title: Psychotropics in pregnancy: safety and other considerations.
abstract: BACKGROUND
  Perinatal psychiatric disorders are important because of their adverse effects on pregnancy outcomes. The aim of this review is investigate psychotropic drugs in the management of antenatal psychiatric disorders with emphasis on the risk of harmful effects.
  
  
  METHODS
  A systematic review of published electronic literature between January 2000 and August 2011 was conducted using the following keywords: pregnancy, pregnancy complications, neonatal complications, congenital anomalies, infant/child development, antidepressants, antipsychotics, and lithium. The search was conducted for each class of psychotropic agents. Further hand searches were conducted. Anticonvulsants were excluded.
  
  
  RESULTS
  Antidepressants are associated with increased risk of spontaneous abortions, stillbirths, preterm deliveries, respiratory distress, endocrine and metabolic disturbance. There is evidence of discontinuation syndrome and of increased risk of cardiac defects. Antipsychotics are associated with increased gestational weight and diabetes and with increased risk of preterm birth. The effects of antipsychotics on birth weight are inconclusive. In addition, the findings in relation to malformations are inconclusive. Lithium is associated with increased birth complications such as polyhydramnios, pre-eclampsia, respiratory distress syndrome, hypotonia, and preterm birth. Lithium has previously been associated with markedly increased risk of Ebstein's anomaly. However, recent re-evaluation of the data casts doubt on the previous estimates. There is evidence that lithium is associated with cardiac septal defects.
  
  
  CONCLUSIONS
  Psychotropic drugs remain an important treatment option during pregnancy to properly manage symptoms of psychiatric diseases. Clinicians need to remain aware of the potential risk of adverse effects associated with psychotropic drug treatment.
authors.affiliation: National Centre for Mental Health, 25 Vincent Drive, Edgbaston, Birmingham B15 2FG, United Kingdom. Femi_Oyebode@msn.com
authors.forename: Femi
authors.initials: F
authors.lastname: Oyebode
authors.forename: Abhinav
authors.initials: A
authors.lastname: Rastogi
authors.forename: Giles
authors.initials: G
authors.lastname: Berrisford
authors.forename: Floriana
authors.initials: F
authors.lastname: Coccia
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D000818:Animals; D000928:Antidepressive Agents / Q000009:adverse effects; D018692:Antimanic Agents / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced*; D011619:Psychotropic Drugs / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs