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Safety and Efficacy of Psychiatric Medication While Pregnant or Breastfeeding

Describe your topic.
Advising a pregnant or breastfeeding woman to discontinue medication exchanges the fetal or neonatal risks of medication exposure for the risks of untreated maternal illness. Maternal psychiatric illness, if inadequately treated or untreated, may result in poor compliance with prenatal care, inadequate nutrition, exposure to additional medication or herbal remedies, increased alcohol and tobacco use, deficits in mother–infant bonding, and disruptions within the family environment. All psychotropic medications studied to date cross the placenta, are present in amniotic fluid, and can enter human breast milk. We would like this evidence review to evaluate the safety and efficacy of treatments for various psychiatric illnesses in women who are pregnant or breastfeeding.
Describe why this topic is important.
It is estimated that more than 500,000 pregnancies in the United States each year involve women who have psychiatric illnesses that either predate or emerge during pregnancy, and an estimated one third of all pregnant women are exposed to a psychotropic medication at some point during pregnancy (Doering 1978). The use of psychotropic medications is a cause of concern for physicians and their patients because of the potential teratogenic risk, the risk of perinatal syndromes or neonatal toxicity, and the risk for abnormal postnatal behavioral development. With the limited information available on the risks of the psychotropic medications, clinical management must incorporate an appraisal of the clinical consequences of offspring exposure, the potential effect of untreated maternal psychiatric illness, and the available alternative therapies.
Tell us why you are suggesting this topic.
A rigorous systematic review on this topic would greatly benefit the field of OBGYNs, and thereby the patients they treat.
Target Date.
Describe what you are doing currently and what you are hoping will change because of a new evidence report.
We have guidance on the Use of Psychiatric Medications during Pregnancy and Lactation. However, this report would strength the evidence platform to allow us to update our clinical guidance and provide that to our membership.
How will you or your group use the information from a new evidence report?
We will use this report to inform our clinical guidance.
How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
We would disseminate the information to our membership of OBGYNs.
Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
Yes, we are part of a medical organization that would disseminate and implement the research findings from this evidence report.
Information About You: (optional)
Provide a description of your role or perspective.
Professional society
If you are you making a suggestion on behalf of an organization, please state the name of the organization.
American College of Obstetricians and Gynecologists
Please tell us how you heard about the Effective Health Care Program.
Page last reviewed May 2018
Page originally created March 2018

Internet Citation: Safety and Efficacy of Psychiatric Medication While Pregnant or Breastfeeding. Content last reviewed May 2018. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.

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