General Approach to Pharmacological Treatment: During the Perinatal Period

Abstract

Psychopathological conditions are the most common morbidities affecting women during pregnancy and postnatal period, and it has been well documented that they may determine detrimental effects on the mother, the gestation, and the fetus/infant. Even though most of the studies so far published in the field of perinatal mental disorders have been focused on “nonpsychotic mental illnesses,” e.g., depression and anxiety, it has been as well documented an increasing evidence of cases with “severe and persistent mental illnesses.” So far, no RCT are allowed, for ethical purposes, in the perinatal period, so that only a few well-designed prospective investigations and a few observational studies investigated the safety of psychotropic drugs during pregnancy and breastfeeding. Therefore, the “conventional” clinical recommendation has, in many cases, to discontinue them, especially during pregnancy, due to the risk of birth defects and neonatal adverse reactions. However, in the last decade, more evidence-based data, including original cohort studies, systematic reviews, and meta-analyses, established that several psychotropic drugs can be considered relatively safe in early and late pregnancy as well as during breastfeeding and that not using them for psychiatric illness can be at greater risk for both the mother and infant. Some critical issues in the evaluation of the studies so far published on the safety of such medications during pregnancy and breastfeeding have been also discussed. General principles and recommendations to help clinicians in the use of psychotropic medications during the perinatal period are provided, according to the best recent international guidelines, overviews of the literature, and expert opinions in the field of perinatal psychiatry and psychopharmacology.