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Am J Psychiatry 1996; 153:592-606
Copyright © 1996 by American Psychiatric Association
Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines
LL Altshuler, L Cohen, MP Szuba, VK Burt, M Gitlin and J Mintz
UCLA Neuropsychiatric Hospital, USA.
OBJECTIVE: Given concerns about use of psychotropic medication during
pregnancy, the authors reviewed the literature regarding the effects of
prenatal exposure to psychotropic medications on fetal outcome. METHOD: A
MEDLINE search of all articles written in English from 1966 to 1995 was
performed to review information on the effects of psychotropic drug use
during pregnancy on fetal outcome. Where sufficient data were available and
when methodologically appropriate, meta-analyses were performed to assess
risk of fetal exposure by psychotropic medication class. RESULTS: Three
primary effects are associated with medication use during pregnancy: 1)
teratogenicity, 2) perinatal syndromes (neonatal toxicity), and 3)
postnatal behavioral sequelae. For many drug classes there are substantial
data regarding risk for teratogenicity. Tricyclic antidepressants do not
seem to confer increased risk for organ dysgenesis. The available data
indicate that first-trimester exposure to low-potency phenothiazines,
lithium, certain anticonvulsants, and benzodiazepines may increase the
relative risk for congenital anomalies. However, the absolute risk of
congenital malformations following prenatal exposure to most psychotropics
is low. CONCLUSION: Exposure to certain psychotropic drugs in utero may
increase the risk for some specific congenital anomalies, but the rate of
occurrence of these anomalies even with the increased risk remains low. Use
of psychotropic medications during pregnancy is appropriate in many
clinical situations and should include thoughtful weighing of risk of
prenatal exposure versus risk of relapse following drug discontinuation.
The authors present disorder-based guidelines for psychotropic drug use
during pregnancy and for psychiatrically ill women who wish to conceive.
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|
|
|
|
|
|
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|
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