Psychotropic drugs in pregnancy - do they reduce or increase the risks for the fetus?Part two: mood stabilizers, anxiolytics

Abstract

© Pediatrie pro praxi, 2017. There is an increasing number of women, who plan to become or already are pregnant, and concurrently use psychotropic drugs for mental illness. Most of psychotropic drugs pass through the placenta to developing fetus and thus may affect the embryogenesis. On the other hand, untreated psychiatric disorder represents a risk factor of adverse pregnancy outcome and poor neonatal adaptation of an exposed newborn, as well. We review current published data on the impact of prenatal exposure to untreated bipolar disorder and anxiety disorders, and effects of mood stabilizers and anxiolytics on the fetus development, pregnancy outcome, and neonatal adaptation. Available data suggests that some mood stabilizers have a high teratogenic potential and therefore should not be prescribed during pregnancy. The risks for fetus resulting from untreated bipolar disorder seems to be high. Psychiatrists should prefer safer drugs in pregnancy such as lithium and newer (atypical) antipsychotics for pregnant bipolar patients. There is no solid evidence that anxiolytics as a group have a significant teratogenic potential. Their use during pregnancy is relatively safe; however, the risks increase with higher daily dose. Administration of benzodiazepine during third trimester of pregnancy increases the risk of poor neonatal adaptation of exposed child. Pharmacotherapy is indicated in severe cases, where the risk of untreated illness outweighs the risk of drug exposure.