Safety of the Use of Psychiatric Medications in Pregnant Patients. A Review of Current Medical Knowledge

Abstract

Pregnancy is a period of increased vulnerability to mental disorders and therapeutic challenges. Depression affects 10-15% of pregnant women, anxiety disorders up to 20%, and bipolar disorder 1-2% of women of reproductive age. Discontinuation of mood stabilizers is associated with up to a twofold increase in the risk of relapse. Untreated disorders increase the risk of obstetric and neonatal complications as well as suicide. This paper is a narrative review of the literature from 2020-2025 (PubMed/MEDLINE, Embase, PsycINFO) concerning the safety of psychiatric medications during pregnancy. SSRIs, SNRIs, TCAs, antipsychotics, mood stabilizers, and benzodiazepines were discussed, taking into account the risk of congenital malformations, neonatal outcomes, and child development. Among the agents considered relatively safe were sertraline, haloperidol, quetiapine, and lamotrigine; valproate and paroxetine are contraindicated; data for some drugs remain limited. The importance of an individualized risk--benefit analysis, use of the lowest effective dose, avoidance of polytherapy, and planning of perinatal care was emphasized. ECT was indicated as an alternative option. Discontinuation of treatment in severe disorders is not recommended.