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Use of psychotropic medications during pregnancy and the postpartum period: Review on Recent Works and Clinical Scenarios

Published online by Cambridge University Press:  19 July 2023

E. Román ,
M. Natividad ,
J. Cobo ,
R. Ayesa ,
H. Cachinero ,
I. Figueras ,
E. Izquierdo ,
E. Martínez ,
J. P. Paolini San Miguel  and
J. A. Monreal
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E. Román*
Affiliation:
Mental Health, Mutua Terrassa University Hospital. University of Barcelona (UB). CIBERSAM
M. Natividad
Affiliation:
Mental Health, Mutua Terrassa University Hospital. Fundació Docència i Recerca. University of Barcelona. CIBERSAM., Terrassa
J. Cobo
Affiliation:
Mental Health, Parc Tauli University Hospital. Autonomous University of Barcelona (UAB). I3PT. CIBERSAM, Sabadell
R. Ayesa
Affiliation:
Psychiatry, Marqués Valdecilla University Hospital. IDIVAL. National University of Distance Education. CIBERSAM, Santander
H. Cachinero
Affiliation:
Mental Health, Mutua Terrassa University Hospital. University of Barcelona. Fundació Docència i Recerca Mutua Terrassa
I. Figueras
Affiliation:
Mental Health, Mutua Terrassa University Hospital. Fundació Docència i Recerca Mutua Terrassa. University of Barcelona
E. Izquierdo
Affiliation:
Mental Health, Mutua Terrassa University Hospital. Fundació Docència i Recerca Mutua Terrassa. University of Barcelona., Terrassa
E. Martínez
Affiliation:
Mental Health, Mutua Terrassa University Hospital. Fundació Docència i Recerca Mutua Terrassa. University of Barcelona
J. P. Paolini San Miguel
Affiliation:
Mental Health, Parc Tauli University Hospital. Autonomous University Hospital. I3PT. CIBERSAM, Sabadell
J. A. Monreal
Affiliation:
Mental Health, Mutua Terrassa University Hospital. Fundació Docència i Recerca Mutua Terrassa. University of Barcelona. CIBERSAM. Inst. Neurociències UAB
A. González-Rodríguez
Affiliation:
Mental Health, Mutua Terrassa University Hospital. Fundació Docència i Recerca Mutua Terrassa. University of Barcelona. CIBERSAM, Terrassa, Spain
*
*Corresponding author.

Abstract

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Introduction

The effects of antidepressant and antipsychotic medications in the perinatal period in both mothers and children have been a subject of interest for many decades. Risks and benefits should be considered according to the illness stage, trimester of pregnancy/ postpartum period, and neonatal outcomes.

Objectives

Our goal was to summarize the knowledge about the use of antidepressants and antipsychotics in the perinatal period. To illustrate the complexity of treatment decisions with clinical reports.

Methods

Review: A narrative review was carried out using the PubMed database including papers published in 2022. Evidence about the risks and benefits of using antidepressants and antipsychotics in the perinatal period is presented. Search terms: antidepressants OR antipsychotics AND (perinatal OR pregnancy OR postpartum).

Case reports (5 clinical scenarios): (1) pre-pregnancy counselling, (2-4) first-, second- and third-trimester of pregnancy, and (5)postpartum/breastfeeding.

Results

Review: (1)Depression/antidepressants. Treating maternal depressive symptoms is associated with a lower risk of pregnancy complications. Although placental passage of sertraline is low, drug monitoring is recommended. Antidepressant use in pregnancy is associated with preterm delivery and low weight at birth. (2)Psychosis/Antipsychotics. Antipsychotic intrauterine exposure is not significantly associated with increased risk of major congenital malformations. Minimum effective doses are recommended.

Case reports. (1)Pre-pregnancy counselling. Schizoaffective disorder receiving perphenazine, quetiapine and lithium. (2)First-trimester pregnancy. Discontinuation of treatment in major depressive disorder. (3-4)Second/third trimester. Occurrence of anxiety symptoms in posttraumatic stress disorder. (5)Postpartum/Breastfeeding. Discontinuation of antidepressants.

Conclusions

Shared decision-making models for antidepressants and antipsychotics prescription represent patient-centered approaches to be recommended in perinatal period.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 66 , Special Issue S1: Abstracts of the 31st European Congress of Psychiatry , March 2023 , pp. S1125 - S1126
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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