|Medication||Risks to offspring associated with use in pregnancy||Maternal risks associated with use in pregnancy|
Severe toxicity in newborn. There are limited and conflicting data regarding the risk of cardiovascular malformations (including Ebstein’s anomaly) following lithium exposure in utero. A large cohort study in 2017 showed that the relative risk was still elevated (1.7), and also dose dependent, but lower than previously thought. Absolute risk remains low (< 1/1500).|
Non-teratogenic associations include low birth weight, cyanosis, bradycardia, GI bleeding, polyhydramnios, seizures.
|Renal lithium clearance rises during pregnancy, so levels need to be monitored regularly to maintain therapeutic levels.|
Significantly elevates the risk of major defects (7 times higher). These include spina bifida, atrial septal defect, cleft palate, hypospadias, polydactyly and craniosynostosis. See Table 4 and main text for further details.|
Non-teratogenic associations include case reports of intra-uterine growth restriction, infant hepatic toxicity and foetal distress during labour.
Neurodevelopmental associations – foetal exposure to valproate in utero is associated with 1.7 times risk of autism spectrum disorder.
|Increased hepatic clearance of valproate and increased apparent volume of distribution cause lower maternal levels of the drug.|
|Carbamazepine||Risk of major congenital abnormalities increased 1.8 times, including malformations of neural tube, urinary tract and cardiovascular system, and cleft palate.||Crosses placenta and lowers maternal serum levels, so doses may need to be increased.|
Conflicting evidence on the risk of malformations, especially regarding dose response.|
Evidence emerging that it appears to be a relatively safe drug in pregnancy.
|Crosses placenta and lowers maternal serum levels, so dose may need to be increased. Dizziness, diplopia and ataxia have been reported following these dose increases in pregnant women.|
|Atypical antipsychotics||Most do not appear to significantly increase malformation rate. Risperidone requires additional study.||Crosses placenta and lowers maternal serum levels, so doses may need to be increased.|