Principles of psychotropic use in females of childbearing potential

It is estimated that approximately a quarter of pregnancies in Australia are unintended. When treating a female of childbearing potential who has a psychiatric disorder, consider the impact of the disorder and its treatment on a potential pregnancy. Discuss contraception with them—psychotropics cross the placenta and people taking teratogenic drugs should use effective contraception to prevent inadvertent fetal exposure.

It is preferable for a psychiatric disorder to be in remission before pregnancy because of the:

  • poorer patient, neonatal and parenting outcomes associated with unstable psychiatric disorders in the perinatal period
  • increased risk of postpartum relapse if the patient is symptomatic during pregnancy.

If a patient wishes to become pregnant, undertake preconception planning. Preconception planning allows for time to trial a withdrawal or change of treatment, and to formulate a relapse management plan. Preconception planning is particularly important for patients taking teratogenic drugs; however, all psychotropics cross the placenta and are excreted into breast milk (albeit to varying degrees). If a psychotropic is taken during pregnancy or while breastfeeding; the fetus or infant will be exposed to it. Consequently, treatment choice must optimise the health and safety of the patient and fetus or infant—consider and discuss:

The patient, their significant other(s) and the clinician can then plan the preferred treatment approach during the perinatal period using shared decision making.