Pharmacological treatment in pregnancy

Question 1

Most vulnerable period for major infant malformations in relation to medication taken during pregnancy

Answer 1

6-10 weeks

Question 2

Trimester in which drug doses may need to be increased

Answer 2

3rd trimester

Question 3

General treatment principles used for schizophrenia in pregnancy

Answer 3

Antipsychotic treatment used throughout pregnancy
If patients already maintained on antipsychotic this is often not changed
Olanzapine often used

Question 4

General treatment principles used for depression in pregnancy

Answer 4

Starting antidepressants is postponed to the 2nd trimester where possible
If a patient is on an antidepressant already with a high risk of relapse they are maintained on that antidepressant
CBT often tried first

Question 5

General treatment principles used for bipolar affective disorder in pregnancy

Answer 5

Most patients who become pregnant on medication are maintained on their medication
Consider stopping mood stabilisers pre pregnancy for women who have been stable for a long time
Avoid valproate

Question 6

Medications given if valproate or carbamazepine are given during pregnancy

Answer 6

5mg OD folic acid and prophylactic vitamin K

Question 7

TCAs which should be given preferentially during pregnancy

Answer 7

Nortriptyline
Desipramine

Question 8

SSRI which should not be used in pregnancy

Answer 8

Paroxetine

Question 9

Increase in spontaneous abortion with maternal use of SSRIs

Answer 9

13.3%

Question 10

Cardiac malformations linked to maternal use of paroxetine during pregnancy

Answer 10

VSD
ASD

Question 11

SSRIs/SNRIs with the highest risk of neonatal withdrawal syndrome

Answer 11

Paroxetine
Venlafaxine

Question 12

SSRI with the most evidence to suggest its safety in pregnancy

Answer 12

Fluoxetine

Question 13

SSRI with the least placental exposure

Answer 13

Sertraline

Question 14

Risk of infant malformation if lithium is used in the first trimester

Answer 14

10%

Question 15

Increased risk of Ebstein’s anomaly with maternal use of lithium during pregnancy

Answer 15

10-20x increased

Question 16

Absolute risk of Ebstein’s anomoly with maternal use of lithium during pregnancy

Answer 16

1 in 1000

Question 17

Percentage risk of spina bifida in an infant with maternal use of carbamazepine during pregnancy

Answer 17

0.5-1%

Question 18

Most common abnormalities caused by maternal use of carbamazepine during pregnancy

Answer 18

Fingernail hypoplasia
Developmental delay
Craniofacial defects

Question 19

Most teratogenic mood stabiliser

Answer 19

Valproate

Question 20

Risk of birth defects with maternal use of valproate during pregnancy

Answer 20

7.2%

Question 21

Congenital anomalies caused by maternal use of valproate during pregnancy

Answer 21

Neural tube defects
Digit and limb defects
Congenital cardiac disease - VSD, pulmonary stenosis
Urogenital malformations including hypospadias
Low birth weight

Question 22

Most common adverse effect of maternal use of valproate in pregnancy

Answer 22

Low IQ in the child

Question 23

Congenital defect seen with maternal use of lamotrigine during pregnancy

Answer 23

Cleft palate

Question 24

Congenital abnormalities seen with maternal use of benzodiazepines during pregnancy

Answer 24

Oral cleft malformation
Urinary tract malformation

Question 25

Monitoring requirements for pregnant women remaining on lithium

Answer 25

Level taken every 4 weeks

Question 26

Dose requirements for pregnant women remaining on lithium

Answer 26

Increased dose required in third trimester Dose requirement rapidly goes back to usual after delivery

Question 27

Antipsychotic most often used to treat schizophrenia during pregnancy

Answer 27

Olanzapine

Question 28

Ultrasound and ECHO monitoring required when lithium is used in pregnancy, to screen for Ebstein's anomaly

Answer 28

6 weeks gestation 18 weeks gestation

Question 29

Risks to infant of SSRI use during pregnancy

Answer 29

Neonatal irritability Spontaneous abortion Premature birth Reduced birth weight

Question 30

Risk of neural tube defect when valproate is used during pregnancy

Answer 30

1%

Question 31

Physiological change during pregnancy which leads to the most risk during ECT

Answer 31

Delayed gastric emptying

Question 32

Risk relating to delayed gastric emptying when giving ECT while pregnant

Answer 32

Aspiration

Question 33

Neurocognitive function most affected in children exposed to valproate during pregnancy

Answer 33

Verbal IQ

Question 34

Prevalence of Ebstein's anomoly in the general population

Answer 34

1 in 20000

Question 35

Where valproate treatment is deemed necessary in pregnancy, maximum dose limit

Answer 35

1000mg/day

Question 36

Drug class which can cause persistent pulmonary hypertension in the infant when taken in late pregnancy

Answer 36

SSRIs

Question 37

Antidepressant recommended first line for a pregnant woman

Answer 37

Sertraline

Question 38

Infant effects of benzodiazepine use during pregnancy

Answer 38

Urinary tract malformations Oral cleft/malformations Floppy baby syndrome

Question 39

First line medication for insomnia during pregnancy

Answer 39

Promethazine

Question 40

Drugs associated with Ebstein's anomoly

Answer 40

Lithium Benzodiazepines

Question 41

Monitoring of lithium levels required if continued through pregnancy

Answer 41

Monthly until 36 weeks Weekly after 36 weeks