Pregnancy and breastfeeding

Question 1

Mood stabiliser

Answer 1

Both valproate and carbamazepine are associated with an increased risk of spina bifida (1-2% and 0.5-1% respectively). Valproate is considered more dangerous than carbamazepine.

Lithium is associated with Ebstein’s anomaly (relative risk 10-20 times that of control, absolute risk 1:1000)

Question 2

Benzodiazepines

Answer 2

Benzodiazepines appear to be associated with oral clefts in newborns and floppy baby syndrome.

Question 3

Antipsychotics

Answer 3

Olanzapine is recommended by the Maudsley guidelines in the situation of a pregnant patient in need of an antipsychotic. Suggested in pregnancyOlanzapine, haloperidol, clozapine, chlorpromazine
Suggested in breastfeedingOlanzapine, sulpride

Question 4

Antidepressant

Answer 4

Paroxetine is more commonly associated with neonatal withdrawal than other SSRIs, it is also associated with an increased risk of congenital malformations (particulaly heart defects) compared with other antidepressants (Thormahelen 2006) Suggested in pregnancyFluoxetine, amitriptyline, imipramine, (avoid paroxetine)
Suggested in breastfeedingSertraline, paroxetine
.

Question 5

TCA in breastfeeding

Answer 5

All tricyclic antidepressants, except doxepin, can safely be given to a woman who is breastfeeding provided the infant is full term, healthy and his or her progress is monitored. Poor sucking and swallowing, muscle hypotonia, drowsiness and vomiting were reported in a 9 day old breastfed infant whose mother was taking doxepin 35mg daily.