Prescribing in Pregnancy: What Every Psychiatrist Should Know-View Presentation

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The presentation, "Prescribing in Pregnancy: What Every Psychiatrist Should Know," addressed critical considerations in managing psychiatric medications during pregnancy and breastfeeding, emphasizing evidence-based risk assessment and patient-centered discussions. Mental health conditions affect a significant proportion of pregnant and postpartum women (20%), with mental illness contributing to 23% of maternal deaths in the U.S. Despite this, many psychiatrists lack training or confidence in treating perinatal patients, and access barriers often delay timely care, worsening outcomes.<br /><br />Key points highlighted the physiological changes of pregnancy affecting drug metabolism, necessitating dose adjustments, especially for SSRIs, lamotrigine, and lithium, and underscored the high risk of mood episode recurrence when medications are discontinued. The baseline risk of congenital malformations is 2-5%, and few psychiatric medications significantly increase this risk; for example, lithium slightly increases cardiovascular malformations but discontinuation poses greater maternal risk. Valproate (Depakote) is contraindicated due to high risks of neural tube defects and cognitive impairments and should be avoided or discontinued preconception.<br /><br />Case discussions illustrated risk-benefit analyses for common medications, including lithium, SSRIs, and ADHD stimulants, stressing individualized, informed decision-making with patients. Medication continuation is generally safer for maternal and fetal health than abrupt discontinuation. Breastfeeding considerations were reviewed, noting most psychiatric medications are safe with low infant exposure, though lithium requires pediatric monitoring.<br /><br />Additional resources include national Perinatal Psychiatry Access Programs offering expert consultations, educational toolkits, and community support. Practical recommendations included slow tapering when discontinuation is necessary, collaborative care, psychotherapy integration, and addressing substance use disorders with evidence-based treatments. Overall, the talk aimed to empower psychiatrists to provide confident, nuanced perinatal psychiatric care, improving outcomes for mothers and infants.

Keywords

Prescribing in pregnancy

Perinatal psychiatry

Psychiatric medications

Pregnancy and breastfeeding

Risk assessment

Mental health in pregnancy

Medication dose adjustment

SSRIs in pregnancy

Lithium use

Valproate contraindications

Mood episode recurrence

Breastfeeding and psychotropics

Perinatal psychiatric care