Course of psychiatric disorders in pregnancy. Dilemmas in pharmacologic management.

Although it is generally believed that pregnancy is a time of emotional well-being, many women develop or have a recurrence of psychiatric illness during this time. The risks associated with leaving a woman untreated during pregnancy are potentially substantial and must be weighed against the risks of exposing the fetus to the potentially teratogenic medications. Large prospective and retrospective studies suggest a relative safety of use of tricyclic antidepressants during pregnancy. Data available for neuroleptics, lithium, benzodiazepines, and the anticonvulsants valproic acid and carbamazepine, although mixed, point to increased risks of congenital malformations in the children of mothers exposed to these agents in the first trimester of pregnancy. Very little is known about the behavioral abnormalities in offspring of mothers exposed to these agents. Animal studies suggest changes in brain receptor number and function in the offspring of mothers on a variety of psychotropic drugs studied to date. The few human studies do not suggest long term effects, but given the very limited data, no definitive conclusions can be drawn. Large epidemiologic follow-up studies of children exposed to medication in utero may help clarify questions relating to behavioral changes and thus help guide clinical decisions.