Published online by Cambridge University Press: 16 April 2020
This presentation is focused to analyse the safety of SSRIs and mood stabilisers in pregnancy and breastfeeding in order to reduce the risks associated with pre- and postnatal exposure to both classes of psychotropic drugs.
SSRIs
Recent literature information seems to suggest that SSRIs as group, sertraline, and, especially, paroxetine, may be associated with an increased risk of fetal malformations (cardiovascular anomalies, prevalently).
Moreover, exposure to such agents late in pregnancy is associated with an increased risk of inducing neonatal complications.
Further, the repercussions of SSRI exposure through placenta on the infant's neuropsychological development remain substantially unknown.
On the other hand, only sporadic case-reports have described unwanted reactions (of low degree of severity, however) in infants breastfed by mothers who were treated with SSRIs during lactation.
(1) Classic and emergent mood stabilizers
Classic mood stabilizers have been associated with an increased risk of fetal major malformations.
As regards atypical antipsychotics, available data are still insufficient to confirm or exclude an intrinsic teratogenic potential.(2) Conversely, information on lamotrigine seems to be quite reassuring.
Placental exposure to valproate is also associated with impaired neurodevelopmental outcomes.
Finally, all mood stabilising agents show too limited data for suggesting their safe use in lactation.
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