Perinatal_EO Flashcards
What is the prevalence and onset of baby blues?
30-75%
3-5 days after delivery
What is the prevalence of post partum depression, onset and risk factors?
10-15% 3-6 months after delivery #1 risk factor is past hx of PPD FamHx of MDD Personal Hx of anxiety Low SES Undesired pregnancy Stressors Primiparité Insecure attachement with mother
What is the prevalence, onset and risk factors of postpartum psychosis?
0,1-0,2% within a few days; 2-3 weeks after delivery Sudden (not gradual onset) BAD is the most common cause of PPP 50-60% primipares 50% have family history of mood disorder
What are causes and consequences of PPP?
Sudden drop in oestrogen and progesteron after delivery
Anti-thyroid antibody can be implicated
Blood loss and anemia NOT implicated
50% have perinatal complications
50% risk of relapse in the subsequent pregnancy
5% suicide
4% infanticide
What is the percentage of postpartum depression in fathers?
10%
What to know about lithium in pregnancy?
1) less teratogenic mood stabilisor (D)
2) Epstein anomaly : 1/1000 vs 1/20 000 in gen pop in first trimester
3) monitor blood level Qmonth ad 34 weeks, then weekly to term since the increase in GFR requires higher doses
4) reduces lithium at the end of 3rd trimester and stop 24-48hrs prior delivery - since volume reduction there is increased intox risk and floppy baby syndrome risk at delivery
5) dose requirements return rapidly to pre-pregnancy dose by 48hrs post delivery
6) monitor lithium level twice weekly first week PP, then once weekly in week 2 and 3
7) lithium is possibly hazardous (L5) during breastfeeding ; relative infant dose is 10-17% of maternal dose
What are the risks of untreated BAD in pregnancy?
85% chance of mood episode
Increased risk of c-section, pre-eclampsia, PPP, pre-term birth
What are the risk of epival during pregnancy and breasfeeding?
Dose related risk of neural tube defect (5%), ASD and low IQ (D)
Probably safe in breasfeeding (L3)
What are the risks of SSRI during pregnancy and breasfeeding?
Sertraline, citalopam and escit safest during pregancy (C)
sertraline <1-3% passage into breast milk ; paxil, cital, escital safe (L2)
Caution with prozac because 1% if exclusive postpartum exposure, 22% passage in breast milk if used during pregnancy as well
SSRI in pregancy are not associated to major malformation, stillbirth ,low birth weight ;; which are all risks of untreated depression. (Studies that showed otherwise did not control for mother untreated depression )
PPHN in 3rd trimester : absolute risk is only significantly elevated (2.5/1000) and FDA 2011 warning says there is insufficiant evidence to conclude anything about PPHN and SSRI
What’s to know about lamictal in pregnancy?
Clearance increases up to 300% of pre-pregnancy levels because of increased hepatic metabolisme
Requires a dose increase of at leat 25% of pre-pregnancy levels
Cleft palate risk equals risk with gen pop
Give folic acid
What’s to know about antipsychotics in pregnancy and breasfeeding?
Quetiapine has the lowest placenta passage, olanzapine has the highest (C)
Quetiapine has 0.1-0.43% relative infant dose in breasfeeding (L3)
Increase dose of quetiapine because metabolisme of CYP3A4 is increased in pregnancy
What’s to know about benzo in preganct?
Cleft palate, low birth weight, low APGAR, floppy baby during pregnancy
Use those without metabolites (lorazepam)
Is ok to use during breastfeeding only for PRN - chose lorazepam or oxazepam
