Skip to main content

The Use of Psychotropic Drugs during Pregnancy and Nursing

  • Chapter
The Practitioner’s Guide to Psychoactive Drugs

Part of the book series: Topics in General Psychiatry ((TGPS))

  • 54 Accesses

Abstract

Treatment of a pregnant or nursing patient presents unusual challenges to the physician, who must consider not only the usual guidelines for administering drugs but also the special problems of pregnancy and the postpartum period. These include:

  1. 1.

    The significant alterations in maternal physiology during pregnancy and delivery.

  2. 2.

    The vulnerability of the developing fetus.

  3. 3.

    The physiological changes in the neonate.

  4. 4.

    The transfer of various agents to the newborn through milk.

  5. 5.

    The possibility of long-term neuroendocrine or behavioral effects on the developing nervous system.

The author would like to thank Jeffrey P. Koplan for his support.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Nahas C., Goujard J.: Phenothiazines, benzodiazepines, and the fetus, in Scarpelli E. M., Cosmi E. V. (eds): Reviews in Perinatal Medicine. New York, Raven Press, 1978, pp 243–280.

    Google Scholar 

  2. Gelenberg A. J.: Psychotropic drugs during pregnancy and the perinatal period. Mass Gen Hosp Newslett Biol Ther Psychiatry 2: 41–42, 1979.

    Google Scholar 

  3. Vorhees C. V., Brunner R. L., Butcher R. E.: Psychotropic drugs as behavioral teratogens. Science 205: 1220–1225, 1979.

    Article  PubMed  Google Scholar 

  4. Lewis P. D., Patel A. J., Bendek G.,: Do drugs acting on the nervous system affect cell proliferation in the developing brain? Lancet 1: 399–401, 1977.

    Article  Google Scholar 

  5. Kellogg C., Yervo D., Ison J.,: Prenatal exposure to diazepam alters behavioral development in rats. Science 207: 205–207, 1980.

    Article  PubMed  Google Scholar 

  6. Gelenberg A. J.: Intrauterine drug exposure: A sequel. Mass Gen Hosp Newslett Biol Ther Psychiatry 8: 32, 1980.

    Google Scholar 

  7. Ananth J.: Side effects in the neonate from psychotropic agents excreted through breast feeding. Am J Psychiatry 135: 801–805, 1978.

    PubMed  Google Scholar 

  8. Sovner R., Orsulak P.: Excretion of imipramine and desipramine in human breast milk. Am J Psychiatry 136: 451–452, 1979.

    PubMed  Google Scholar 

  9. Vorherr H.: Drug excretion in breast milk. Post grad Med 56: 97–104, 1974.

    Google Scholar 

  10. Patrick M. J., Tilstone W. J., Reavey P.: Diazepam and breast feeding. Lancet 1: 54 2543, 1972.

    Google Scholar 

  11. Gelenberg A. J.: Amoxapine, a new antidepressant, appears in human milk. J Nery Ment Dis 167: 635–636, 1979.

    Article  Google Scholar 

  12. Contamination of the ideal food. Therapeutics 1: 16–17, 1971.

    Google Scholar 

  13. Martin E.: Hazards of Medication. Philadelphia, Lippincott, 1971, pp 279–280.

    Google Scholar 

  14. Weinstein M., Goldfield M.: Lithium carbonate treatment during pregnancy. Dis Nerv Syst 30: 828–832, 1969.

    PubMed  Google Scholar 

  15. Targum S.: Dealing with psychosis during pregnancy. Ann Pharm 19: 18–21, 1979.

    Google Scholar 

  16. Rumeau-Rouquette C., Goujard J., Huel G.: Possible teratogenic effects of phenothiazines in human beings. Teratology 15: 57–64, 1977.

    Article  Google Scholar 

  17. Slone D., Siskind V., Heinonen O. P.,: Antenatal exposure to the phenothiazines in relation to congenital malformations, perinatal mortality, birth weight and intelligence quotient score. Am J Obstet Gynecol 128: 486–488, 1977.

    PubMed  Google Scholar 

  18. Robertson R., Majka J., Bokelman D.: Effects of prenatal exposure to chlorpromazine on postnatal development and behavior of rats. Toxico! Appl Pharmacol 48: A117, 1979.

    Article  Google Scholar 

  19. Ananth J.: Side effects on fetus and infant of psychotropic drug use during pregnancy. !nt Pharmacopsychiatry 11: 246–260, 1976.

    Google Scholar 

  20. Levy W., Wisnerewski K.: Chlorpromazine causing extrapyramidal dysfunction. NY State Med J 74: 684–685, 1974.

    Google Scholar 

  21. Hill L. M., Desmond M. M., Kay J. L.: Extrapyramidal dysfunction in an infant of a schizophrenic mother. J Pediatr 69: 589–595, 1966.

    Article  PubMed  Google Scholar 

  22. Falterman C. G., Richardson J. C.: Small left colon syndrome associated with ingestion of psychotropic drugs. J Pediatr 97: 308–310, 1980.

    Article  PubMed  Google Scholar 

  23. Kopelman A., McCullar F., Haggeness L.: Limb malformations following maternal use of haloperidol. JAMA 231: 62–64, 1975.

    Article  Google Scholar 

  24. Archer J. D.: Another possible teratogen? JAMA 231: 69, 1975.

    Article  PubMed  Google Scholar 

  25. Hanson J. W., Oakley G. P.: Haloperidol and limb deformity. JAMA 231: 26, 1975.

    Article  PubMed  Google Scholar 

  26. Ayd F. J. Jr. (ed): Is haloperidol teratogenic? Int Drug Ther Newslett 10:8, 1975.

    Google Scholar 

  27. Ayd F. J. Jr.: Excretion of psychotropic drugs in human breast milk. Int Drug Ther Newslett 8: Nos. 9 and 10, 1973.

    Google Scholar 

  28. Yamer A., McKey R., Arias D.,: Phenothiazine-induced extrapyramidal dysfunction in the neonate. J Pediatr 75: 479–480, 1969.

    Article  Google Scholar 

  29. Yalom I. D., Lunde D. T., Moos R. H.,: The “postpartum blues” syndrome: Description and related variables. Arch Gen Psychiatry 18: 16, 1968.

    Article  PubMed  Google Scholar 

  30. Kane F. J.: Postpartum disorders, in Freedman A., Kaplan H. I., Sadock B. J. (eds): Comprehensive Textbook of Psychiatry II, Baltimore, Williams & Wilkins, 1975, vol 1, pp 1055–1059.

    Google Scholar 

  31. Howard F. M., Hill J. M.: Drugs in pregnancy. Obstet Gynecol Sury 34: 643–653, 1979.

    Article  Google Scholar 

  32. McBride W. G.: Limb deformities associated with iminodibenzyl hydrochloride. Med J Aust 1: 192, 1972.

    Google Scholar 

  33. Bannister P., Smith C. D., Miller J.: Possible teratogenicity of tricyclic antidepressants. Lancet 1: 838–839, 1972.

    Google Scholar 

  34. Freeman R.: Limb deformities: Possible association with drugs. Med J Aust 1: 606–607, 1972.

    PubMed  Google Scholar 

  35. Buckfield P.: Major congenital faults in newborn infants: A pilot study in New Zealand. NZ Med J 78: 195–204, 1973.

    Google Scholar 

  36. Australian Drug Evaluation Committee: Tricyclic antidepressants and limb reduction deformities. Med J Aust 1: 768–769, 1973.

    Google Scholar 

  37. Goldberg H. L., DiMascio A.: Psychotropic drugs in pregnancy, in Lipton M. A., DiMascio A., Killam K. F. (eds): Psychopharmacology: A Generation of Progress. New York, Raven Press, 1978, pp 1047–1055.

    Google Scholar 

  38. Webster P. A. C.: Withdrawal symptoms in neonates associated with maternal antidepressant therapy. Lancet 2: 318–319, 1973.

    Article  PubMed  Google Scholar 

  39. Eggermont E., Raveschot J., Deneve V.,: The adverse influence of imipramine on the adaptation of the newborn to extrauterine life. Acta Paediatr Belg 26: 197–204, 1972.

    PubMed  Google Scholar 

  40. Hill M., Stern L.: Drugs in pregnancy: Effects on the fetus and newborn. Drugs 17: 18 2197, 1979.

    Google Scholar 

  41. Weinstein M., Goldfield M.: Cardiovascular malformations with lithium use during pregnancy. Am J Psychiatry 132: 529–531, 1975.

    PubMed  Google Scholar 

  42. Gelenberg A. J.: Lithium during pregnancy: Risks of cardiovascular malformations. Mass Gen Hosp Newslett Biol Ther Psychiatry 4: 1, 1981.

    Google Scholar 

  43. Nora J. J., Nora H. A., Toems W. A.: Lithium, Ebstein’s anomaly and other congenital heart defects. Lancet 2: 594–595, 1974.

    Article  PubMed  Google Scholar 

  44. Park J. M., Sridaromont S., Ledbetter E. O.,: Ebstein’s anomaly of the tricuspid valve associated with prenatal exposure to lithium carbonate. Am J Dis Child 134: 703704, 1980.

    Google Scholar 

  45. Targum S. D., Davenport Y. B., Webster M. J.: Postpartum mania in bipolar manic—depressive patients withdrawn from lithium carbonate. J Nery Ment Dis 167:572–574, 1979. 1

    Google Scholar 

  46. Berkowitz R. L., Constan D. R., Michizuki T.: Handbook for Prescribing Medications during Pregnancy. Boston, Little, Brown, 1980.

    Google Scholar 

  47. Havdala H. S., Borison R. L., Diamond B. I.: Potential hazards and applications of lithium in anesthesiology. Anesthesiology 50: 534–537, 1979.

    Article  PubMed  Google Scholar 

  48. Woody J. N., London W. L., Wilbanks G. D.: Lithium toxicity in the newborn. Pediat rics 47: 94–96, 1971.

    Google Scholar 

  49. Wilbanks G. D., Bressler B., Peete H. C. Jr.,: Toxic effects of lithium carbonate in a mother and newborn infant. JAMA 213: 856–857, 1970.

    Article  Google Scholar 

  50. DiMascio A., Goldberg H.: Psychotropics in pregnancy: Safer than you think. Curr Prescript 2: 56–58, 1976.

    Google Scholar 

  51. Sobel D. E.: Fetal damage due to ECT, insulin coma, chlorpromazine or reserpine. Arch Gen Psychiatry 2: 606–611, 1960.

    Article  Google Scholar 

  52. Remick R., Maurice W.: ECT in pregnancy. Am J Psychiatry 135: 761–762, 1978.

    PubMed  Google Scholar 

  53. Safra M. J., Oakley G. P.: Association between cleft lip with or without cleft palate and prenatal exposure to diazepam. Lancet 2: 478–480, 1975.

    Article  PubMed  Google Scholar 

  54. Saxen I.: Associations between oral clefts and drugs taken during pregnancy. Int J Epidemiol 4: 37–44, 1975.

    Article  PubMed  Google Scholar 

  55. Saxen E., Saxen L.: Association between maternal intake of diazepam and oral clefts. Lancet 2: 498, 1975.

    Article  PubMed  Google Scholar 

  56. Saxen I.: Epidemiology of cleft lip and palate. Br J Prey Soc Med 29: 103–110, 1975.

    Google Scholar 

  57. Aarskog D.: Association between maternal intake of diazepam and oral clefts. Lancet 2: 921, 1975.

    Google Scholar 

  58. Athinaragan P., Pierog S. H., Nigam S. K.,: Chlordiazepoxide withdrawal in the neonate. Am J Obstet Gynecol. 124: 212–213, 1976.

    Google Scholar 

  59. Milkovich L., van dan Berg B. J.: Effects of prenatal meprobamate and chlordiazepoxide hydrochloride on human embryonic and fetal development. N Engl J Med 291:1268–1271, 1974.

    Google Scholar 

  60. Hartz S. C., Heinonen O. P., Shapiro S.,: Antenatal exposure to meprobamate andchlordiazepoxide in relation to malformations, mental development and childhood mortality. N Engl J Med 292: 726–728, 1975.

    Article  PubMed  Google Scholar 

  61. Mazzi E.: Possible neonatal diazepam withdrawal: A case report. Am J Obstet Gynecol 129: 586–587, 1977.

    PubMed  Google Scholar 

  62. Rementeria J. L., Bhatt K.: Withdrawal symptoms in neonates from intrauterine expo-sure to diazepam. J Pediatr 90: 123–126, 1977.

    Article  PubMed  Google Scholar 

  63. Heinonen O. P., Slone D., Shapiro S.: Birth Defects and Drugs in Pregnancy. Littleton, New York: Publishing Sciences Group, 1977, pp 323–334.

    Google Scholar 

  64. Saxen I.: Cleft palate and maternal diphenhydramine intake. Lancet 1: 407–408, 1974.

    Article  PubMed  Google Scholar 

  65. Siep M.: Growth retardation, dysmorphic facies and minor malformations following massive exposure to phenobarbitone in utero. Acta Pediatr Scand 65: 617–621, 1976.

    Article  Google Scholar 

  66. Smith D. W.: Teratogenicity of anticonv ilsive medications. Am J Dis Child 131: 1337, 1977.

    PubMed  Google Scholar 

  67. Desmond M. M., Schwanecke R. P., Wilson G. S.,: Maternal barbiturate utilization and neonatal withdrawal symptomatology. J Pediatr 80: 190–197, 1972.

    Article  PubMed  Google Scholar 

  68. Hill R. M., Verniaud W. M., Morgan N. F.,: Urinary excretion of phenobarbital in a neonate having withdrawal symptoms. Am J Dis Child 131: 546–550, 1972.

    Google Scholar 

  69. Karacan I., Heine W., Agnew H.,: Characteristics of sleep patterns during late pregnancy and the postpartum periods. Am J Obstet Gynecol 101: 579–586, 1968.

    Google Scholar 

  70. Mannor S. M.: Hyperemesis gravidarum, in Iffey L., Kaminetsky H. A. (eds): Principles and Practice of Obstetrics and Perinatology. New York, John Wiley & Sons, 1981, vol 2, pp 1155–1164.

    Google Scholar 

  71. Indications for Bendectin narrowed. FDA Drug Bull 11: 13, 1981.

    Google Scholar 

  72. Williams J. W.: Nausea and vomiting, in Pritchard J. A., MacDonald P. C. (eds): Obstetrics, ed 16. New York, Appleton—Century Crofts, 1980, p 342.

    Google Scholar 

  73. Mann E. C., Armistead T. N.: Pregnancy and sexual behavior, in Freedman A. M., Kaplan H. I., Sadock B. J. (eds): Comprehensive Textbook of Psychiatry II, Baltimore, Williams & Wilkins, 1975, vol 2, p 1437.

    Google Scholar 

  74. Perlmutter J.: Heroin addiction and pregnancy. Obstet Gynecol Sury 29: 439–446, 1974.

    Article  Google Scholar 

  75. Reddy A., Harper R., Stern G.: Observations on heroin and methadone withdrawal in the newborn. Pediatrics 48: 353, 1971.

    PubMed  Google Scholar 

  76. Kandall S., Gartner L. M.: Delayed presentation of neonatal methadone withdrawal. Pediatr Res 7: 320–392, 1973.

    Google Scholar 

  77. Zelson C.: Current concepts, infant of the addicted mother. N Engl J Med 228: 1393 1395, 1973.

    Google Scholar 

  78. Fleming J. W., Rosser P.: The congenitally methadone-addicted infant. Birth Defects 15: 99–117, 1979.

    PubMed  Google Scholar 

  79. Glass L., Evans H. E.: Narcotic withdrawal in the newborn. Am Fam Physician 6: 75–78, 1972.

    PubMed  Google Scholar 

  80. Rajegowda B. K., Glass L., Evans H. E.,: Methadone withdrawal in newborn infants. J Pediatr 81: 532–534, 1972.

    Article  PubMed  Google Scholar 

  81. Herzlinger R. A., Kandall S. R., Vaughn H. G.: Neonatal seizures associated with narcotic withdrawal. J Pediatr 91: 638–641, 1977.

    Article  PubMed  Google Scholar 

  82. Olsen G. D., Lees M. H.: Ventilatory response to carbon dioxide of infants following chronic prenatal exposure. J Pediatr 96: 983–989, 1980.

    Article  PubMed  Google Scholar 

  83. Cohen S.: Caffeine. Drug Abuse Alcoholism Newslett 10: 1–3, 1981.

    Google Scholar 

  84. Levine J. N.: Amphetamine ingestion with biliary atresia. J Pediatr 79: 130–131, 1971.

    Article  Google Scholar 

  85. Van Blerk G. A., Majerns T. C., Myers R. A.: Teratogenic potential of some psychopharmacologic drugs: A brief review. Int J Gynecol Obstet 17: 399–402, 1980.

    Google Scholar 

  86. Long S. Y.: Does LSD induce chromosomal change and malformations? Teratology 6: 75–90, 1972.

    Article  PubMed  Google Scholar 

  87. Golden N. L., Sokol R. J., Rubin L.: Angel dust: Possible effects on the fetus. Pediatrics 65: 18–20, 1980.

    PubMed  Google Scholar 

  88. Langer A., Caghan E. N.: Drug and alcohol abuse during pregnancy, in Iffy L., Kaminetsky H. A.: Principles and Practice of Obstetrics and Perinatology, New York, John Wiley & Sons, 1981, vol 1, pp 543–552.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1983 Plenum Publishing Corporation

About this chapter

Cite this chapter

Koplan, C.R. (1983). The Use of Psychotropic Drugs during Pregnancy and Nursing. In: Bassuk, E.L., Schoonover, S.C., Gelenberg, A.J. (eds) The Practitioner’s Guide to Psychoactive Drugs. Topics in General Psychiatry. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-8049-2_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-8049-2_10

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4615-8051-5

  • Online ISBN: 978-1-4615-8049-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics