Maternal mental health Flashcards
1
Q
Counsel woman about risks of lithium use in pregnancy
A
Pre-pregnancy/antenatal:
- Small increased risk of teratogenicity 7 in 1000:
- Cardiac: Ebstein anomaly (tricuspid valve and right ventricle)
- RVOT defects
- Aortic coarctation
- Mitral atresia
- Preterm birth
- Diabetes insipidus and polyhydramnios
- Neonatal lithium toxicity: resp depression, cardiac arrhythmias, feeding difficulties, lethargy, hypotonia, seizures.
- Lithium dose will need to be increased during pregnancy.
- Check lithium level every 2-4 weeks until 36 weeks, then weekly.
- Check TFT and renal function every 3 months.
Intrapartum:
- Stop lithium at IOL/in labour.
- Adequate hydration in labour.
Postpartum:
- Restart lithium postpartum at pre-pregnancy dose.
- Monitor neonate for lithium toxicity.
- Avoid breastfeeding if taking lithium.
2
Q
Outline preconceptual counselling for a woman with BPAD
A
- Assess BPAD status:
- Avoid pregnancy if not stable within the last 2 years.
- Risks: flare of mood episodes during pregnancy and postpartum including psychosis; congenital anomalies associated with medications; PTB; IOL or CS.
- Risk of relapse if stops medications completely.
- Medication: avoid valproate; continue carbamazepine and lithium.
- High dose folic acid
- Contraception: LARC ideally.
- MDT input: high risk obstetrics, MMH, MW
3
Q
Counsel a woman about SSRI use in pregnancy:
A
- Aim for lowest dose/single agent to control symptoms; sertraline and fluoxetine safest.
- Risk of miscarriage, poor neonatal adjustment syndrome
