Mood stabilizers during pregnancy: maternal-fetal outcomes

Abstract

Objective: To analyze maternal–fetal outcomes associated with the use of mood stabilizers during pregnancy, considering pharmacokinetic aspects, teratogenic safety, and implications for child neurodevelopment. Literature review: Pregnancy in women with affective disorders, especially bipolar disorder, represents a relevant clinical challenge, as it requires balancing maternal psychiatric stability and fetal safety. Physiological changes during pregnancy modify the pharmacokinetics of mood stabilizers, affecting their efficacy and requiring frequent monitoring and dose adjustments. Among the main drugs, lithium, lamotrigine, and valproate present distinct safety profiles. Valproate is associated with a higher risk of congenital malformations and neurodevelopmental impairment. Lithium, although related to cardiac malformations, has a lower absolute risk than previously described. Lamotrigine, in turn, shows a more favorable profile. Additionally, untreated psychiatric illness is associated with worse obstetric outcomes, such as prematurity, fetal growth restriction, and neonatal complications. Final considerations: The use of mood stabilizers during pregnancy requires an individualized and multidisciplinary approach, with strict monitoring to ensure a balance between therapeutic efficacy and fetal safety.