Since many women with mental illness are or will be pregnant, medication during pregnancy is a major concern for most families. The issue of pregnancy in patients with mental illness is complex. From a eugenic point of view, it is preferable that the mother not take any medication during pregnancy, but the reality of mental illness treatment is that discontinuing medication for any period of time greatly increases the probability of relapse. So it’s a dilemma.
Although there is no evidence of any relationship between the use of psychotropic medications and the incidence of congenital malformations in the fetus, no significant effect of atypical antipsychotics on the fetus has been found. (Except for those psychotropic drugs with evidence of fetal harm in Class D drugs.) But this absence of current evidence does not indicate that it is absolutely safe for pregnancy. The effects of drugs on pregnancy cannot be studied in humans for ethical reasons.
I. The U.S. Food and Drug Administration (FDA) has promulgated criteria for grading the safety of drugs in pregnancy, which are graded as follows (abbreviated).
Grade A: No signs of fetal harm seen in women in the third trimester of pregnancy.
Grade B: In animal reproductive studies (no controlled studies in pregnant women), no effects on the fetus were observed.
Grade C: It has been shown to have side effects on the fetus in animal studies, but not in controlled women.
Grade D: There is clear evidence of harm to the fetus.
Grade X: It has been shown in animal or human studies to cause fetal abnormalities.
Among the drugs commonly used in psychiatric clinics: clozapine, Maprotiline, Synthroid, and buspirone are grade B; promethazine, paroxetine tablets, phenobarbital, valproate, lithium salts, carbamazepine, and most tranquilizers (eszopiclone and triazolam are grade X) are grade D. Most other antipsychotics and antidepressants are grade C.
In 2007, the psychiatric branch of the Chinese Medical Association formulated the “Guidelines for the Prevention and Treatment of Mental Disorders in China”, which set the following principles
1. Women of childbearing age should take reliable and effective contraceptive measures before using psychiatric drugs.
2. Once pregnancy is detected during the course of medication, termination of pregnancy should be considered first, and pregnancy should not be conceived until the condition is completely stabilized and the psychiatrist is consulted.
3.Patients with stable disease, no past history of relapse and a high level of clinical remission can temporarily discontinue medication and wait for 12 weeks of pregnancy before using medication again.
4. For patients who do need maintenance treatment, the drug with the least toxicity and safest toxicity to the fetus at the maternal level can be considered, and the dosage should be reduced to the lowest effective dose.
Third, the current general understanding.
1. At present, most psychiatric drugs are not clinically proven to have a definite effect on pregnancy (with the exception of a few Class D Class X drugs).
However, the adverse effects of psychotropic drugs on pregnancy cannot be ruled out.
3. It is best to prohibit the use of psychiatric drugs during the 12 weeks of pregnancy.
4.If pregnancy is to be considered, it is best if the disease has been stable for more than 2 years, there is no previous history of relapse when the dosage is reduced, and the patient is currently recovering well from social functioning.
5.Application in breastfeeding women: Almost all psychotropic drugs can be secreted into breast milk, so breastfeeding women taking psychotropic drugs should avoid breastfeeding infants and children, and use other breastfeeding methods instead.