during pregnancy is increasing as clinicians seek to ameliorate these risks. This chapter discusses the research into medications commonly used to treat psychiatric illness, namely antidepressants, antipsychotics and mood stabilisers. Although anticonvulsant medications are frequently used as mood stabilisers, they are addressed elsewhere in this publication and are not covered here.