Study Examines Risks of Psychiatric Drugs on Fetuses

Pregnant women aren't supposed to take certain medications. A new study looks at the risks of psychiatric medications on fetuses. Yale Medical School professor and medical contributor Dr. Sydney Spiesel speaks with host Madeleine Brand.

MADELEINE BRAND, host:

Every year, half a million American women with some form of mental illness will become pregnant. Should they or should they not take psychiatric medication? Some people are afraid that could hurt the fetus. A recent study looked at the risks and offered some recommendations, and Dr. Sydney Spiesel is here now to share the results of that study. He's a Yale Medical School professor, a pediatrician, and a regular on this program. Welcome back, Syd.

Dr. SYDNEY SPIESEL (Professor, Yale Medical School): Thank you, Madeleine, always nice to be here.

BRAND: Well, first of all, tell us the risks that this medication, some of the medication, could pose to developing fetuses.

Dr. SPIESEL: There are risks that we know and risks that we don't know, and I want to make that distinction here. The risks that we know - the known ones are usually physical risks. For example, we know that if women take Lithium or Paxil, that there's a small increase in risk for the developing fetus of heart abnormalities. There are some drugs that are called mood stabilizers that are used often for bipolar disorder, also used to treat seizures, drugs like Depakote and Tegretol. And again, they're associated with a small risk of physical malformations, and those are the things that we're most aware of.

But you know, there are some worries that there may be unknown risks that we simply don't know, although we've been looking for them. For example, the possibility that these medications might cause subtle neurological or behavioral consequences later on. And then there's still more unknowable things - what about the possibility, as we're beginning to understand, that there might be individual genetic differences, which might make only one or rare developing fetus especially susceptible to risk.

BRAND: And I suppose the risks of not taking these drugs are acute for women who suffer from depression.

Dr. SPIESEL: Oh, they're very acute indeed. You know, the problem is that if women who need these medications are off their medications, some are not going to be able to comply well with prenatal care. Perhaps they're more likely to drink, to smoke, to use other drugs, that I think for many of them, often is a kind of self-medication. And these could be much more harmful. Smoking, drinking, using other drugs could be much more harmful than the medications.

If an illness is untreated and it gets worse and worse, then after the baby's born, the mother might not be in a psychological condition to be able to fully attach emotionally to the baby, or might not be adequately attentive to the baby, or give unfocused care. Or in fact, if she has a very serious thought disorder, she might do completely irrational things.

BRAND: So, Syd, this, I guess, collection of recommendations is put out by the American College of Obstetricians and Gynecologists, and what do they say, what do they recommend?

Dr. SPIESEL: Well, the most important thing is that adequate care for the mother often best serves the needs of the fetus. If the mother's illness is severe, you sometimes need to use somewhat risky medications if other choices aren't available or if they're ineffective. It's best to use a single medication even at a higher dose rather than a collection of meds. It's always important to keep in mind that the most risky time for developing embryo fetus is the third to eighth week of gestation. And they urge team management: obstetricians, psychiatrists, pediatricians, the mother's primary care provider.

BRAND: Thank you, Syd.

Dr. SPIESEL: Thank you.

BRAND: That's Dr. Sydney Spiesel. He teaches at the Yale Medical School, and you can read his medical examiner column at slate.com.

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