January was Birth Defects Prevention Month, and MotherToBaby launched a free app designed to provide evidence-based information to pregnant and breastfeeding women. There is Information on a broad range of medications, some herbal remedies, maternal illness, infections and vaccines, alcohol and other substances, occupational exposures, and other exposures (including things like lead, hair dye).
We are particularly interested in how this app handles psychotropic medications. If you look up fluoxetine (Prozac), for example, it will give you about two pages of information on reproductive safety, including impact on fertility, risk for miscarriage, risk for birth defects and long-term neurobehavioral effects. The information provided looks to be fairly complete and is similar to what we would provide during a consultation. The language used is relatively easy to understand and nonjudgmental.
With regard to other psychotropic medications, there are some important omissions. There’s information on the antipsychotic medication, olanzapine (Zyprexa), but there is no information on other atypical antipsychotic medications, including aripiprazole (Abilify) and quetiapine (Seroquel), which are probably used more commonly than olanzapine.
There is information on valproic acid (Depakote) and carbamazepine (Tegretol) but no information on lamotrigine (Lamictal), which is a mood stabilizer and anticonvulsant used during pregnancy.
Nonetheless it’s a good resource for women who are pregnant or planning to conceive. Is it a substitute for talking to your doctor? No, but it is a good place to start. It seems that often women are poorly informed regarding the reproductive safety of the medications they are taking, either under- or overestimating the risk. While this app provides up-to-date and evidence-based information, an app cannot be considered a stand-in for a thorough and thoughtful discussion with a medical provider, which reviews the risks of medication exposure during pregnancy, while at the same time taking into consideration the risks associated with untreated illness in the mother and an appraisal of alternative treatments, including non-pharmacologic interventions.
Ruta Nonacs, MD PhD