All of our information on the reproductive safety of medications comes from non-randomized studies. However, many of these studies fail to take into consideration other factors associated with maternal psychiatric illness which may also affect outcomes.
While many peri- and post-menopausal women request bioidentical hormones, there is no data to suggest that bioidential hormones are safer or more effective than FDA-approved hormone replacement therapies.
Despite the unequivocal benefits of folic acid supplementation and recommendations urging all women of reproductive age to take folic acid supplements, preconceptual use of folic acid has not increased substantially.
In a cohort of 351 children exposed to second generation antipsychotic during pregnancy, the risk of major congenital malformations did not differ from a comparison group of non-exposed children.
In this large study with over 1500 exposures, duloxetine exposure during the first trimester does not appear to increase risk of major malformations.
Given limited data on the reproductive safety of oxcarbazepine, we would recommend using alternate medications during pregnancy, when possible.Â
The most recent publication from the National Pregnancy Registry focuses on overall risk of malformations associated with the class of antipsychotic medications.
Multiple studies have associated first trimester exposure to topiramate with increased risk of oral clefts.
Bupropion is commonly used to treat depression, and is also prescribed to support smoking cessation. Early data on bupropion-exposure during pregnancy raised concern for a possible increase in risk of malformations of the heart and large blood vessels in bupropion-exposed infants. Subsequent data from bupropion pregnancy registries has been reassuring, however, and do not demonstrate an overall increase in risk of cardiac defects following first trimester bupropion exposure. Although the overall risk of cardiac defects was not increased, the distribution of specific defects in these registries was unexpected in some ways. For example, the GlaxoSmithKline Bupropion Pregnancy Registry included two cases of coarctation of the aorta out of the 675 bupropion-exposed infants, compared to the rate of 6 cases per 10,000 births in the general population.
Despite the increasing use of the newer atypical or second-generation antipsychotic agents to treat a spectrum of psychiatric disorders, including psychotic disorders, bipolar disorder, major depression, PTSD and other anxiety disorders, we have relatively little [...]
