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| |  DG DISPATCH: APA - Treating Mood Disorders During Pregnancy and Lactation By Lara Pullen Special to DG News CHICAGO, IL -- May 23, 2000 -- The treatment goal for mood disorders during pregnancy and the post-partum period is to minimize fetal/neonatal exposure to the drugs while maintaining maternal mental health. Dr. Zachary N. Stowe of the Emory University School of Medicine, Atlanta, GA presented data on drug dosing and corresponding fetal exposure in the treatment of pregnant women at the 2000 Annual Meeting of the American Psychiatric Association. Dr. Stowe began his presentation by stating that there are "no controlled studies of any psychiatric medication in pregnancy and there never will be." He went on to explain that all mood stabilizers are potentially teratogenic with anticonvulsants at highest risk during days one -28 post-conception and lithium at highest risk during days 21-54. There is no evidence of direct teratogenesis for antidepressants. Older data with benzodiazepines suggest increased risk of cleft lip/palate at eight -12 weeks gestation. While medication can negatively impact the developing fetus, so, too can mental illness. Depression results in increased risk for low birthweight, small for gestational age and preterm infants. Dr. Stowe emphasized that if the decision is made to medicate, the physician must treat to wellness. Evidence suggests that there are decreased serum levels of medications later in pregnancy and that the dose must be increased in order to maintain therapeutic drug concentrations. Dr. Stowe concluded that this might be the only chance for psychiatrists to do preventive care for the infant. This can be done by minimizing fetal exposure to both medication as well as illness.
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