A staff-written summary of a presentation by Marlene P. Freeman, MD, (Current Psychiatry, May 2009, p. 56) paraphrased her as saying “atypical antipsychotics may pose a lower risk of fetal malformations compared with lithium or anticonvulsants.” Dr. Freeman did not make this statement and states that available data are insufficient to support this comparison. She wishes to clarify what the scientific evidence supports when treating bipolar disorder in pregnant patients:
“Because relapse rates for bipolar women who discontinue medication during pregnancy are high, it is recommended that patients consider the serious risks of untreated bipolar disorder as well as medication exposure. Valproate appears to be the mood stabilizer associated with the greatest teratogenic potential. Among the anticonvulsants, lamotrigine appears to have the most favorable reproductive safety profile, and lithium appears to have a much lower risk of teratogenicity than was thought years ago, with a very low absolute risk of malformations with first-trimester exposure. More data are needed to inform the use of atypical antipsychotics across pregnancy and breast-feeding.”