Mindful Evidence
By Dr Elsa du Toit
Mental illness in pregnancy is an exposure.
When we talk about risk, it is not enough to look at medication alone.
We must consider both exposures, the illness and the treatment, because the illness itself carries risk.
Untreated perinatal mental illness affects not only mood and behaviour, but also pregnancy outcomes and early child development.
It contributes to obstetric complications, impaired self-care and biological changes that influence the developing fetus.
That is why maternal mental health is not separate from health, it is health.
And maternal health and early child development are inseparable.
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Episode 1:Â
Balancing Maternal–Fetal Exposures to Mental Disorders and Drug Treatments
Reference:
Perinatal Psychiatry: Balancing Maternal–Fetal Exposures to Mental Disorders and Drug Treatments Nielsen, Stika & Wisner (2025), Seminars in Perinatology, Volume 49
Explore
Reframing Risk
The question is not:
“Is this psychotropic risky?”
The question is:
“What are the risks of this medication in this particular woman, with her illness, in her unique context?”
It’s not should we treat, but how we treat, using the best available evidence to support both mother and baby.
Key Takeaways
- Untreated maternal mental illness is a significant biological, psychological, and social exposure.
- Psychotropics carry manageable risks - for most women, far lower than the risks of untreated illness.
- Our task is not to eliminate risk, but to balance it wisely - illness versus treatment, stability versus relapse.
- For most women, effective treatment is protective.
A Shift in Thinking
This paper asks us to move beyond fear-based prescribing toward context-based care.
Medication risk cannot be assessed in isolation.
It must be viewed within the full context of maternal health, illness severity, and social circumstances.
When we counsel women, the question is not “Should she be on medication?”
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The question is:
“What is the safest and most effective way to keep her well for her sake, and her baby’s?”
