What's A Mom To Do? Mental Health Medications During Pregnancy & Breastfeeding
By Layne A. Gritti DO
Sweetgrass Psychiatry Reproductive Psychiatrist
Most people would probably prefer not to take any medication during pregnancy or breastfeeding. The concern every parent has when deciding to use medication or not during pregnancy is whether their actions could harm their unborn child. Many also assume giving medication to the birthing parent will harm the fetus. This idea is false and harmful because during pregnancy, mother and fetus are inseparable, otherwise known as a dyad.
The biggest harm with an all-or-nothing approach is this: when medications are stopped, changed, or not started during pregnancy, this can cause mental health issues that result in pregnancy complications.
Dr. Layne Gritti, DO - Reproductive Psychiatrist
Risk-Risk Analysis
To understand and consider how medications affect the mother-baby dyad, we use something called a risk-risk analysis. This helps us assess the risk associated with medication exposure to the birthing person and the fetus compared to the risk of untreated illness to the birthing person and the fetus. Looking through this lens helps us understand that when mental health disorders are involved, there is no no-risk option.
Often, we have limited data on these medications during pregnancy so we will also consider the unknown risks of medication during the risk-risk analysis.
There are efforts to increase what is known about medications during pregnancy. If you are pregnant, taking medication, and would like to participate in improving our collective knowledge, please check out the National Pregnancy Registry for Psychiatric Medications.
Other Professional Resources:
1. Professional Organizations and Guidelines
American Psychiatric Association (APA) The APA provides guidelines and position statements on the use of psychiatric medications during pregnancy and breastfeeding. Their resources are evidence-based and regularly updated to reflect the latest research.
American College of Obstetricians and Gynecologists (ACOG) ACOG offers practice bulletins and committee opinions that address the use of psychotropic medications in pregnant and breastfeeding women. These guidelines are crucial for both psychiatrists and obstetricians.
2. Specialized Textbooks and Manuals
“Medications and Mothers’ Milk” by Dr. Thomas Hale This comprehensive reference book is often considered the gold standard for information on the transfer of medications into breast milk. It provides detailed information on the safety of various medications for breastfeeding mothers.
“Antidepressant Use in Pregnancy and Lactation” by Lee S. Cohen and Ruta M. Nonacs This book specifically addresses the use of antidepressants during pregnancy and lactation, providing insights into the risks and benefits.
3. Online Databases and Tools
LactMed Database LactMed is a free online database maintained by the National Library of Medicine. It provides information on the levels of various medications in breast milk and potential effects on breastfeeding infants.
MotherToBaby MotherToBaby is a service of the Organization of Teratology Information Specialists (OTIS). It offers fact sheets, phone counseling, and chat services to provide up-to-date information on the safety of medications during pregnancy and breastfeeding.
MGH Center for Women’s Mental Health is a free online website that provides ample resources for reproductive age women pertaining to mental health topics. https://womensmentalhealth.org/resource-2/patient-support-services/
4. Peer-Reviewed Journals
Journal of Clinical Psychiatry This journal frequently publishes research articles and reviews on the use of psychiatric medications in pregnant and breastfeeding women. It’s a valuable resource for staying current with the latest findings.
Archives of Women’s Mental Health This journal focuses on all aspects of women’s mental health, including the impact of psychiatric medications during pregnancy and lactation.
5. Support and Advocacy Groups
Postpartum Support International (PSI) PSI offers resources and support for women experiencing perinatal mood and anxiety disorders. They provide educational materials on medication safety and can connect women with healthcare providers who specialize in perinatal mental health.
Mothers’ Mental Health Toolkit Developed by the IWK Health Centre, this toolkit provides practical advice for healthcare providers and mothers on managing mental health during the perinatal period.
My Approach
While many think they must avoid medication during pregnancy, this is usually not the safest option. Keeping mom mentally healthy is critical for fetal and infant development. More often than not, the risks of uncontrolled mental illness outweigh the risks of medication. I can help you navigate the best treatment options tailored to your individual needs.
As a reproductive/perinatal psychiatrist, I aim to maintain a stable mood for moms throughout pregnancy and afterward. Why is this crucial? Keeping in mind that mental health during pregnancy influences postpartum mental health, studies indicate that stable postpartum mental health strongly influences long-term child behavior and mental health.
To schedule an appointment with Dr. Gritti via telehealth, fill out an intake form with Sweetgrass Psychiatry or call/text (843) 800-1303.
