Perinatal psychiatry: balancing maternal-fetal exposures to mental disorders and drug treatments.

Abstract

Introduction: The potential effects of psychotropic medications during pregnancy must be balanced against those of untreated maternal mental illness, which has been under-appreciated as an exposure that impacts development.

Methods: This is an expert, non-systematic literature review of the effect of maternal stress and psychotropic medication on fetal development.

Results: Studies on the outcomes of pregnancy and child development following exposures to stress, mental disorders and psychotropic medications during pregnancy are reviewed. Alterations in pharmacokinetics due to the physiology of pregnancy may change the efficacy of drug treatment. The impact of stress and mental health conditions in pregnancy is difficult to separate from other exposures; however, these exposures have adverse effects on fetal and child development independent from medication treatment. A focus on optimal treatment to reduce psychiatric symptoms, which is the justification for use of the drug, is critical. Building healthy fetal brains through adequate maternal essential nutrient intake holds promise to support reduction of the risk for adverse neurodevelopmental outcomes.

Conclusion: Untreated maternal mental illness is an exposure that impacts outcomes, the course of comorbid medical disorders, and offspring development. The current knowledge base dictates that treatment of psychiatric disorders be prioritized in the benefit-harm decision process.