Psychotropic drugs in pregnancy and breastfeeding

The perinatal period is considered at-risk period for women suffering of severe mental illnesses (SMI). The management of SMI during this phase is challenging and becomes even more difficult when pregnancy is unplanned, which is the case in nearly half of pregnancy. Therefore, it is crucial that clinicians discuss the potential risks of a psychotropic drug treatment at the time of prescription for all women of reproductive age. Prescribing psychotropic medications during the perinatal period should be reserved to women suffering from severe psychopathological conditions or in those cases where non-pharmacological treatments have not been effective. It is a good clinical approach, when a drug treatment is indicated in a pregnant woman, to carefully evaluate both the risk of the drug exposure for the foetus and the risk of an untreated maternal SMI. Several guidelines and consensus guidance have been published in the last 10 years to provide recommendations for an appropriate clinical management of psychotropic medication in women affected by psychopathological conditions during the perinatal period. In this chapter, we have summarized the most relevant studies on the safety of the most frequently prescribed psychotropic drugs during pregnancy and breastfeeding. Original cohort studies, systematic reviews and meta-analyses represent the main sources of data reported for antidepressants, benzodiazepines and Z-drugs, antipsychotics and mood stabilizers.