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Risk of Medication Exposures in Pregnancy and Lactation

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Women's Mood Disorders

Abstract

Treatment of perinatal mood and anxiety disorders (PMADs) requires an individualized approach that considers the health and well-being of the mother, the infant, and the mother-infant relationship. The known risks of untreated illness are weighed against the potential risks and benefits of treatment. There are important pharmacologic considerations during pregnancy and lactation. This chapter will review use of medications, including sleep medications, selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), other antidepressants, benzodiazepines and other anti-anxiety medications, mood stabilizers, antipsychotics, and hormones for the treatment of PMADs. Other treatment modalities including repetitive trans-cranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), and the novel therapeutic agent, brexanolone, will also be discussed for PMADs. The benefits and risks of treatments during pregnancy and lactation as well as potential long-term effects will be addressed. Specifically, evidence regarding risks of teratogenicity, obstetric and neonatal complications, and long-term developmental outcomes will be reviewed. General lactation guidelines will also be included. Lastly, other treatment and diagnostic considerations will be reviewed, and a general treatment algorithm will be presented.

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  1. Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Erin Brooks, Elizabeth Cox, Mary Kimmel & Anne Ruminjo

  2. Assad Meymandi Distinguished Professor and Chair, Director UNC Center for Women’s Mood Disorders, The Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Samantha Meltzer-Brody

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    Elizabeth Cox

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Brooks, E., Cox, E., Kimmel, M., Meltzer-Brody, S., Ruminjo, A. (2021). Risk of Medication Exposures in Pregnancy and Lactation. In: Cox, E. (eds) Women's Mood Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-71497-0_6

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