Psychiatric Disorders in Pregnancy Flashcards
List red flag presentations for perinatal mental health problems
Recent significant change in mental state or emergence of new symptom
New thoughts or act of violent self-harm
New and persistent expressions of incompetency as a mother or estrangement from their baby
Give examples of screening questions used in pregnancy for mental health issues
During last month have you been bothered by feeling down, depressed or hopeless?
During last month, have you been bothered by having little interest/ pleasure in doing things?
Is this something you feel you need or want help with?
List some risk factors for mental illness in pregnant women
Young female/ Single mother Domestic issues Lack of support Substance misuse Unplanned pregnancy Pre-existing mental illness Personal or family history of mental illness
List indications for referral to psychiatry team in pregnancy
Psychosis Severe anxiety/depression/suicidal/self-harm History of bipolar/schizophrenia History of puerperal psychosis If on psychiatric medication Previous admission to mental health unit
When does puerperal psychosis typically onset?
Within 2 weeks of delivery
List clinical features of puerperal psychosis
Sleep disturbance Confusion Delusions, hallucinations Irrational ideas Mania
Puerperal psychosis is an emergency. True/False?
True
List major risk factors for puerperal psychosis
Bipolar disorder (50%)
Previous puerperal psychosis
1st degree relative with history
Outline management options for puerperal psychosis
Needs urgent admission to mother-baby unit
Antidepressants, antipsychotics, mood stabilisers, ECT
What is the percentage risk of puerperal psychosis recurrence in further pregnancies?
80%
Postnatal depression occurs in __ of women
10%
When does postnatal depression typically onset?
2-6 weeks postnatally
List clinical features of postnatal depression
Anxiety, irritability, tearfulness Lack of enjoyment Poor sleep Weight loss Concerns re baby
How does postnatal depression differ from “baby blues”?
Baby blues is more brief and self-limiting
Baby blues occur in __ of women
50%
When does baby blues usually occur?
Day 3-10 post-partum
How are baby blues managed?
Support from MDT
Reassurance and education
Warning signs of post-natal depression
How is mild-moderate postnatal depression managed?
Self help
Counselling
How is moderate-severe postnatal depression managed?
Psychotherapy
Antidepressants (option to start at 36 weeks partum)
Consider admission
What is the percentage risk of postnatal depression recurrence in further pregnancies?
25%
Outline risks to child of untreated perinatal mental health disorders
Low birth weight
Preterm delivery
Adverse childhood outcomes e.g. ADHD
Poor engagement/ bonding with child
What is the principle of psychiatric treatment in pregnancy?
Low dose monotherapy, consider stopping/changing
Increased screening of fetus (cardiac, growth scans)
Contingency plans if they get unwell
When should a foetal anomaly scan be carried out in someone pregnant and on psychiatric medication?
16 weeks
What is the main risk associated with psychiatric medications during the 1st trimester?
Risk of teratogenicity
What is the main risk associated with psychiatric medications during the 3rd trimester?
Risk of neonatal withdrawal
What is the main risk associated with psychiatric medications during breastfeeding?
Risk of medications passing into breast milk
Breastfeeding should be encouraged whenever possible in psychiatric pregnant patients. True/False?
True
Medications used in pregnany should be continued (generally in utero risk greater than exposure in milk)
Which antidepressant can cause fetal heart defects in an infant during the 1st trimester?
Paroxetine
All antidepressants can cause withdrawal and toxicity in neonates. True/False?
True
Usually self-limiting though
What is the main risk to the fetus of using SSRI’s after 20 weeks?
Neonatal pulmonary hypertension
State the lowest risk SSRIs and TCAs respectively, safe to use during pregnancy
SERTRALINE, fluoxetine
Imipramine, amitriptyline
SSRIs are generally safe during breastfeeding. Which should be avoided?
Citalopram
Doxepin
Why should benzodiazepines be avoided in pregnancy and breastfeeding?
Fetal malformations
Floppy baby syndrome
Lethargy, weight loss
Which antipsychotics - typical or atypical - are generally safe to use in pregnancy?
Typicals
Which antipsychotics are contraindicated in pregnancy?
Clozapine can cause agranulocytosis
Olanzapine can cause GDM and weight gain
Can anticholinergic drugs be used in pregnancy?
No
What foetal defect can lithium cause?
Ebstein’s anomaly
Is lithium contraindicated in breastfeeding?
Yes
What foetal defects can sodium valproate cause?
Neural tube defects Craniofacial defects IUGR Reduced IQ Cleft
Sodium valproate is safe to use in breastfeeding. True/ False
True
However, should be stopped before planning pregnancy and avoided in women of child-bearing age
It is normally ok to breastfeed if you are on an anticonvulsant. True/False?
True
What effect does carbamazepine have on the newborn?
Vitamin K deficiency
Haemorrhagic disease of newborn
Which mood stabiliser/anticonvulsant is considered safest to use in pregnancy?
Lamotrigine
List risks to mother of substance abuse during pregnancy
Other mental health conditions HIV, Hep B, Hep C Nutritional deficiency VTE STIs Endocarditis/ sepsis Poor venous access Opiate tolerance/ withdrawal Drug overdose/ death Risk of domestic abuse
What is the RCOG advice on alcohol during pregnancy?
Abstinence best but no evidence that 2 units a week is detrimental
List risks associated with alcoholism during pregnancy
Miscarriage Foetal alcohol syndrome Withdrawal Wernicke's encephalopathy (B1 deficiency) Korsakoff syndrome
List features of foetal alcoholic syndrome
Facial deformity Lower IQ Neurodevelopmental delay Epilepsy Hearing defect Cardiac + renal defects
List fetal risks of substance abuse during pregnancy
Teratogenic Abruption IUGR Preterm labour, miscarriage Developmental delay Withdrawal
What should be considered management-wise if substance abuse is occurring in pregnancy?
Methadone programmes Social work/child protection Labour planning - analgesia, anaesthesia Postnatal contraception plan Smear history
Breastfeeding is contraindicated in which cases of substance misuse?
Alcohol intake >8 units
Maternal HIV
Use of cocaine
