Psychopharmacotherapy for Pregnant Women / 대한정신약물학회지

ABSTRACT

Authors reviewed the risk of psychopharmacotherapies during pregnancy. Psychopharmaotherapy in pregnants should be determined by considering the risk of disease recurrence in the mother and the impacts on the fetus. The American College of Obstetricians and Gynecologists does not recommend the routine use of antipsychotics in pregnancy, but risk-benefit assessments may indicate that such use is appropriate. Generally, antipsychotics are indicated for severe mental disorder, the benefits to the mother appear to outweigh the unknown risk. Folate (4 mg/day) has been recommended for women taking atypical antipsychotics because they may have a high risk of neural tube defects due to inadequate folate intake and obesity. Mood stabilizers should be avoided during pregnancy because of their potential teratogenicity. Lamotrigine or topiramate are relatively safe and combination with folate could be reduced the risk of neural tube defects. Antidepressants have been used in pregnant women with relative safety, but we should be considered the risk of major defects and neonatal syndrome. Especially, prenatal eochocardiography is recommended if it has been exposed in the first trimester of pregnancy. Paroxetine should be avoided in the first trimester of pregnancy due to the risk of congenital anomalies. There are many controversies in causal association between benzodiazepine and congenital defects. But, if the maternal condition requires the use of benzodiazepine during pregnancy, the lowest possible dose should be taken. Although no congenital malformation have been reported, data are too limited to confirm the risk of zolpidem for pregnancy, further evaluation are needed.