Pharmacotherapy of Psychiatric Disorder in Pregnancy and during Breastfeeding: A Review

Abstract

The literature in most European languages was consulted for guidelines regarding the drug treatment of psychiatrically disturbed pregnant or lactating women. The available information allows only a few conclusions. Lithium exposure during the first trimester seems to increase the risk of congenital heart disease, especially Ebstein's anomaly. As there is still insufficient evidence to prove the safeness of other psychoactive drugs for the fetus, caution seems warranted here too. A causal link between pharmacotherapy of the mother-to-be and malformation of the baby is difficult to prove. But toxic and withdrawal symptoms in infants born to women treated regularly until shortly before confinement are well documented for most psychoactive drugs.

Healthy Outcome under Olanzapine Treatment in a Pregnant Woman

“…Disturbances of fetal growth, adaptive difficulties in the postnatal period and poor sucking and swallowing, as were reported with typical neuroleptics (Brazelton, 1970;Thiels, 1987;Altshuler et al, 1996), did not occur in our case, although the olanzapine plasma concentration was about one third of the mothers.…”

Antipsychotics and Breast-Feeding

“…The integration of results from earlier clinical case reports [2,[12][13][14]32] with results from more recently published studies with larger patient samples [4,30,31] permits a tentative conclusion. The integration of results from earlier clinical case reports [2,[12][13][14]32] with results from more recently published studies with larger patient samples [4,30,31] permits a tentative conclusion.…”

“…Antipsychotic drugs pass into the breast milk [2,4,[12][13][14] but information about their pharmacokinetics and possible adverse effects in breast-fed infants is restricted by the small number of individuals studied (until 1998, only 17 mother-infant pairs or dyads in all, plus the reports on 12 dyads in 1998), [4] and by methodological limitations. [4,15] The question most frequently asked is 'Should I breast feed while on medication?'…”

Maternal Behavior Their Adjustments and Implicated Factors

“…In case of the rats on Day 25 attachments are dependent on recent suckling experience [36], although pups prefer first nutritive to nonnutritive suckling at 17 day [37]. Suckling behavior does not differ between 25-day-old rat pups that were housed with a dam whose nipples were ligated and pups housed with an intact dam [38] suggesting that milk contributes slight to the maintenance of suckling before Day 25.…”