Psychopharmacologic Therapy in Pregnancy: Effects on Newborns

The management of psychiatric problems and pharmacologic treatment in pregnancy is complex and burdened with many biologic and personal factors.5 Psychiatrists need to consider the impact of untreated illness on the mother and the fetus, as well as the possibility of increased risk for obstetric complications and congenital malformations associated with pharmacologic treatment. It should be stressed that untreated psychiatric illnesses pose a tremendous threat to the fetus because of maternal behavior and that discontinuing effective psychotropic treatments may exacerbate maternal mental illness and cause secondary effects on the fetus. All currently available psychopharmacologic agents and their metabolites cross the placenta,6 and in some cases, intrauterine exposure to psychiatric drugs may lead to neonatal withdrawal syndrome (NWS), also called neonatal abstinence syndrome. NWS occurs in newborns going through withdrawal symptoms as a result of the mother's use of psychoactive drugs during pregnancy. It is characterized by signs and symptoms of CNS hyper-irritability, GI dysfunction, and respiratory distress; and by vague autonomic signs and symptoms that include yawning, sneezing, mottling, and fever. This syndrome usually begins within 72 hours but may appear up to 2 weeks after birth.6,7 The clinical presentation of neonatal drug with withdrawal varies depending on the drug(s), timing, and amount of the last maternal use, maternal and infant metabolism and excretion, and other unidentified factors.8 Psychotropic medications given to the mother cause pharmacologic effects on the fetus. These effects are related to the mechanism of action and therapeutic objectives of the treatment (for the mother) and can produce symptoms and signs in the newborn that are distinct from those of NWS. In many cases, the clinical picture is very similar and, thus, difficult to differentiate.