Risks associated with psychotropic drugs during pregnancy

Unplanned pregnancies in women with psychiatric illness are common and result in exposure of the fetus to multiple psychotropics during the first trimester. Literature reveals that olanzapine may rarely cause major malformations and selective serotonin reuptake inhibitors may be associated with primary pulmonary neonatal hypertension. We present a rare case of 39-year-old (middle-aged) female Gravida 4 para 2 abortion 1 live 2, with bipolar affective disorder with gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) presenting in the third trimester of her pregnancy. The patient continued 5 mg olanzapine and 150 mg sertraline throughout pregnancy unsupervised. Ultrasonographic findings revealed multiple congenital anomalies in the fetus, and emergency cesarean was conducted in the 32nd week of pregnancy, which was followed by neonatal complications including bradycardia, gasping, absent birth cry and reflexes, and weak gross motor activity and early neonatal death. The anomalies observed in the fetus are similar to the anomalies that have been observed and discussed with psychotropics in the past. Thus, we report this case to understand in naturalistic setting – the complications and risks associated with psychotropic medications in pregnancy along with other physical morbidities including GDM and PIH in the female suffering from bipolar disorder.