Women with a psychiatric history may wonder about the risks associated with pregnancy & parenthood. A safe pregnancy for mother & baby is often possible, but it is vital for the woman to work closely with a knowledgeable physician.

Symptoms of many psychiatric conditions (depression, mania, panic, & even schizophrenia) frequently seem relatively inactive during pregnancy. Meds may be necessary, however, & some are less risky than others.

General Guidelines Women on psychiatric medications who want to get pregnant should follow these guidelines in consultation with a physician:

Medication Risks

Any kind of medication exposes a developing fetus to possible risks. Specific types of medications have particular risks: Sedatives such as Valium or Klonopin & anticonvulsants such as Tegrotol & Depakene should be avoided. Anticonvulsants cause neural tube defects like spinal bifida & anencephaly. Antipsychotics such as Haldol & Prolixin should be prescribed only in small doses. Antidepressants may cause rare cases of infant distress such as muscle spasms, fast heart rate, congestive heart failure, & respiratory disease. Lithium carries a particularly high risk of heart malformation (about 13 times higher than usual), especially when used during the first three months of pregnancy.

When used at the end of pregnancy, lithium may cause lethargic & listless babies with irregular suck & startle responses. These newborns may also appear bluish due to problems with oxygen absorption in the blood. When used in the second trimester, lithium is safe. When used in the third trimester, lithium is associated with congenital hypothyroidism. Special Considerations for women with mood disorders. It may still be prudent to prescribe lithium for severe episodes of manic depression during pregnancy. The possible consequences of an untreated episode (injury, severe stress, dehydration, malnutrition, profound sleep deprivation, & suicide) can be riskier to the fetus than the side effects of lithium. The safest way to treat severe depression in a pregnant woman is probably electroconvulsive (ECT) therapy. Patients & families are sometimes frightened by the idea of "shock treatment," but in fact ECT is safer than antidepressant medication for a depressed pregnant woman. It can be used during any state of pregnancy, but is less risky after the first trimester. The most common side effect of ECT is short term memory loss. Less frequent side effects usually respond to simple treatment. These may include: headaches, mild muscle soreness, nausea, adverse reactions to anesthetic or muscle relaxants, heartbeat irregularities, or, rarely, heart attacks.

Breastfeeding Woman with psychiatric disorders may be at greater risk for postpartum difficulties than other women. After delivery it may be advisable for the mother to resume medication as soon as possible. Because most medications can be excreted in breast milk, they pose some risk for a nursing infant. Woman should discuss thoroughly with their physicians whether nursing is a viable option, or whether they should plan to bottle feed their baby. Although there are some benefits to breastfeeding, the most important consideration is keeping the mother healthy so she can appropriately care for her new infant.

This article was posted by D.J. Jaffe on behalf of the Alliance for the Mentally Ill/Friends and Advocates of the Mentally Ill, a NYC Chapter of the National Alliance for the Mentally Ill.