Therapeutic Drug Monitoring Considerations in Pregnancy.

Physiological changes during pregnancy can impact the pharmacokinetics of medications. Due to a variety of practical and ethical factors, clinical pharmacokinetic studies are challenging to perform during pregnancy. In addition, information on fetal toxicity of drugs requires years of study. As a result, evidence-based guidance for optimizing drug dosing in pregnancy, including therapeutic drug monitoring (TDM), is currently sparse. The most complete practice guidelines are related to antiseizure medications, with data also accumulating for antipsychotic and antidepressant medications. There are many avenues for future research and clinical practice improvement for TDM in pregnancy.