Pre and post natal Flashcards
What percent of pregnant women will meet criteria for a MDE during pregnancy?
14-23%
What percent of women have some symptoms of a MDE postpartum?
50%
What percent of women have some type of mood disturbance postpartum?
85%
True or false: antenatal or postpartum depression increases the likelihood of a later MDE
True
More or less education is a risk factor for postpartum depression?
Less
Increased or decreased physical symptoms with pregnancy is a risk factor for postpartum depression?
Increased
True or false: a distant h/o depression is a risk factor for postpartum depression
True
What are the “baby blues”?
Mood disorder that presents within the first few days after delivery, and usually resolves within 2 weeks
What is the incidence of baby blues?
50-85% of women
What are the s/sx of baby blues? (4)
- Mood lability
- Tearfulness
- Anxiety
- Irritability
What is the duration of baby blues?
Peak on 4th-5th day, and last from a few hours, to a few days
True or false: the baby blues in and of themselves are not a disorder
True
When is evaluation for baby blues needed?
If longer than 2 weeks
When does postpartum depression begin?
Usually emerges 2-3 months postpartum, but must occur within 4 weeks of delivery
True or false: postpartum depression is clinically indistinguishable from depression at other times
True
What is the depression scale for postpartum depression?
Edinburgh postnatal depression scale
What is the correlation between serum levels of hormones with postpartum depression?
There is none
True or false: postpartum anxiety is equally common as postpartum depression
True
What are the anxiety disorders that can appear postpartum? (4)
- GAD (adequacy of parenting)
- Panic attacks
- Hypochondriasis
- OCD (thoughts of harming baby)
Who in particular is worried about parenting skills?
Those who had bad childhood experiences with their parents
Why are panic attacks more common during pregnancy? (2)
- Hotter than usual during pregnancy–may predispose to panic attacks
- Baby kicks and hyperfocus on body
What is the common presentation of OCD in new mothers?
Involves thoughts of harming the baby
True or false: excessive thoughts of harming a baby in the postpartum period is common
True
What is postpartum psychosis?
Typically a mixed or manic episode as part of a bipolar illness
When do s/sx of postpartum psychosis usually begin?
2-3 days or within 2 weeks
What percent of women who develop postpartum psychosis have no psych history?
50%
What are the three major initial symptoms of postpartum psychosis?
- Restlessness
- Irritability
- Insomnia
What are the later s/sx of symptoms of postpartum psychosis? (4)
- Rapidly confusing or shifting depressed or elated mood
- Confusion
- Erratic behavior
- Delusions or hallucinations
What is the major concern with postpartum psychosis?
Risks for suicide and infanticide are high
What four things must be judged to assess for postpartum psychosis?
- Judgement
- Reality testing
- Anger control
- Intent
What is the way to talk about the thoughts of harming infants (if not psychotic)?
- High stress–normal
- “Thoughts are not behavior”
What are the risks to the baby of untreated depression during pregnancy?
- Preterm
- Low birth weight
- SMGA
What is the best predictor of long term neurocognitive outcomes with maternal depression?
Maternal mood–not medication exposure
What are the primary treatments for intrapartum depression? (2)
- Interpersonal psychotherapy
- CBT
What is the pharmacotherapy for intrapartum depression?
SSRIs
True or false: medication risks are similar to untreated depression during pregnancy
True
What are the fetal abnormalities with SSRIs?
Septal heart defects
True or false: there is an elevated risk of miscarriage with SSRIs
True?
True or false: there is not a risk of preterm birth with SSRIs intrapartum
False
What is the SSRI of choice for pregnant women? Which is contraindicated?
- Sertraline is good
- Paroxetine is bad
What is the role of SNRIs in pregnancy?
Not used, but not studied enough
What are the s/sx of the SSRI use in the neonate? (6)
- Restlessness
- Tremor
- Rigidity
- Tachypnea
- Hypoglycemia
- Szs
What is the treatment for pregnant women with mild to moderate depression?
Therapy
What is the treatment for pregnant women with severe depression?
Meds
What is the treatment for pregnant women with bipolar disorder?
Medications–really need to control it
What should be done with pregnancy if a woman is already on an SSRI? Why?
Take their preference into account
-6x increase in depression relapse if taken off
If a woman is on an SSRI that is not recommended in pregnancy, should she switch to one that is more studied in pregnancy?
No–leads to possible increased switching.
Unless she asks to change
What are the bipolar drugs that have a high risk of teratogenic effects?
Tegretol (carbamazepine) and depakote (valproic acid)
What is the safest bipolar drug in pregnancy?
Li
What is the major risk of valproic acid in pregnancy?
autism or congenital malformations (ASDs, cleft palate)
What are the risks of untreated postpartum depression? (3)
- Less mother-child bonding
- Poorer mental and motor development at 1 yr
- Insecurity / behavioral disturbance
What are the most common complications in modern obstetrics?
Postpartum depression
Why are depressive symptoms common postpartum?
Very high expectations and demands
The safest medication to treat depression while breastfeeding is what?
Whatever medication is likely to get the woman well
True or false: postpartum depression is highly resistant to treatment
False
Why is postpartum depression / anxiety underreported?
Shame around being depressed, or anxious thoughts
