Managing Medications in Pregnancy

Medication Adjustment and Monitoring

The American College of Obstetricians and Gynecologists recommends continuing SSRIs at the lowest effective dose rather than discontinuing, as risks of untreated maternal depression outweigh small fetal risks 1
Escitalopram or sertraline are preferred first-line options as they have the most extensive pregnancy safety data among SSRIs 1
Multiple reviews have not identified adverse neurodevelopmental outcomes among infants born to women treated with SSRIs during pregnancy 1
Monitor closely for 2-4 weeks after switching from desvenlafaxine to an SSRI for symptom recurrence or worsening 2
The American Journal of Obstetrics and Gynecology suggests that if ADHD symptoms become severely impairing, consider intermittent methylphenidate use or bupropion as an alternative 2

Lamotrigine can be safely continued during pregnancy with appropriate monitoring 3
Lamotrigine levels decrease significantly during pregnancy due to increased metabolism and clearance, and should be checked monthly during pregnancy 3
Many women require dose increases of 50-100% or more during pregnancy to maintain stability, and the dose should be rapidly reduced postpartum to avoid toxicity 3
Obtain baseline lamotrigine level in the first trimester, and recheck levels every 4 weeks to adjust the dose and maintain pre-pregnancy therapeutic level 3