114b - Psychopharmacology of Pregnancy Flashcards

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1
Q

What is neonatal adaptation syndrome?

Which medications is it associated with?

A

Uncomfortable infant: fussy, gittery, stiff, tremulous, feeding/breathing concerns

Generally does not require a higher level of care or delay discharge post-partum

  • SSRIs
  • Benzos
  • Antipsychotics

In general, it is best to treat maternal depression, anxiety, and/or psychosis and accept risk of neonatal adaptation syndrome

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2
Q

Which antipsychotic is associated with fetal malformations/

A

Risperidone (at ≥ 2mg/day)

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3
Q

Which concerns for benzos in pregnancy are supported by evidence?

A
  • Increased risk of neonatal adaptation syndrome
  • Behavioral development may be delayed at first, but caught up by 2 years
  • Withdrawal symptoms
    • But no seizures
  • Risk for sedation due to transfer to breast milk
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4
Q

Which concerns for SSRIs in pregnancy are supported by evidence?

A
  • Neonatal adaptation syndrome
    • Known association with SSRI, but generally does not require a higher level of care or delay discharge post-partum
  • *Slight* increase in mild persistent pulmonary hypertension in babies exposed to SSRIs during 3rd trimester

No evidence for association with cardiac malformation, autism, pre-term delivery

In general, risks of untreated maternal depression are much higher than those associated with SSRIs

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5
Q

Which concerns for Lithium in pregnancy are supported by evidence?

A
  • Increased risk of cardiac malformation (Ebstein’s anomoly)
    • But lower than perviously thought
    • Can continue at lowest effective dose, supplement with folate
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6
Q

Which concerns for antipsychotics in pregnancy are supported by evidence?

A
  • Maternal weight gain, metabolic changes
    • Increased risk of gestational diabetes
  • Neonatal adaptation syndrome
  • Slower neuromotor development at first, but catch up by 2 years

Exception: risperidone has a higher risk of cardiac malformation; not first line in pregnancy

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7
Q

How would you advise mothers who are breastfeeding and taking psychotropic medications?

A
  • Most do transfer to breast milk, bu tth erelative infant dose is much lower than maternal dose
  • If taking Li, monitor breast milk levels
  • Monitor babies for weiht concerns, agitation, sleep issues
  • Milk supply will not be impacted
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8
Q

Levels of which psychotropic medication should be monitored in breastmilk, if breastfeeding?

A

Lithium

Others do not need to be monitored unless concern for weight, agitation, sleep issues in the infant

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