Abstract
Psychiatrists have to routinely make decisions whether to initiate, continue, or withdraw treatment with psychotropics in pregnant or breast-feeding women. However, no controlled data are available; the only information comes from animal studies, epidemiological trials, drug registries, case series, and anecdotal case vignettes.
Psychiatrists have to weigh the known risks of treatment discontinuation versus potential risks for the fetus and infant. Alternative non-pharmacological interventions (psychotherapy, ECT, rTMS) should be also considered.
Recently published data suggest relative increase in teratogenic risk for some antidepressants (paroxetine). Moreover, administration of antidepressants has been associated with prenatal and perinatal complications, withdrawal symptoms in neonates, persistent pulmonary hypertension after exposure to SSRI, and slight delay in the psychomotor development.
Antipsychotics also pose a minor risk of congenital malformations, and may increase incidence of postpartum diabetes. A specialized outpatient clinic for treatment during pregnancy and lactation has been opened at the Prague Psychiatric Center since 2005.
The Clinic provides diagnostic, therapeutic, and consultation services to patients, psychiatrists, gynaecologists, and other physicians. The patients? data are recorded in the registry and their offspring are prospectively followed.
More information and data availability can help in the development of guidelines on treatment of psychiatric disorders in pregnancy and lactation.