114. Pregnancy Psychopharmacology

Question 1

Antidepressants in pregnancy

• most common med
• risk of malformations
• SE

Answer 1

SERTRALINE MOST COMMON
no increased risk of cardiac malformations (maybe slight persistent pulm HTN), no risk of decreased gestational length
-low birth weights in exposed mothers, but no difference in untreated depressed mothers!

SE: Neonatal Adaptation Syndrome (NAS)!!

• sx: uncomfortable infant (fussy, stiff, feeding/breathing concerns)
• does not require further hospitalization
• possible hypotheses: too much 5HT, med withdrawal, maternal depression compromises interaction with child, teratogenic?

Question 2

Benzodiazepines in pregnancy

- risks

Answer 2

• Cleft Lip/Palate
• NAS
• Withdrawal Sx
• Long term behavior/development delays until 2yo
• Breast Feeding: could cause sedation

Question 3

Antipsychotics in pregnancy

• types used
• Risks, SE, malformations

Answer 3

1st gen: haloperidol
2nd gen: Quetiapine, Olanzipine, Clozapine (cause weight gain, metabolism changes - need to look out for)

NO MALFORMATIONS (risperidone - slight increase in risk)

Risks: NAS, lag in neurodevelopment until 2yo

Question 4

Mood Stabilizers in Pregnancy

• types used with risks
• prevention of SE

Answer 4

Li: Ebstein’s Anomaly (RV Outflow Tract Obstruction) - barely increase in risk
Valproate: AVOID, cause NTDs, low IQ, risk of ASD
Lamotrigine: no known risk in defects, may need to increase dose as metabolism changes in pregnancy, higher doses in breastmilk than other AEDs

tx: FOLIC ACID SUPPLEMENTATION

Question 5

Breastfeeding

• what drugs are found in breast milk?
• what is the infant dosage?
• how do drugs change breast milk supply?

Answer 5

All drugs found in breastmilk
0-10% of mom dose in breastmilk (MUCH LOWER)
drugs do NOT change supply (neither more nor less milk)