Perinatal Flashcards
Risk of major malformation in all pregnancies
2-3%
When is risk of psychiatric episodes greatest in perinatal?
3 months postpartum
Most common psychiatric illnesses in postpartum period?
Mood disorder - 80%
Risk of depression during pregnancy
7-15% (7% outside of pregnancy)
Relapse rate of depression during pregnancy if history of depression
50%
Risk of postpartum depression
10%
Risk factors for postpartum depression
Previous depression
Highest risk with bipolar
Risk of postpartum psychosis
0.1-0.25% in general population
50% in bipolar
50-90% in those with history of postpartum psychosis
Incidence of puerpural psychosis
1 in 1000 births
Risk of relapse of bipolar in first month postpartum
8x increase, most relapses depressive
Most vulnerable period for fetus of teratology from meds
Week 6-10
What happens to medications during 3rd trimester?
Increase often needed as blood volume expands by 30%
Treatment of SCZ in pregnancy
High risks associated with untreated SCZ, thus consensus to use antipsychotic at every stage of pregnancy.
Common antipsychotics used in pregnancy
Olanzapine - most common
Haloperidol
Clozapine
Treatment of depression in pregnancy
Delay until 2nd or 3rd trimester if possible
Explore CBT
If high risk of relapse or mod-severe depression then antidepressant during and after pregnancy
Recommended antidepressants in pregnancy
Nortriptyline
Amitriptyline
Imipramine
Fluoxetine
Treatment for pregnant women if treated on valproate or carbamazepine
Prophylactic folic acid 5mg OD from at least a month before conception
Prophylactic Vit K to mum and neonate after delivery
Risk of SSRI in pregnancy
Neonatal withdrawal
No increase in risk of major malformation except Paroxetine - VSD and ASD
13.3% risk of spontaneous abortion
Decreased gestational age
Low birth weight
In late pregnancy risk of persistent pulmonary hypertension
Risk of Lithium use in pregnancy
1 in 10 chance of malformation in first trimester
3x risk of all types of malformations, 8x risk of cardiac malformations
Ebsteins anomaly - 10-20x higher than general population, absolute risk is 1 in 1000
When is risk of malformation with lithium greatest?
2-6 weeks after conception
Impact of lithium use on neonate
Hypotonia
Lethargy
Poor reflexes
Respiratory difficulties
Risks of use of carbamazepine in pregancny
0.5-1% risk of spina bifida, craniofacial abnormalities, growth retardation, developmental delay
Risk of birth defect on valproate
10% - any malformation
Dose-related
Mostly seen 17-30 days post conception
Increased risk in FHx of neural defects
Impact of valproate use on neonate
Growth retardation 1-2% neural tube defect risk 10x increase risk of spina bifida 4x risk of VSD and pulmonary stenosis Digital and limb defects Low IQ