Psychiatry in Pregnancy

Question 1

Are children of depressed mothers more likely to be SGA or macrocosmic?

Answer 1

SGA

Question 2

When should meds be considered being stopped?

Answer 2

Only if having no positive effect

Consider changing

Question 3

What is the most important step in management?

Answer 3

Prep

• plan pregnancy
• if high risk of postnatal conditions - discuss
• if stopped lithium in pregnancy discuss restarting

Question 4

The best drug at the beginning of the pregnancy is the same best drug throughout. T/F?

Answer 4

F - best drug varies throughout trimesters

Question 5

What is the first line antidepressants in pregnancy?

Answer 5

Still SSRIs

Fluoxetine
Sertraline

Question 6

Antipsychotics are bad in pregnancy. T/F?

Answer 6

F - v.little risk
esp. olanzapine

Just gestational diabetes risk in second gen.

Question 7

What anti-epeletic/mood stabiliser MUST be avoided?

What is the time frame in which it causes problems?

Answer 7

Sodium valproate

By 28 days - neural` tubes are closed by then

Question 8

Should lithium be avoided in pregnany? Why?

Answer 8

Yes - but can be given just needs additional monitoring

Can cause Ebstein’s anomaly

Question 9

Why are benzos avoided in later pregnancy?

Answer 9

Have sedation affect - “floppy baby”

Question 10

Is there more or less drug exposure in uterus or breastmilk?

What is the one exception?

Answer 10

Breastmilk has less exposure - typically if drug used in 3rd trimester safe in breastfeeding

Lithium - more concentrated in breastmilk must be AVOIDED

Question 11

Baby is born with low nasal bridge, smooth philtrum, small eyes, small head and thin upper lip. What is this baby at risk of, which is cause of death in 20% of kids with same condition?

Answer 11

Wernick’s encephalopathy

Foetal alcohol syndrome

Question 12

Is female suicide more frequent postnatally?

Answer 12

No but more emotive

Question 13

What are red flag symptoms of suicide in mothers?

Answer 13

• Signficiant change in mental state
• Violent self harm
• Estrangement from baby (useless or no feelings towards baby)

Question 14

Would you refer a woman with diagnosed bipolar and stable with meds to perinatal mental health team?

Answer 14

Yes - high risk factors

Bipolar meds could be teratogenic

Good to plan with perinatal mental health team

Also refer anyone who has had previous episodes of anet/postnatal illness

Question 15

50% of women have baby blues. How long does it last?

Answer 15

Day 3-10

Normal hormonal reaction 
Tearful
Irritable
Anxious
Poor sleep and concentration

Question 16

What is puerperal psychosis?

When does it occur?

How is it managed?

Answer 16

Psychosis and CONFUSION post birth

Within a couple of weeks

Emergency and have to be admitted to mother-baby unit (emergency due to increased suicide and infanticide risk)

Question 17

At what time does postnatal depression occur and how long does it last?

How many mothers are affected? More common than general pop?

Answer 17

10% - same as general pop - just tends to be worse than normal depression

Onset 2-6wks
Can last weeks to months