Mental Health Disease in Pregnancy

Question 1

Maternal risks of untreated mental health conditions

Answer 1

Poor engagement in medical care
Exacerbation of chronic conditions
Smoking
Substance use disorders
Severe morbidity/mortality
Preeclampsia

Question 2

Fetal Risks of untreated mental health conditions?

Answer 2

Stillbirth
Pretermbirth
FGR
Low birth weight
Impaired bonding
Adverse infant neurodevelopment
Mental health concerns in offspring

Question 3

What is considered “perinatal” mental health?

Answer 3

Up to 12 months postpartum

Question 4

Risk factors for postpartum psychosis?

Answer 4

Previous postpartum psychosis
Bipolar disorder
Fm hx bipolar disorder

Question 5

Positive screen for biopolar disorder?

Answer 5

MDQ >/= 7
Do once prenatally, once postnatally, and before starting monotherapy for unipolar depression

Question 6

Bipolar increases risk of what?

Answer 6

PP Psychosis
Infancide
Suicide

Question 7

Difference between bipolar 1 and bipolar 2?

Answer 7

Bipolar 1 = manic episode (lasts 7 days)
Bipolar 2 = hypomanic (lasts 4 days)

Question 8

Depression screening

Answer 8

PHQ9 >/= 10

Question 9

Diagnosis of depression?

Answer 9

SIG E CAP (need 5 symptoms for at least 2 weeks) including depressed mood or anhedoina

Sleep
Interest
Guilt
Energy
Concentration
Appeptite
Psychomotor

Question 10

Anxiety Screening

Answer 10

GAD >/= 5 is positive

Question 11

Prinicples of treatment of mental health in pregnancy

Answer 11

Use lowest dose possible
Avoid polypharmacy
Avoid switching agents
Consider untreated an “exposure”

Question 12

What mental health medication is contraindicated in pregnancy?

Answer 12

Paroxetine (Paxil)
May increase risk of heart defects during first trimester exposure

Question 13

Risks of antidepressant use in pregnancy?

Answer 13

Persistent pulmonary hypertension of the newborn
- Rare, but 20% mortality risk
- SSRI exposure can cause vasoconstriction and smooth muscle cell proliferation in fetal lung
- Inreased risk if > 20 wks during use

**Sertraline least likely to cause this

Transient neonatal adaption syndrome (risk 10-30%)
- Irritability, restlessness, tremores, sleep disturbance, poor feeding
- Resolves on its own within 2 weeks

Question 14

Treatment for bipolar?

Answer 14

Refer to Psych for management
Continue what they were taking pre pregnancy (except valproate)
Lithium = mood stabilizer first line

Check levels
Get level II, risk of Ebstein anomaly