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Teratogenicity, pregnancy complications, and postnatal risks of antipsychotics, benzodiazepines, lithium, and electroconvulsive therapy

Victoria Hendrick, MD
Section Editor
Paul Keck, MD
Deputy Editor
David Solomon, MD


Among women with an established pregnancy, surveys estimate that psychotropic drugs are taken by 21 to 33 percent [1,2]. Although these medications are often necessary to control a psychiatric illness that predates or emerges during pregnancy, pharmacotherapy entails risks of structural malformations, pregnancy complications, neonatal toxicity and withdrawal, and adverse developmental effects.

This topic reviews the risks of antipsychotics, benzodiazepines, lithium, and electroconvulsive therapy during pregnancy. The risks of antidepressants and antiepileptics during pregnancy and the principles of teratology are discussed separately. (See "Risks of antidepressants during pregnancy: Selective serotonin reuptake inhibitors (SSRIs)" and "Risks associated with epilepsy and pregnancy", section on 'Effect of antiseizure drugs on the fetus' and "Approach to congenital malformations".)


Teratogens are factors that can alter normal intrauterine development of fetal growth, anatomic structures, physical functioning, and postnatal development. This definition encompasses environmental exposures, maternal medical disorders, infectious agents, and genetic conditions.

Most discussions of teratogens usually center on drug exposures. In determining whether a drug is a teratogen, many authorities stipulate that the exposure causes a pattern of defects [3]. Thus, if exposure is associated with an increase in birth defects greater than that expected in the general population, but the defects vary and there is no discernible pattern, the drug is generally not considered teratogenic. An overview of teratology is discussed separately. (See "Approach to congenital malformations", section on 'Teratogens'.)


All psychotropic drugs presumably cross the placenta and are present in the amniotic fluid [4]. Embryonic and fetal exposure to maternal pharmacotherapy can cause [2,5-7]:


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