Chapter 11: Psychiatric Complications During Pregnancy

Question 1

Psychiatric Complications

Answer 1

• depression
• bipolar disorder
• schizophrenia
• anxiety disorders
• eating disorders

Question 2

Depression

Answer 2

• increase risk of preterm birth, low birth weight, and abnormal stress responses in offspring
• psychotherapeutic counseling is beneficial to mild to moderate ill women
• medication used with severe major depressive disorder
• electroconvulsive therapy is effective and safe during pregnancy

Question 3

Medications for Depression

Answer 3

-SSRIs (fluvoxamine, sertraline, citalopram, fluoxetine)
-Tricyclic anti-depressants (TCAs) (amitriptyline, clomipramine, doxepin, protriptyline
>conflicting data regarding SSRI exposure regarding first trimester
>late pregnancy exposure has been associated with neonatal abstinence syndrome, persistent pulmonary hypertension, cardiac dysrhythmias, and transient neonatal complications (jitteriness, weak cry, poor tone, and mild respiratory distress)
-breastfeeding usually safe with SSRIs

Question 4

Bipolar Disorder

Answer 4

• early prenatal exposure to lithium, which is the treatment for bipolar disorder, may be associated with congenital cardiac malformations; later exposure associated with cardiac arrhythmias, hypoglycemia, polyhydramnios, and preterm birth
• maternal physiological alterations affect the absorption, distribution, metabolism, and elimination of lithium
• monitor serum lithium levels during prenatal period
• anticonvulsants (valproate, carbamazepine, and lamotrigine) are used in treatment of bipolar disorder; valproate and carbamazepine is contraindicated in pregnancy

Question 5

Schizophrenia

Answer 5

-women often experience worsening of their symptoms
-because of the potential teratogenic effects on the fetus, the prescribed psychotropic medication may need to be discontinued or changed
-maternal high-risk symptoms: psychotic denial of pregnancy, self-mutilation, fetal abuse, and neonaticide
>nurse should assess for delusions, and coexisting health problems such as depression, eating disorders, STIs, alcohol or drug abuse, an chronic conditions such as diabetes mellitus and hypertension
>prenatal patient educations on ensuring that community support services ad referrals to community agencies are in place for the patient and her family members during antepartum period

Question 6

Anxiety Disorders

Answer 6

• childbearing associated wit onset or worsening panic disorder or OCD, woman are at greatest risk for exacerbation of both disorders in postpartum period
• benzodiazepines and anxiolytic medications may be associated with fetal oral cleft
• medication should not be abruptly withdrawn
• infants exposed to benzodiazepines shortly before birth require close monitoring for “floppy infant syndrome”: hypothermia, lethargy, poor respiratory effort, and feeding difficulties

Question 7

Eating Disorders

Answer 7

• anorexia nervosa has been associated with higher rates of perinatal mortality, obstetric complications, and congenital anomalies
• bulimia nervosa has been associated with extreme maternal weight gain, preeclampsia, and eclampsia

Question 8

Management: Strategies to help identify mental health problems during pregnancy

Answer 8

• placing psychoeducational materials throughout all patient areas
• routinely inquiring about the patient’s and her family’s psychiatric history during the initial interview
• administering the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory, the Postpartum Depression Screening Scale
• assessing woman’s access to social and family supports
• referring the woman to community resources such as home heath visitation and the local mental health agency