#92 Use Of Psychiatric Meds In Pregnancy And Breastfeeding Flashcards
What are used to treat anxiety (broad categories)?
Benzodiazepines
Antidepressants
Psychotherapy
What are used to treat major depressive disorder (broad categories)?
Antidepressants
ECT
Therapy
What are used to treat bipolar disorder (broad categories)?
Lithium
Anticonvulsants
Antipsychotics
ECT
What are used to treat schizophrenia (broad categories)?
Antipsychotics
For pregnant patients on psychiatric medication is it better to do high dose of one medication or low doses of multiple medications?
Better to have higher dose of one medication
What is the prevalence rate of depression in adults in the US?
17%
Are women more or less likely to suffer depression than men? By how much?
2x as likely to have depression
What percentage of pregnant women fulfill diagnostic criteria for depression?
10-16%
What are the lactation risk categories?
L1, safest; L2, safer; L3, moderately safe; L4, possibly hazardous; L5, contraindicated.
What psychiatric med is contraindicated for breastfeeding?
Doxepin [tricyclic antidepressant] (case reports of respiratory depression)
Does continuation of antidepressant in women with a history of depression decrease the risk of relapse?
Yes. Risk of 68% vs 25%
What survey tools are designed to help detect postpartum depression?
Edinburgh Postnatal Depression Scale, Beck Depression Inventory, and the Postpartum Depression Screening Scale
What birth defects are associated with benzodiazepines?
Basically none. Possible increased incidence of cleft lip/palate (from 6 in 10k to 7 in 10k)
What birth defects are associated with SNRIs and SSRIs?
None
What birth defects are associated with tricyclic antidepressants?
None
What birth defects are associated with early lithium use?
Heart defects - ebstein’s anomaly.
What birth defects are associated with antipsychotic medications?
None confirmed
What is the prevalence of bipolar disorder in America?
3.9 to 6.4%
What is the typical age of onset of bipolar disorder in women?
Teens to early 20s
What are rates of postpartum relapse in patients with bipolar disorder?
32% to 67%
What is the risk of postpartum psychosis in patients with bipolar disorder?
As high as 46%
Does OCD get better or worse during the postpartum period?
Worse
What is the prevalence of schizophrenia in women?
1-2%
What adverse pregnancy outcomes have been associated with schizophrenia?
preterm delivery, low birth weight infants, small for gestational age fetuses, placental abnormalities and antenatal hemorrhage, increased rates of congenital malformations, especially of the cardiovascular system, and a higher incidence of postnatal death
Which SSRI is Category D and associated with birth defects?
Paroxetine. Congenital cardiac malformations, anencephaly, craniosynostosis, and omphalocele. But the data for this is weak, and likely clinically insignificant.
What can be seen at birth with infants exposed to SSRIs close to delivery?
Withdrawal. including jitteriness, mild respiratory distress, transient tachypnea of the newborn, weak cry, poor tone, and neonatal intensive care unit admission
Is electroconvulsive therapy safe to use during pregnancy?
Yes
What is associated with lithium use later in pregnancy?
Fetal and neonatal cardiac arrhythmias, hypoglycemia, nephrogenic diabetes insipidus, polyhydramnios, reversible changes in thyroid function, premature delivery, and floppy infant syndrome
What are symptoms of neonatal lithium toxicity?
flaccidity, lethargy, and poor suck reflexes, which may persist for more than 7 days
What are the treatment guidelines for women with bipolar disorder being treated with lithium who want to conceive?
1) If mild and infrequent episodes of illness, taper lithium gradually before conception;
2) If more severe episodes but only moderate risk for relapse in the short term, treatment with lithium should be tapered before conception but reinstituted after organogenesis;
3) If especially severe and frequent episodes of illness, treatment with lithium should be continued throughout gestation and the patient counseled regarding reproductive risks
In addition to routine prenatal care, what should be considered for patients with lithium exposure during first trimester?
Fetal echocardiogram
What is the concern with prenatal exposure of valproate?
Neural tube defects (1-3.8% risk). Craniofacial anomalies. Limb anomalies. Cardiovascular anomalies.
What is the concern with carbamazepine exposure during pregnany?
facial dysmorphism and fingernail hypoplasia
What is the risk of fetal exposure to lamotrigine?
May have risk of midline facial clefts, but overall good reproductive safety
What is floppy infant syndrome?
Characterized by hypothermia, lethargy, poor respiratory effort, and feeding difficulties, is associated with maternal use of benzodiazepines shortly before delivery
What are fetal and neonatal toxicity from typical antipsychotics?
Neuroleptic malignant syndrome, dyskinesia, extrapyramidal side effects manifested by heightened muscle tone and increased rooting and tendon reflexes persisting for several months, neonatal jaundice, and postnatal intestinal obstruction
What is the risk ratio of congenital heart abnormalities in fetus’s of mothers taking lithium?
1.2 - 7.7
