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85% of all pregnancies produce live births.
7%–14% of deliveries are
2%–4% of live births result
in infants with significant malformations, and up to 12% have
>60% of all
women take at least one prescription medication during pregnancy.
In the ideal pregnancy, as defined by the Centers for
Disease Control and Prevention, maternal weight is ±15% of
ideal body weight, and the mother was taking prenatal vitamins with
folic acid for 6 weeks before conception.
Most women learn of pregnancy at 5–8 weeks' gestation
and therefore may be past the window of risk for fetal anomalies associated
with psychotropic medications.
Pregnancy is not protective against psychiatric illness.
Major depressive episodes occur with similar incidence
during pregnancy as during nongravid periods.
Obsessive-compulsive disorder may have its onset or
may worsen during pregnancy.
The incidence of psychotic disorders varies throughout
pregnancy; there are limited data suggesting a need to decrease dosage
of antipsychotic medications.
The teratogenic risk of psychotropic medications has
been historically overestimated.
Increasing data on obstetrical outcome and follow-up
of infants of mothers taking psychotropic medications are comparable in
study sample sizes to data on most other prescription drugs.
Untreated maternal mental illness may adversely affect
obstetrical outcome and infant development.
The long-term neurobehavioral effects of in utero exposure
to psychotropic medications are unknown, although initial studies
have not reported adverse effects for several medications.
>60% of women
plan to breast-feed.
5%–17% of all nursing women
take a prescription medication during breast-feeding.
12%–20% of nursing women
Breast-feeding is supported by numerous professional
organizations as the ideal form of nutrition for the infant.
The postnatal period is a high-risk time for onset
or relapse of psychiatric illness.
All psychotropic medications studied to date are excreted
in breast milk.
Untreated maternal mental illness has an adverse effect
on mother–infant attachment and later infant development.
The adverse effects of psychotropic agents on infants
are limited to case reports.
The nursing infant's daily dose of psychotropic
agents is less than the maternal daily dose.
The nursing infant's exposure to psychotropic
medications is less than the fetal exposure.
Psychotropic medications are excreted in breast milk
with a specific individual time course, allowing the minimization
of infant exposure with continuation of breast-feeding.
The long-term neurobehavioral effects of infant exposure
to psychotropic medications through breast-feeding are unknown.