Abstract
The pregnant psychiatric patient on or requiring psychotropic medication presents an unusual clinical dilemma, often placing the physician between a teratologic rock and a clinical hard place.1 Although ethical considerations have precluded adequately controlled studies with pregnant woman, the rate of psychotropic use in pregnancy2,3 together with the prevalence of certain psychiatric conditions in women during pregnancy4 and in women of childbearing potential5 in general underscore the need for treatment guidelines to help clinicians manage pregnant patients with psychiatric disorders.
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References
Cohen L. S., Heller V. L., Rosenbaum J. F.: Treatment guidelines for psychotropic drug use in pregnancy. Psychosomatics 30:25–33, 1989.
Doering J. C., Stewart R. B.: The extent and character of drug consumption during pregnancy. JAMA 239:843–846, 1978.
Kasilo O., Romero M., Bonati M., et al: Information on drug use in pregnancy from the Viewpoint Regional Drug Information Center. Eur J Clin Pharmacol 35:447–453, 1988.
O’Hara M. W., Zekoski E. M., Phillips L. H., et al: A controlled prospective study of postpartum mood disorders: Comparison of childbearing and nonchildbearing women. J Abnorm Psychol (in press).
Frank E., Kupfer D. J., Jacob M., et al: Pregnancy related affective episodes among women with recurrent depression. Am J Psychiatry 144:288–293, 1987.
Calabrese J. R., Gulledge A. D.: Psychotropics during pregnancy and lactation: A review. Psychosomatics 26:413–426, 1985.
Robinson G. E., Stewart D. E., Flak E.: The rational use of psychotropic drugs in pregnancy and postpartum. Can J Psychiatry 31:183–190, 1986.
Slone D., Siskind V., Heinonen O. P., et al: Antenatal exposure to the phenothiazines in relation to congenital malformations, perinatal mortality age, birth weight and intelligence quotient score. Am J Obstet Gynecol 128:486–488, 1977.
Rumeau-Rouguette C., Goujard J., Huel G.: Possible teratogenic effect of phenothiazines in human beings. Teratology 15:57–64, 1977.
Milkovich L., Van den Berg B. J.: An evaluation of the teratogenicity of certain antinauseant drugs. Am J Obstet Gynecol 125:244–248, 1976.
Edlund M. J., Craig T. J.: Antipsychotic drug use and birth defects: An epidemiologic reassessment. Compr Psychiatry 25:32–37, 1984.
Kuenssberg E. V., Knox J. D.: Imipramine in pregnancy. Br Med J 2:292, 1972.
Idanpaan-Heikkila J., Saxen L.: Possible teratogenicity of imipramine-chloropyramine. Lancet 2:282–284, 1973.
Czeizel A., Lendvay A.: In-utero exposure to benzodiazepines (letter). Lancet 1:628, 1987.
Rosenberg L., Mitchell A., Parsells J., et al: Lack of relation of oral cleft to diazepam use during pregnancy. N Engl J Med 309:1282–1285, 1983.
Shiono B. H., Mills J. L.: Oral clefts and diazepam use during pregnancy (letter). N Engl J Med 311:919–920, 1984.
Langman J.: Human development-normal and abnormals, in Langman J. (ed.): Medical Embryology (ed. 5). Baltimore, Williams & Wilkins, 1985, p 123.
Dicke J. M.: Teratology: Principles and practice. Med Clin North Am 73:567–581, 1989.
Coyle I. R.: Changes in developing behavior following prenatal administration of imipramine. Pharmacol Biochem Behav 3:799–807, 1975.
Robertson R. T., Majka J. A., Peter C. P., et al: Effects of prenatal exposure to chlorpromazine on postnatal development and behavior of rats. Toxicol Appl Pharmacol 53:541–549, 1980.
Kellogg C., Ison J., Miller R.: Prenatal diazepam exposure: Effects on auditory temporal resolution in rats. Psychopharmacology 79:332–337, 1983.
Miller G. C., Friedhoff A. G.: Prenatal neurotransmitter programming of postnatal receptor function. Prog Brain Res 2:509–522, 1987.
Webster P. A. C.: Withdrawal symptoms in neonates associated with maternal antidepressant therapy. Lancet 2:318–319, 1973.
Shearer W. T., Schreiner R. L., Marshall R. E.: Urinary retention in a neonate secondary to maternal ingestion of nortriptyline. J Pediatr 81:570–572, 1972.
Cree J. E., Meyer J., Hailey D. M.: Diazepam in labour: Its metabolism and effect on the clinical condition and thermogenesis of the newborn. Br Med J 4:251–255, 1973.
Hill R. M., Desmond M. M., Kay J. L.: Extrapyramidal dysfunction in an infant of a schizophrenic mother. J Pediatr 69:589–595, 1966.
Tamer A., McKey R., Arias D., et al: Phenothiazine-induced extrapyramidal dysfunction in the neonate. J Pediatr 7:479–480, 1969.
Levy W., Wisniewski K.: Chlorpromazine causing extrapyramidal dysfunction in newborn infants of psychotic mothers. NY State J Med 74:684–685, 1974.
Gelenberg A. J.: Pregnancy, psychotropic drugs, and psychiatric disorders. Psychosomatics 27:216–217, 1986.
Gelenberg A. J.: Psychotropic drugs during pregnancy and the perinatal period. Biol Ther Psychiatry 2:41–42, 1979.
Nahas C., Goujard J.: Phenothiazines, benzodiazepines and the fetus, in Scarpelli E. M., Cosmi E. V. (eds): Reviews in Perinatal Medicine. New York, Raven Press, 1978, pp 243–280.
Rivera-Calimlin L.: The significance of drugs in breastmilk: Pharmacokinetic considerations. Clin Perinatol 14:51–70, 1987.
Anderson P. O., McGuire G. G.: Neonatal alprazolam withdrawal-possible effects of breast feeding. Drug Intell Clin Pharm 23:614, 1989.
Gelenberg A. J.: Antidepressants in milk. Biol Ther Psychiatry 10:1, 1987.
Charney D., Heninger G.: Abnormal regulation of noradrenergic function in panic disorder. Arch Gen Psychiatry 43:1042–1054, 1986.
Siever L., Uhde T.: New studies and perspectives on the noradrenergic receptor system in depression: Effects of the alpha two adrenergic agonist clonidine. Biol Psychiatry 19:131–156, 1984.
Cohen L. S., Rosenbaum J. F., Heller V. L.: Panic attack-associated placental abruption: A case report. J Clin Psychiatry 50:266–267, 1989.
Avant K.: Anxiety as a potential factor affecting maternal attachment. J Obstet Gynecol Neonatal Nurs 10:416–419, 1981.
Brazelton T. B.: Mother infant reciprocity, in Klaus M. H., Leger T., Trause M. A. (eds): Maternal Attachment and Mothering Disorders: A Roundtable. North Brunswick, NJ, Johnson & Johnson, 1975.
Zahn-Waxler C., Cummings E. M., Ianoff R. J., et al: Young offspring of depressed patients: A population of risk for affective problems and childhood depression, in Cichetti D., C Schneider-Rosen (eds): Childhood Depression. San Francisco, Jossey-Bass, 1984.
Cogill S. R., Caplan H. L., Alexandra H., et al: Impact of maternal depression of cognitive development of young children. Br Med J 292:1165–1167, 1986.
Sapolsky R.: Stress glucocorticoids and the rate of brain aging. Presented at Annual Meeting of the American College of Neuropsychopharmacology, December, 1988, Nashville, TN.
Protheroe C.: Puerperal psychoses: A long term study 1927–1961. Br J Psychiatry 115:9–30, 1961.
Kopelman A. E., McCullar F. W., Heggeness, L.: Limb malformations following maternal use of haloperidol. JAMA 231:62–64, 1975.
Scokel P. W., Jones W. D.: Infant jaundice after phenothiazine drugs for labour: An enigma. Obstet Gynecol 20:124–127, 1962.
Falterman L. G., Richardson D. J.: Small left colon syndrome associated with maternal ingestion of psychotropics. J Pediatr 97:300–310, 1980.
Spear L. P., Shalaby I. A., Brick J.: Chronic administration of haloperidol during development: Behavioral and psychopharmacological effects. Psychopharmacology 70:47–58, 1980.
Desmond M. M., Rudolph A. J., Hill R. M., et al: Behavioral alterations in infants born to mothers on psychoactive medication during pregnancy, in Farrell G. (ed): Congenital Mental Retardation. Austin, University of Texas, 1967.
Platt J. E., Friedhoff A. J., Broman S. H., et al: Effects of prenatal exposure to neuroleptic drugs on childrens growth. Neuropsychopharmacology 1:205–212, 1988.
Kris E. B.: Children of mothers maintained on pharmacotherapy during pregnancy and postpartum. Curr Ther Res 31:690–695, 1965.
Zajicek E.: Psychiatric problems during pregnancy, in Wolkind S., Zajicek E. (eds): Pregnancy: A Psychological and Social Study. London, Academic Press, 1981, pp 57–73.
O’Hara M. W., Neunaber D. J., Zekoski E. M.: Prospective study of postpartum depression: Prevalence, course, and predictive factors. J Abnorm Psychol 93:158–171, 1984.
O’Hara M. W.: Social support, life events, and depression during pregnancy and the puerperium. Arch Gen Psychiatry 43:573, 1986.
O’Hara M. W.: Postpartum blues, depression, and psychosis: A review. J Psychosom Obstet Gynecol 7:205–227, 1987.
Targum S. D., Gershon E. S.: Pregnancy, genetic counselling and the major psychiatric disorders, in genetic diseases, in Schulman J., Simpson J. (eds): Pregnancy-Maternal Effects and Fetal Outcome. New York, Academic Press, 1981.
Akiskal H. S., Walker P., Puzantian V. R., et al: Bipolar outcome in the course of depressive illness: Phenomenologic, familiar, and pharmacologic predictors. J Affect Disord 5:115–128, 1983.
McBride W. G.: Limb deformities associated with iminodibenzyl hydrochloride (letter). Med J Aust 1:492, 1972.
Crombie D., Pinsent R. J., Felming D.: Imipramine and pregnancy. Br Med J 1:745, 1972.
Coyle I. R., Singer G.: The interaction of post-weaning housing conditions and prenatal drug effects of behavior. Psychopharmacology 41:237–244, 1975.
Giller E., Bialos D., Riddle M., et al: Monoamine oxidase inhibitor responsive depression. Psychiatry Res 6:41–48, 1982.
Liebowitz M. R., Quitkin F., Stewart J., et al: Phenelzine vs. imipramine in atypical depression. Arch Gen Psychiatry 41:669–677, 1984.
Poulson E., Robson J. M.: Effect of phenelzine and some related compounds in pregnancy. J Endocrinol 30:205–215, 1964.
Quitkin F. M.: The importance of dosage in prescribing antidepressants. Br J Psychiatry 147:593–597, 1985.
Schou, M. Concerning the start of the Scandinavian Register of Lithium Babies. Acta Psychiatr Scand 207(suppl.):96–97, 1969.
Ackerman D., Jefferson J., Griest J., et al: The lithium index: An innovative approach to consultation by computer. Am J Psychiatry 141:415–417, 1984.
Weinstein M. R., Goldfield M. D.: Cardiovascular malformations with lithium use during pregnancy. Am J Psychiatry 132:529–531, 1975.
Kirklin J. W., Barratt-Boyes B. G.: Ebstein’s malformation, in Kirklin J. W., Barratt-Boyes B. G. (eds): Cardiac Surgery. New York, John Wiley & Sons, 1986, pp 889–907.
Elia J., Katz I. R., Simpson G. M.: Teratogenicity of psychotherapeutic medications. Psychopharmacol Bull 23:531–585, 1987.
van Gent E. M., Nabarro G.: Haloperidol as an alternative to lithium in pregnant women (letter). Am J Psychiatry 144:1241, 1987.
Post R. M., Uhde T. W., Ballenger J. C., et al: Prophylactic efficacy of carbamazapine in manic— depressive illness. Am J Psychiatry 140:1602–1604, 1983.
Prien R. F., Gelenberg A. J.: Alternatives to lithium for preventive treatment of bipolar disorder, Am J Psychiatry 146:840–848, 1989.
Nidely J. R., Blake D. A., Freeman J. M., et al: Carbamazapine levels in pregnancy and lactation. Obstet Gynecol 53:139–140, 1979.
Nakne Y., Okuma T., Takahashi R., et al: Multi-institutional study on the teratogenicity and fetal toxicity of antiepileptic drugs: A report of a collaborative study group in Japan. Epilepsia 21:663–680, 1980.
Paulson G. W., Paulson R. B.: Teratogenic effects of anticonvulsants. Arch Neurol 40:140–143, 1981.
Sullivan F. M., McElhatton P. R.: A comparison of the teratogenic activity of the antiepileptic drugs carbamazepine, clonazepam, ethosuximide, phenobarbital, phenytoin, and pyrimidone in mice. Toxicol Appl Pharmacol 40:365–378, 1977.
Jones K. L., Lacro R. V., Johnson K. A., et al: Pattern of malformations in the children of women treated with carbamazepine during pregnancy. N Engl J Med 320:1661–1666, 1989.
Dallesio D. J.: Seizure disorders in pregnancy. N Engl J Med 312:559–564, 1985.
Cohen L. S., Heller V. L.: Manic depressive illness in pregnancy and the peurperium (letter). Psychosomatics, 1990, in press.
McElroy S. L., Keck P. E., Pope H. G., et al: Valproate in the treatment of rapid cycling mood disorder. J Clin Psychopharmacol 8:275–279, 1988.
Lindhout D., Schmidt D.: In utero exposure to valproate and neural defects. Lancet 1:329–393, 1986.
Schou M.: What happened later to the lithium babies: A follow-up study of children born without malformations. Acta Psychiatr Scand 54:193–197, 1976.
Cohen L. S., Rosenbaum J. F., Heller V. L.: Prescribing lithium for pregnant women (letter). Am J Psychiatry 145(6):773, 1988.
Weinstein M. R., Goldfield M. D.: Cardiovascular malformations with lithium use during pregnancy. Am J Psychiatry 132:529–531, 1975.
Impasato D. J., Gabriel A. R., Lardara M.: Electric and insulin shock therapy during pregnancy. Dis Nerv Syst 25:542–546, 1964.
Wise M. G., Ward S. C., Townsend-Parchman W., et al: Case report of ECT during high-risk pregnancy. Am J Psychiatry 141:99–101, 1984.
Repke J. T., Berger N. G.: Electroconvulsive therapy in pregnancy. Obstet Gynecol 63(suppl):39–40, 1984.
Remick R. A., Maurice W. L.: ECT in pregnancy (letter). Am J Psychiatry 135:761–762, 1978.
Boyd J. H., Weissman M. M.: Epidemiology, in Paykel E. S. (ed): Handbook of Affective Disorders. New York, Guilford Press, 1982, p 6.
Istvon J.: Stress, anxiety, and birth outcome: A critical review of the evidence. Psychol Bull 100:331–348, 1986.
Rementaria J. L., Blatt K.: Withdrawal symptoms in neonates from intrauterine exposure to diazepam. J Pediatr 90:123–126, 1977.
George D. T., Ladenheim J. A., Nutt D. J.: Effect of pregnancy on panic attacks. Am J Psychiatry 144:1078–1079, 1987.
Cohen L. S., Rosenbaum J. F., Heller V. L., et al: Course of panic disorder in 24 pregnant women. Presented at the 142nd annual meeting of the American Psychiatric Association, San Francisco, May 11, 1989.
Rosenbaum J. F.: The drug treatment of anxiety. N Engl J Med 306:401–404, 1982.
Klein D. F.: Anxiety reconceptualized, in Klein D. F., Raskin J. (eds): Anxiety: New Research and Changing Concepts. New York: Raven Press, 1981.
Safra M. J., Oakley G. P.: Association between cleft lip with or without cleft palate and prenatal exposure to diazepam. Lancet 2:478–480, 1975.
Saxen I.: Association between oral clefts and drugs taken during pregnancy. Int J Epidemiol 4:37–44, 1975.
Laegreid L., Olegard R., Wahlstrom J., et al: Abnormalities in children exposed to benzodiazepines in utero. Lancet 1:108–109, 1987.
Winter R. M., Czeizel A., Lendvay A., et al: In-utero exposure to benzodiazepines. Lancet 1:627, 1987.
Ballenger J. C.: Pharmacotherapy of panic disorders. J Clin Psychiatry 47(suppl 6):27–32, 1986.
Cohen L. S., Rosenbaum J. F.: Clonazepam: New uses and potential problems. J Clin Psychiatry 48(suppl):50–55, 1987.
Barry W. S., St. Clair S. M.: Exposure to benzodiazepines in utero (letter). Lancet 1:1436–1437, 1987.
Spier A. S., Tesar G. E., Rosenbaum J. F., et al: Clonazepam in the treatment of panic disorder and agoraphobia. J Clin Psychiatry 47:238–242, 1986.
Pollack M. H., Tesar G. E., Rosenbaum J. F., et al: Clonazepam in the treatment of panic disorder and agoraphobia: A one year follow-up. J Clin Psychopharmacol 6:302–304, 1986.
Tesar G. E., Rosenbaum J. F., Pollack M. H., Sachs G. S., Herman J. B., Cohen L. S., Sidari J: Panic Disorder: Clonazepam versus alprazolam and placebo. New Research Section, American Psychiatric Association, 141 st Annual Meeting, Montreal, May 12, 1988.
Herman J. B., Rosenbaum J. F., Brotman, A. W.: The alprazolam to clonazepam switch for treatment of panic disorder. J Clin Psychopharmacol 7:175–178, 1987.
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Cohen, L.S., Rosenbaum, J.F., Heller, V.L. (1991). Psychotropic Drug Use in Pregnancy. In: Gelenberg, A.J., Bassuk, E.L., Schoonover, S.C. (eds) The Practitioner’s Guide to Psychoactive Drugs. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-1137-0_10
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