Perinatal Psychiatry Flashcards
Which antidepressants should be avoided
in 1st trimester?
paroxetine-increased risk of fetal heart defects
Which antidepressants can be used in 3rd trimester?
SSRI: lowest risk with sertraline & fluoxetine
TCA: imipramine/amitriptyline (lower risk than SSRI)
Which antidepressants are safe to use during breastfeeding?
SSRI: sertraline/paroxetine
TCA: imipramine
Which antidepressant should be AVOIDED in breastfeeding?
SSRI: citalopram
TCA: doxepine
Why should benzodiazepines be avoided in pregnancy?
1st trimester: causes fetal malformations (cleft palate)
3rd trimester: floppy baby syndrome (resp depression, hypothermia, hypotonia, withdrawal effects)
breastfeeding: risk of lethargy & weight loss
Which antipsychotics are safer in pregnancy?
Generally typicals are safer than atypical antipsychotics
Which atypical antipsychotic should be avoided during pregnancy?
clozapine-agranulocytosis
olanzapine-GDM & weight gain
Which class of antipsychotic causes EPSE?
- depot antipsychotics (in neonates)
- anticholinergics (mother in pregnancy)
What are the risks of lithium during pregnancy?
1st trimester: Ebstein abnormality (avoid sudden discontinuation)
3rd trimester: monitor serum levels monthly until 3 weeks and then weekly then 24h before birth
Lithium toxicity can mimic pre-eclampsia
breastfeeding: AVOID. consider prophylactic reintroduction if not breastfeeding
What are the risks of sodium valproate in pregnancy?
AVOID. Avoid in women of childbearing age
- inc risk of neural tube, craniofacial defect and intellectual development
- low risk in breastfeeding (no evidence of adverse effect)
What other anti-epileptics should be avoided in pregnancy?
carbamazepine-neural tube defect, facial dysmorphism, fingernail hypoplasia
lamotrigine -oral cleft (avoid in 1st trimester). Steven-johnson’s syndrome in breastfeeding
What is the guideline for alcohol consumption during pregnancy?
- complete abstinence
- no evidence of harm if <2 units a week
- > 8 units a week could cause miscarriage
What are the risks of alcohol consumption in pregnancy?
- foetal alcohol syndrome, withdrawal
- wernicke’s encephalopathy –> karsakoff syndrome
What are the risks of drug abuse (cocaine, amphetamine and ecstasy) in pregnancy?
- pre-eclampsia
- placenta abruption
- teratogenicity
- IUGR
- pre term labour
- miscarriage, stillbirth, SIDS
- developmental delay
- withdrawal
What are the effects of opiates during pregnancy?
- withdrawal
- IUGR
- SIDS, stillbirth
