Developmental risks associated with use of psychoactive drugs during pregnancy are largely unknown. Authors’ reply

We would like to thank Dr. Paumgartten for his interest in our survey and agree that the developmental risks associated with the use of psychoactive drugs are largely unknown, as there are far fewer studies reporting on these risks.

However, we believe that Dr. Paumgartten missed the important data that we reported and instead focused on the safety of psychotropic drug use in pregnancy. The objective of our study was to evaluate the risk perception of psychotropic drug use in pregnancy among physicians in different medical specialties, as clearly stated in both the abstract and main text.

We would like to reiterate that, based on scientific evidence, psychotropic drugs in general do not pose a significant teratogenic risk.¹,² Even paroxetine, which women are advised to avoid in pregnancy, is associated with an only marginal increase in risk (odds ratio [OR] 1.29, 95% confidence interval [95%CI] 111 to 149), not exceeding the percentage researched in our article as being “perceived high risk” (> 5%).¹,² A recent review discussed studies that reported teratogenic potential and negative outcomes and noted that, when evaluating the benefit/risk ratio of SSRI treatment during pregnancy, the risks associated with discontinuation of treatment - e.g., higher frequency of relapse, increased risk of obstetric complications and postpartum depression - appeared to outweigh the teratogenic potential.³ Even if we consider that the risks of antidepressants are still unknown, despite thousands of reported pregnancy outcomes in the literature, untreated perinatal depression can cause significant distress and is associated with known risks to the mother-infant relationship and to child development.

The take-home message of this survey was that most physicians, even those with informed experience in the treatment of psychiatric disorders during pregnancy, are reluctant to prescribe psychotropics in this setting. Challenges that surround drug treatment in the perinatal period are not just related to the safety/risk of medications, but also include the continuing stigma of mental illness, as well as fear of possible legal ramifications.⁴ When this is factored in with an unrealistically high perception of treatment risk, it is understandable that physicians may be hesitant to treat a pregnant woman, even if armed with evidence-based information that suggests relative safety.

Deciding whether to continue to take a psychotropic medication during pregnancy is a complex decision for both women and their physicians. Information from friends, family, the media, and physicians can also have an important impact on decision-making regarding pharmacotherapy for psychiatric disorders during pregnancy. Empathy towards these women, combined with available evidence-based information, can guide physicians in advising their patients to make an informed decision, despite the absence of definitive clinical guidelines, to ensure the best possible outcome for both mother and child.

References

• ¹
  Bellantuono C, Tofani S, Di Sciascio G, Santone G. Benzodiazepine exposure in pregnancy and risk of major malformations: a critical overview. Gen Hosp Psychiatry. 2013;35:3-8.
• ²
  Myles N, Newall H, Ward H, Large M. Systematic meta-analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations. Aust N Z J Psychiatry. 2013;47:1002-12.
• ³
  Ornoy A, Koren G. Selective serotonin reuptake inhibitors in human pregnancy: on the way to resolving the controversy. Semin Fetal Neonatal Med. 2014;19:188-94.
• ⁴
  Bonari L, Koren G, Einarson TR, Jasper JD, Taddio A, Einarson A. Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making. Arch Womens Ment Health. 2005;8:214-20.

Publication Dates

• Publication in this collection
  Dec 2014

History

• Received
  19 May 2014
• Accepted
  23 May 2014