Background: A significant number of women of childbearing age have bipolar disorder. Several of the drugs used in the treatment of bipolar disorder have been associated with an increased risk of congenital malformation. Objective: The purpose of this review is to examine the risk of major congenital malformations related to medications used in the treatment of pregnant women with bipolar disorder.
Methods: A literature research, using MEDLINE/PubMed, EMBASE and Cochrane databases, to identify studies and meta-analyses assessing the risk of major congenital malformations in infants whose mother was taking lithium, antiepileptics, antipsychotics, SSRIs or venlafaxine during the first trimester of pregnancy.
Results: 22 studies and four meta-analyses were selected for the review. 13 studies adopted a prospective cohort design and nine a retrospective cohort design.
Conclusions: There seems to be an increased risk of major congenital malformations associated with valproate or paroxetine exposure early in pregnancy. Lamotrigine and carbamazepine on the other hand seems to be relatively safe. Reviewed information was too limited to draw satisfying conclusions regarding the risk associated with fluoxetine, fluvoxamine, citalopram, escitalopram, sertralin, venlafaxine, lithium, haloperidol, perhenazine, olanzapine, risperidone, clozapine and quetiapine. No studies on aripiprazole, sertindole, ziprasidone or amisulpride were found. Large, well conducted cohort studies are needed to better assess the risk of each single drug.