A Review of Psychotropic Drug Exposure During Pregnancy and Perinatal Outcomes: Evidence From Cohort Studies and Meta-Analyses
10.22722/KJPM.2025.33.2.69
- Author:
Hee-Cheol KIM
- Publication Type:Review Articles
- From:Korean Journal of Psychosomatic Medicine
2025;33(2):69-85
- CountryRepublic of Korea
- Language:English
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Abstract:
Objectives:：This review aimed to examine the risks and safety of psychotropic drug use during pregnancy through a systematic literature review and to provide fundamental data for clinical guidelines to aid clinical practice.
Methods:：The author reviewed literature published from 2000 to 2025 using PubMed, EMBASE, the Cochrane Library, and Web of Science. This review included large cohort studies, meta-analyses, and systematic literature reviews that investigated the association between psychotropic drugs and perinatal outcomes, while single case reports and animal studies were excluded.
Results:：During pregnancy, particularly in the later stages, the use of selective serotonin reuptake inhibitors was slightly associated with preterm birth, neonatal adaptation syndrome, and persistent pulmonary hypertension. Among psychotropic drugs, lithium and paroxetine were most strongly associated with an increased risk of congenital heart malformation when exposed during pregnancy. Exposure to benzodiazepines during pregnancy has been associated with a slight increase in premature birth and congenital malformations. Gestational diabetes has been associated with the use of second-generation antipsychotics, particularly quetiapine and olanzapine.Exposure to valproate during pregnancy was associated with congenital malformations in a dose-dependent manner.
Conclusions:：Some psychotropic drugs can be used cautiously during pregnancy, but drugs like lithium, paroxetine, valproate, and certain atypical antipsychotics increase the risk of congenital malformations or metabolic problems if the fetus is exposed during pregnancy. Therefore, the use of these drugs during pregnancy should be avoided unless unavoidable. Close collaboration between psychiatry and obstetrics and gynecology is necessary for the safe and effective perinatal mental health care of mothers.
