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Exposure to Psychotropic Medications and Other Substances during Pregnancy and Lactation: A Handbook for Health Care Providers 

We know that 25 per cent of Canadians smoke,1 five per cent drink alcohol daily and 10 per cent report symptoms consistent with alcohol or illegal drug dependence. We can conclude, then, that many of the over 400,000 Canadian women who give birth each year may have used such substances before they knew they were pregnant. More...

Contents

General issues and background

Psychotropic medications and other substances: Properties, effects and recommendations

Resources

Index of drugs

Preface

(continued from above)

In addition, approximately 10 to 15 per cent of women between the ages of 25 and 44 experience depression. One study2 found that 6.6 per cent of pregnant women between the ages of 15 and 45 had been on an antidepressant during the year prior to conception. Given these figures, a substantial number of these women are likely to be taking antidepressants when they become pregnant. When women who are taking a psychotropic medication find out they are pregnant, they may assume they need to stop treatment. However, while some psychotropics do have effects on the baby, the negative effects of untreated illness can often—as in the case of depression—be very serious.

The health care provider’s challenge is to know the true risks and benefits, to both the mother and her fetus or baby, of taking versus stopping the use of a medication or other substance. Yet the average health care provider is not well equipped to give the best advice to women who are pregnant or breastfeeding and exposed to psychotropics.

  • “Is it ever safe to drink alcohol when breastfeeding?”
  • “What are the risks to the baby if the mother uses cannabis while pregnant or breastfeeding?”
  • “Are the effects of smoking different during pregnancy versus during breastfeeding?”
  • “What is the effect of cocaine on the fetus or neonate?”
  • “If a woman stops taking an antidepressant when she becomes pregnant, what will be the effect on her and the fetus?”
  • “Can a woman safely breastfeed her baby when taking codeine?”

The information in this handbook will provide practitioners with evidence-based facts and recommendations on these and many other questions.
In 2003, CAMH and Motherisk collaborated on Is It Safe for My Baby? Risks and Recommendations for the Use of Medication, Alcohol, Tobacco and Other Drugs during Pregnancy and Breastfeeding, which was written for women and the general public. We know that health care providers will also benefit from a convenient source of evidence-based information on this topic.

Our goal with this publication is to help primary care physicians, psychiatrists, pharmacists, obstetricians, midwives, public health nurses and nurse practitioners provide the best advice, information and care to women who are taking psychotropic medications or other substances during pregnancy and postpartum. Medications and other substances discussed in this handbook have been chosen because of their psychotropic qualities: they all affect brain chemistry and functioning. Drugs and substances that are not psychotropic, that are not used during pregnancy, or about whose effects there is not enough documented evidence (e.g., herbal remedies) are not included.

The sections on psychotropic medications and other substances are organized alphabetically by drug or drug category. When talking about specific drugs, we have included the generic and brand names. The examples given are some of the most commonly used drugs, but do not necessarily include all drugs in that category. An index of drugs lists all the drug categories and generic and brand names used in this handbook.

The information in this handbook is based on the most recent research, and is current as of October 2007.

We trust you will find this handbook useful.

On behalf of CAMH and Motherisk
Betty Dondertman, Project lead, CAMH
October 2007

References

  1. Statistics Canada. (2003, June). . . . Au Courant. Ottawa: Minister of Industry. (Catalogue No. 82-005-XIE). Available: www.statcan.ca/english/ freepub/82-005-XIE/82-005-XIE2002003.pdf. Accessed June 25, 2007.
  2. Ramos, É., Oraichi, D., Rey, É., Blais, L. & Bérard, A. (2007). Prevalence and predictors of antidepressant use in a cohort of pregnant women. British Journal of Obstetrics and Gynaecology. Published OnlineEarly June 12, 2007. Available: www.blackwell-synergy.com/doi/abs/10.1111/j.1471-0528.2007.01387.x. Accessed June 25, 2007.
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