Abstract
Psychopathological conditions are the most common morbidities affecting women during pregnancy and postnatal period, and it has been well documented that they may determine detrimental effects on the mother, the gestation, and the fetus/infant. Even though most of the studies so far published in the field of perinatal mental disorders have been focused on “nonpsychotic mental illnesses,” e.g., depression and anxiety, it has been as well documented an increasing evidence of cases with “severe and persistent mental illnesses.” So far, no RCT are allowed, for ethical purposes, in the perinatal period, so that only a few well-designed prospective investigations and a few observational studies investigated the safety of psychotropic drugs during pregnancy and breastfeeding. Therefore, the “conventional” clinical recommendation has, in many cases, to discontinue them, especially during pregnancy, due to the risk of birth defects and neonatal adverse reactions. However, in the last decade, more evidence-based data, including original cohort studies, systematic reviews, and meta-analyses, established that several psychotropic drugs can be considered relatively safe in early and late pregnancy as well as during breastfeeding and that not using them for psychiatric illness can be at greater risk for both the mother and infant. Some critical issues in the evaluation of the studies so far published on the safety of such medications during pregnancy and breastfeeding have been also discussed. General principles and recommendations to help clinicians in the use of psychotropic medications during the perinatal period are provided, according to the best recent international guidelines, overviews of the literature, and expert opinions in the field of perinatal psychiatry and psychopharmacology.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
National Institute for Health and Clinical Excellence (NICE). Antenatal and postnatal mental health: the NICE guideline on clinical management and service guidance. Updated edition. NICE clinical guidance 192. London: NICE; 2014. Available from: https://www.nice.org.uk/guidance/cg192/evidence/full-guideline-pdf-193396861.
Scottish Intercollegiate Guidelines Network (SIGN). Management of perinatal mood disorders. Edinburgh: SIGN; 2012. (SIGN publication no. 127). Accessed on Mar 2012. Available from: http://www.sign.ac.uk.
McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH, endorsed by the British Association for Psychopharmacology. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 2017;31:519–52.
ACOG Committee on Practice Bulletins--Obstetrics. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111:1001–20.
Larsen ER, Damkier P, Pedersen LH, Fenger-Gron J, Mikkelsen RL, Nielsen RE, Linde VJ, Knudsen HE, Skaarup L, Videbech P, Danish Psychiatric Society; Danish Society of Obstetrics and Gynecology; Danish Paediatric Society; Danish Society of Clinical Pharmacology. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand Suppl. 2015;(445):1–28.
Wisner KL. The last therapeutic orphan: the pregnant woman. Am J Psychiatry. 2012;169:554–6. https://doi.org/10.1176/appi.ajp.2012.12030367.
Huybrechts KF, Palmsten K, Mogun H, Kowal M, Avorn J, Setoguchi-Iwata S, Hernández-Díaz S. National trends in antidepressant medication treatment among publicly insured pregnant women. Gen Hosp Psychiatry. 2013;35:265–71.
Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, Beyene J, Wang Y, McDonald SD. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiat. 2016;73:826–37.
Howard LM, Piot P, Stein A. No health without perinatal mental health. Lancet. 2014;384(9956):1723–4.
Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016;191:62–77.
Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67:1012–24.
Brennan PA, Pargas R, Walker EF, Green P, Newport DJ, Stowe Z. Maternal depression and infant cortisol: influences of timing, comorbidity and treatment. J Child Psychol Psychiatry. 2008;49:1099–107.
O’Connor TG, Ben-Shlomo Y, Heron J, Golding J, Adams D, Glover V. Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children. Biol Psychiatry. 2005;58:211–7.
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800–19.
McFarland J, Salisbury AL, Battle CL, Hawes K, Halloran K, Lester BM. Major depressive disorder during pregnancy and emotional attachment to the fetus. Arch Womens Ment Health. 2011;14:425–34.
Chan J, Natekar A, Einarson A, Koren G. Risks of untreated depression in pregnancy. Can Fam Physician. 2014;60:242–3.
Orsolini L, Valchera A, Vecchiotti R, Tomasetti C, Iasevoli F, Fornaro M, De Berardis D, Perna G, Pompili M, Bellantuono C. Suicide during perinatal period: epidemiology, risk factors, and clinical correlates. Front Psych. 2016;7:138.
Kim JJ, Silver RK. Perinatal suicide associated with depression diagnosis and absence of active treatment in 15-year UK national inquiry. Evid Based Ment Health. 2016;19:122.
Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295:499–507. Erratum in: JAMA 2006; 296:170.
Viguera AC, Whitfield T, Baldessarini RJ, Newport DJ, Stowe Z, Reminick A, Zurick A, Cohen LS. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 2007;164:1817–24. quiz 1923.
Wesseloo R, Burgerhout KM, Koorengevel KM, Bergink V. [Postpartum psychosis in clinical practice: diagnostic considerations, treatment and prevention]. Tijdschr Psychiatr 2015;57:25–33.
Petersen I, Evans SJ, Gilbert R, Marston L, Nazareth I. Selective serotonin reuptake inhibitors and congenital heart anomalies: comparative cohort studies of women treated before and during pregnancy and their children. J Clin Psychiatry. 2016;77:e36–42.
Chisolm MS, Payne JL. Management of psychotropic drugs during pregnancy. BMJ. 2016;532:h5918.
Louik C, Lin AE, Werler MM, Hernández-Díaz S, Mitchell AA. First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. N Engl J Med. 2007;356(26):2675–83. Erratum in: N Engl J Med 2015; 373(7):686.
Grigoriadis S, VonderPorten EH, Mamisashvili L, Roerecke M, Rehm J, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A, Ross LE. Antidepressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta-analysis of the best evidence. J Clin Psychiatry. 2013;74:e293–308.
Furu K, Kieler H, Haglund B, Engeland A, Selmer R, Stephansson O, Valdimarsdottir UA, Zoega H, Artama M, Gissler M, Malm H, Nørgaard M. Selective serotonin reuptake inhibitors and venlafaxine in early pregnancy and risk of birth defects: population based cohort study and sibling design. BMJ. 2015;350:h1798. Erratum in: BMJ 2015;350:h2235.
Wang S, Yang L, Wang L, Gao L, Xu B, Xiong Y. Selective serotonin reuptake inhibitors (SSRIs) and the risk of congenital heart defects: a meta-analysis of prospective cohort studies. J Am Heart Assoc. 2015;4(5):pii:e001681.
WHO (World Health Organization). Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva: World Health Organization; 2017.
NIH. Lactmed. Bathesda, MD: NIH; 2018. Accessed on 10 Jan 2018. Available from: https://www.nlm.nih.gov/pubs/factsheets/lactmedfs.html.
McKeever A, Alderman S, Luff S, De Jesus B. Assessment and care of childbearing women with severe and persistent mental illness. Nurs Womens Health. 2016;20:484–99.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Bellantuono, C., Martellini, M., Orsolini, L. (2019). General Approach to Pharmacological Treatment: During the Perinatal Period. In: Uguz, F., Orsolini, L. (eds) Perinatal Psychopharmacology. Springer, Cham. https://doi.org/10.1007/978-3-319-92919-4_4
Download citation
DOI: https://doi.org/10.1007/978-3-319-92919-4_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-92918-7
Online ISBN: 978-3-319-92919-4
eBook Packages: MedicineMedicine (R0)