Treatments during pregnancy and breastfeeding

How is medication during pregnancy and breastfeeding important?

Medication use during pregnancy requires careful consideration of the mother’s risk of illness relapse against the risk of harm or complications for the developing infant if medication is to be continued. However, there is currently very little robust evidence regarding the use of medications for bipolar disorder during pregnancy and the postpartum period.

What is the evidence for medication use during pregnancy and breastfeeding?

Moderate to low quality evidence suggests a small increased risk of heart defect or lower birth weight in infants exposed to antipsychotics in utero, and a small increased risk of preterm delivery. There is also a small increased risk of neuromotor deficits in early childhood with exposure to antipsychotics in utero. However, studies did not allow correction for other medications, genetic predisposition, or other confounding effects.

There were no differences in the odds of autism spectrum disorders in the offspring of mothers with SSRI antidepressant exposure during pregnancy compared with mothers with no antidepressant exposure during pregnancy.

Low quality evidence is unsure of the risk of relapse following discontinuation of mood stabilisers during pregnancy. Review authors conclude that for severe conditions of bipolar disorder, close monitoring, support and prophylactic medication during pregnancy and the postpartum period is recommended. For women with stable bipolar disorder, a well-planned and slow discontinuation of mood stabilisers before pregnancy could be commenced. For unplanned pregnancies, a slow discontinuation is particularly important. Medication should be re-started soon after delivery, as the risk of postpartum relapse is high.

April 2019

Last updated at: 11:38 pm, 1st April 2019
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Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.