Maternal Mental health

Question 1

Substance use

Answer 1

Always address
Recommend abstinence
Offer referral services
Explain no safe levels

Heroin: Non-teratogenic effects
- IUGR, abruption, PTB, LBW, SUIDs, infection

Cocaine
- Vasoconstriction
- SB, PTB, IUGR, hypoxia, mec liquor, abruption
- Limb defects, cardiac defects
- Neonatal withdrawal SND

Weed
- Gastroschisis
- Evidence of negative performance at 3 years

Meth etc
- Mat risks or PET and HTN
- Fetal: defects, abruption, SB, infection, IUGR, PTB, LBW, withdrawal

Question 2

Depression

Answer 2

Mat risks
- Suicide
- Drug use
- PET

Fetal risks
- Prematurity
- LBW

Management
- Screen with EPDS
- Offer referrals to MMH and SW
- Consider CBT, consider SRRIs

Question 3

Bipolar

Answer 3

High risk of relapse if mood stabiliser stopped
Mg with MDT team
Consider tertiary level anatomy and ECHO, paeds review of baby
Lithium: increases cardiac defects
Will need lithium levels
Carbamazepine and valproate increase NTD
Aim lowest effective stingle dose
High dose folic acid

Question 4

Schizophrenia

Answer 4

Mat risks
- PP psychosis 16%
- Suicide
- Drug use

Fetal
- SB, IUGR, PTB

Medications
- Can cause infertility due to prolactinaemia and metabolic snd and increase cardiac defects slightly