Psychiatric Pharmacy Essentials: Psychotropic Medications in Pregnancy

Many patients and providers can be hesitant to utilize medications during pregnancy due to concerns of harm to the fetus. However, medications in pregnancy cannot always be avoided, especially in patients where the benefit outweighs the risks. Exacerbations of mental health conditions can increase risks for both mother and fetus. For each medication and each individual pregnancy, the risks and benefits must be carefully weighed. The following questions address considerations for using psychotropic medications during pregnancy.

Essential Questions

  • What should be considered when evaluating a psychotropic medication’s safety during pregnancy?1-3
  • Where can I find dependable resources for medications during pregnancy and lactation,4-5 including patient friendly resources?6
  • Why are pregnancy categories (A, B, C, D, X) no longer used for medications?1,7
  • What non-pharmacological therapies are evidence-based recommendations for treating anxiety or depression during pregnancy?8-9
  • What is the evidence for safety and efficacy of antidepressant1,2,10-11 and antipsychotic medication use during pregnancy?1,2,12-14
  • How are postpartum depression3,15-16 and postpartum psychosis treated? 3, 17
  • How is opioid use disorder (OUD) managed during pregnancy?18-19
  • What is the evidence for treating insomnia during pregnancy?20
  • What are the recommendations for managing lithium during pregnancy and post-partum?1,17,21
  • What pharmacokinetic differences should pharmacists consider when managing patients during and after pregnancy?22

Reviewer 1: Breanna Moody, PharmD, BCPP
Reviewer 2: Abby Stocks, PharmD, BCPP
2026-2027 AAPP Resident and New Practitioner Committee

Essential Questions and References
  1. Payne JL. Psychiatric Medication Use in Pregnancy and Breastfeeding. Obstetrics Gynecol Clin North Am. 2021 Mar;48(1):131-149. Elsevier BV. DOI: 10.1016/j.ogc.2020.11.006.
  2. Creeley CE, Denton LK. Use of Prescribed Psychotropics during Pregnancy: A Systematic Review of Pregnancy, Neonatal, and Childhood Outcomes. Brain Sci. 2019 Sep 14;9(9):235. MDPI AG. DOI: 10.3390/brainsci9090235.
  3. ACOG Committee on Clinical Practice Guidelines-Obstetrics. Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5.. Obstet Gynecol. 2023 Jun 1;141(6):1262-1288. DOI: 10.1097/AOG.0000000000005202; PubMed PMID: 37486661.
  4. Bethesda (MD). In: Drugs and Lactation Database (LactMed®).
  5. Van Hoover C, Briggs GG, Freeman RK, Yaffe SJ, Williams L, Wilkins. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 6th Edition. J Midwife Womens Health. 2003 Jul 8;48(4):294-294. Wiley. DOI: 10.1016/s1526-9523(03)00148-x.
  6. MotherToBaby. The Organization of Teratology Information Specialists..
  7. Pregnancy and Lactation Labeling (Drugs) Final Rule. 2014.
  8. Evans K, Spiby H, Morrell JC. Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women. A systematic review and narrative synthesis of women’s views on the acceptability of and satisfaction with interventions. Arch Womens Ment Health. 2020 Feb;23(1):11-28. Springer Science and Business Media LLC. DOI: 10.1007/s00737-018-0936-9.
  9. van Ravesteyn LM, Lambregtse - van den Berg MP, Hoogendijk WJG, Kamperman AM. Interventions to treat mental disorders during pregnancy: A systematic review and multiple treatment meta-analysis. PLoS ONE. 2017 Mar 30;12(3):e0173397. Public Library of Science (PLoS). DOI: 10.1371/journal.pone.0173397.
  10. Huang W, Page R, Morris T, Ayres S, Ferdinand A, Sinha S. Maternal Exposure to SSRIs or SNRIs and the Risk of Congenital Abnormalities in Offspring: A Systematic Review and Meta-Analysis. Elsevier BV; 2024. DOI: 10.2139/ssrn.4917714.
  11. Dandjinou M, Sheehy O, Bérard A. Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case–control study. BMJ Open. 2019 Sep;9(9):e025908. BMJ. DOI: 10.1136/bmjopen-2018-025908.
  12. Huybrechts KF, Straub L, Karlsson P, Pazzagli L, Furu K, Gissler M, et al. Association of In Utero Antipsychotic Medication Exposure With Risk of Congenital Malformations in Nordic Countries and the US. JAMA Psychiatry. 2023 Feb 1;80(2):156. American Medical Association (AMA). DOI: 10.1001/jamapsychiatry.2022.4109.
  13. Wang Z, Chan AYL, Coghill D, Ip P, Lau WCY, Simonoff E, et al. Association Between Prenatal Exposure to Antipsychotics and Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Preterm Birth, and Small for Gestational Age. JAMA Intern Med. 2021 Oct 1;181(10):1332. American Medical Association (AMA). DOI: 10.1001/jamainternmed.2021.4571.
  14. Betcher HK, Montiel C, Clark CT. Use of Antipsychotic Drugs During Pregnancy. Curr Treat Options Psych. 2019 Mar;6(1):17-31. Springer Science and Business Media LLC. DOI: 10.1007/s40501-019-0165-5.
  15. Meltzer-Brody S, Colquhoun H, Riesenberg R, Epperson CN, Deligiannidis KM, Rubinow DR, et al. Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet. 2018 Sep;392(10152):1058-1070. Elsevier BV. DOI: 10.1016/s0140-6736(18)31551-4.
  16. Giannopoulos A, Singh J, Deligiannidis K. Clinical Utility of Zuranolone for Postpartum Depression: A Narrative Review. NDT. 2025 Jan;Volume 21:93-105. Informa UK Limited. DOI: 10.2147/ndt.s466260.
  17. Jairaj C, Seneviratne G, Bergink V, Sommer IE, Dazzan P. Postpartum psychosis: A proposed treatment algorithm. J Psychopharmacol. 2023 Oct;37(10):960-970. SAGE Publications. DOI: 10.1177/02698811231181573.
  18. Substance Abuse and Mental Health Services Administration. 2018;SMA. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  19. ACOG Clinical Practice Update: Use of Nonsurgical Hemorrhage-Control Devices for Postpartum Hemorrhage Management. Obstetrics & Gynecology. 2025 Oct;146(4):569-571. Ovid Technologies (Wolters Kluwer Health). DOI: 10.1097/aog.0000000000006024.
  20. Chaudhry SK, Susser LC. Considerations in Treating Insomnia During Pregnancy: A Literature Review. Psychosomatics. 2018 Jul;59(4):341-348. Elsevier BV. DOI: 10.1016/j.psym.2018.03.009.
  21. Wesseloo R, Wierdsma AI, van Kamp IL, Munk-Olsen T, Hoogendijk WJG, Kushner SA, et al. Lithium dosing strategies during pregnancy and the postpartum period. Br J Psychiatry. 2017 Jul;211(1):31-36. Royal College of Psychiatrists. DOI: 10.1192/bjp.bp.116.192799.
  22. Costantine MM. Physiologic and pharmacokinetic changes in pregnancy. Front Pharmacol. 2014 Apr 3;5. Frontiers Media SA. DOI: 10.3389/fphar.2014.00065.