Pregnancy and psychotropic drugs

Pregnancy is considered a vulnerable period for women affected by a psychopathological condition or generally puts women at a higher risk of developing a psychiatric disorder. Among psychiatric disorders, major depression and anxiety disorders have been considered the most frequently reported during pregnancy; prevalence rates range, according to studies published, from 10% to 20%. There has been a growing number of publications in the field of “perinatal psychiatry,” some focusing on the risk of an untreated psychiatric disorders for the mother, the foetus and the infant, others specifically concerning the efficacy and safety of the available treatments, including psychotropic drugs. As a general rule, a risk/benefit approach is always needed when a psychopharmacological treatment needs to be prescribed during pregnancy. Data available in international literature clearly indicates that in pregnancy, the risk of a severe untreated maternal affective disorder can be far greater than the risk of a psychotropic drug treatment. This chapter provides a short review of the best clinical evidence, including systematic reviews and meta-analyses, focusing on the risk of major malformations and perinatal complications in women treated with psychotropic drugs. Furthermore, some practical clinical recommendations are also provided to better address clinicians in the drug management of pregnant women affected by severe mental disorders.