Depression in pregnancy

Question 1

How would you advise a woman taking SSRI preconception about medication in pregnancy?

Answer 1

• SSRI are Class C (Class C drug – taken by a limited number of women in pregnancy, which may be suspected of causing direct or indirect fetal harm but no evidence of fetal malformation.
  - Evidence for increased risk of – preterm birth, PPH, neonatal convulsions, peristent pulmonary hypertension of the newborn, neonatal adaptation syndrome
  - No evidence for – increased miscarriage, neonatal mortality, growth restriction, cardiac anomalies, low IQ, behavioral problems.
  - Very low concentration in breast milk
  Overall the risks of discontinuation of untreated depression in infant bonding and neurodevelopmental outcomes outweigh the risks fo continuation.

Question 2

How would you justify use of EPDS in pregnancy

Answer 2

• 82% sensitivity
• 86% specificity
• Easy to administer
• Takes less than 2 mins
  Good at monitoring response

Question 3

what would warrant further action in the EPDS?

Answer 3

• score of >10
• positive answer to question 10 (regarding suicidality)