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it could be. When I had been psychotic the year before, I wasn’t safe for myself and certainly not for a baby.” In 2016, Congress passed the 21st Century Cures Act, which established a task force devoted to improving the state of research specific to pregnant and lactating women. Several research centers have set up medication registries. For example, The AmmonPinizzotto Center for Women’s Mental Health at Massachusetts General Hospital runs the National Pregnancy Registry for Psychiatric Medications, which collects data on women who used antidepressants, ADHD medications, and atypical antipsychotics during pregnancy and is currently conducting studies on treatments for postpartum psychosis, a severe form of postpartum depression. These registries help scientists collect data on how drugs may affect pregnancies, which can help inform the safest prescribing guidelines both during and after pregnancy. Most of the data collected in these registries are what scientists call retrospective—for example, a report from a woman who shares, after she’s had her baby, the medications she used while pregnant and the outcome of her pregnancy. Retrospective studies, however, have their limitations and are not considered the gold standard of drug research. They can’t always control confounding factors that may contribute to the risk that researchers are trying to assess, such as a subject’s depression history, genetics, or smoking and drinking habits. “These factors can blur the results of a study,” notes Dr. Sacks, who hosts the podcast Motherhood Sessions. “We also don’t necessarily know whether the risks are because of the antidepressant or because of the impact of depression itself.” Gathering new data is an important step toward finding more answers. (The website WomensMentalHealth.org provides information about new research and offers mental health resources for patients and doctors.)
Weighing the Risks Suicidal ideation, as Emily, the mom of three, experienced, is one of the
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Mothers should feel good before, during, and after their pregnancy.
worst-case scenarios of what can happen when a pregnant woman’s mental health condition goes unmanaged. But research shows that a poor mental state can affect pregnancy in other significant ways too. Louisa, a mom of two boys in Poughkeepsie, New York, who also asked to change her name, manages her depression, anxiety, and bipolar disorder with a combination of Celexa and Latuda, an antipsychotic most often used to treat depressive episodes associated with bipolar disorder and schizophrenia. “I finally felt like a normal person,” she says of starting the medications after years of struggling with “rage spirals.” “My work, my relationships, everything got better. It was the first time I could remember not feeling so angry and anxious all of the time.” When Louisa and her husband decided to start trying to get pregnant,
her doctor advised her to stay on Celexa. But Louisa’s doctor did advise her to wean off Latuda, because there haven’t been adequate and well-controlled studies in pregnant women, and similar drugs have been associated with respiratory distress and other complications in newborns. Louisa conceived her first pregnancy quickly at age 32 but miscarried at 13 weeks. “My mental state was not good after that,” she recalls. She went back on Latuda to help her cope with the loss and stress of trying again. But when she got pregnant a few months later, she stopped taking Latuda and continued on just Celexa. “Every time, it was a huge conversation,” Louisa says. “I was nervous about even staying on Celexa, but I also knew the dangers of my rage attacks.” Both her boys were born healthy, and she resumed her usual medication regimen after breastfeeding. Women with bipolar disorder do have a higher risk for pregnancy complications and birth defects than the general population when taking medication, but discontinuing medication can significantly increase the likelihood of a relapse, according to a 2017 review of 20 studies published in the Journal of Midwifery & Women’s Health. Another study found that women with depression who stopped medication were five times as likely to experience a relapse during pregnancy as women who continued with their prescriptions. “If you’re suffering from a mood or anxiety disorder or another psychiatric condition, you may need to take medication during pregnancy because the benefits of treatment for you and your baby may outweigh potential relative risks,” Dr. Sacks says. “This is true for psychiatric conditions just as it’s true for medical ones like high blood pressure.” Untreated anxiety or depression can also send high levels of cortisol and adrenaline through the body, which may increase the risk of low birth weight, preterm labor, gestational hypertension, and even miscarriage, explains Jennifer Adaeze Okwerekwu, M.D., a reproductive psychiatrist based in Boston. A baby’s social and emotional
