Treatment options

Comment

Antipsychotics

·   Relatively safe during pregnancy; some transient withdrawal and extrapyramidal symptoms; some risk for neonatal jaundice and bowel obstruction

·   Thorazine should be avoided

Anticholinergics

·   Increase in likelihood of minor malformations and anticholinergic side effects in infant

·   Bromocriptine appears to be satisfactory; amantadine has been associated with pregnancy complications and benadryl with oral clefts

Antidepressants

·   No significant teratogenic abnormalities

·   Most long-term safety data available for nortriptyline and desipramine; fluoxetine in third trimester is associated with perinatal complications; MAOIs should be avoided

Lithium

·   No long-term effects on the child reported

·   Consider changing dosage requirements throughout pregnancy (e.g. reduce dosage due to risk of Ebstein’s anomaly during the first trimester and before delivery) depending on illness severity

Anxiolytics

·   Has been associated with floppy infant syndrome and jaundice

·   Clonazepam has no reported teratogenicity; higher doses of diazepam during the first trimester were associated with cleft lip

Anticonvulsants

·   Increased likelihood of neonatal hemorrhage and hepatic dysfunction

·   Serious risk (1-5%) of neural tube defects with valproic acid and spina bifida with carbamazepine; valproic acid is thought to be somewhat safer but both are considered less safe than lithium

Calcium-Channel Blockers

·   Some risk of fetal death and decreased uteroplacental perfusion with verapamil

·   Limb and CNS defects have been associated with nifedipine

Buspirone

·   Sufficient data not available