Psychotropic Medication During Pregnancy
In the public-health setting, a variety of mental-health conditions ranging from depression to bipolar disorder (BD) are encountered, but these illnesses are not always treated appropriately during pregnancy. One-year prevalence rates for major depressive disorder (MDD) range from 7% to 13%, with peak occurrence between 25 and 44 years of age. BD affects between 4% and 6% of women, with onset usually occurring in the teens to early twenties. The onset of schizophrenic disorders commonly occurs during the early childbearing years in women. It is important for the pharmacist to know which psychotropic agents are considered safe during pregnancy and which ones should be avoided, and to keep other members of the health care team up-to-date. This article reviews the various psychotropic medications and how they should or should not be used during pregnancy.
In the evaluation of drug therapy during pregnancy, teratogenicity and embryotoxicity must be considered. Damage caused by teratogens occurs during the first trimester of pregnancy, and malformations of fetal organs or skeletal structures may be seen. Embryotoxicity can occur when drugs are given in the second or third trimester. Manifestations of embryotoxicity in a neonate include jitteriness, crying, and nervousness.
To make an accurate recommendation to other health care providers (HCPs) regarding which psychotropics are safe during pregnancy, it is important to consider the FDA's pregnancy safety ratings (categories A, B, C, D, and X). Category A means that controlled studies show no fetal risks associated with the drug; for category B drugs, there is no evidence of risk in humans, although risks have been noted in animal studies; for category C drugs, risk cannot be ruled out; category D drugs have positive evidence of risk; and category X drugs are contraindicated for use in pregnancy. No approved psychotropics have a category A rating.
Abstract and Introduction
Introduction
In the public-health setting, a variety of mental-health conditions ranging from depression to bipolar disorder (BD) are encountered, but these illnesses are not always treated appropriately during pregnancy. One-year prevalence rates for major depressive disorder (MDD) range from 7% to 13%, with peak occurrence between 25 and 44 years of age. BD affects between 4% and 6% of women, with onset usually occurring in the teens to early twenties. The onset of schizophrenic disorders commonly occurs during the early childbearing years in women. It is important for the pharmacist to know which psychotropic agents are considered safe during pregnancy and which ones should be avoided, and to keep other members of the health care team up-to-date. This article reviews the various psychotropic medications and how they should or should not be used during pregnancy.
In the evaluation of drug therapy during pregnancy, teratogenicity and embryotoxicity must be considered. Damage caused by teratogens occurs during the first trimester of pregnancy, and malformations of fetal organs or skeletal structures may be seen. Embryotoxicity can occur when drugs are given in the second or third trimester. Manifestations of embryotoxicity in a neonate include jitteriness, crying, and nervousness.
To make an accurate recommendation to other health care providers (HCPs) regarding which psychotropics are safe during pregnancy, it is important to consider the FDA's pregnancy safety ratings (categories A, B, C, D, and X). Category A means that controlled studies show no fetal risks associated with the drug; for category B drugs, there is no evidence of risk in humans, although risks have been noted in animal studies; for category C drugs, risk cannot be ruled out; category D drugs have positive evidence of risk; and category X drugs are contraindicated for use in pregnancy. No approved psychotropics have a category A rating.
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