Psychiatry in Pregnancy

Question 1

BPAD

Answer 1

Lithium frequently used –> increases risk of cardiac abnormality

Increased excretion of lithium during pregnancy, monitor levels

If low-risk patient attempt withdrawing lithium –> risk of relapse

High risk of maternal suicide and postnatal medication is important

Question 2

Depression

Answer 2

Common postnatal

3% of women who conceive taking antidepressants
SSRIs (fluoxetine) better than TCAs
Avoid Paroxetine as it causes cardiac abnormalities

Question 3

Schizophrenia

Answer 3

Therapy continued as before

Risk of ramifications of relapse greater than risk of medications

Avoid clozapine and olanzapine

Question 4

Anxiety

Answer 4

CBT recommended

Avoid benzodiazepines

Question 5

Fetal Alcohol Syndrome

Answer 5

Facial abnormalities
IUGR
Small or abnormal brain
Developmental delay
Usually >18 units/day alcohol exposure

Question 6

Tobacco

Answer 6

1/3 of women smoke during pregnancy

Dose-response manner
Increased risk of miscarriage, IUGR, PTD, placental abruption, stillbirth and SIDS
PET is more severe if associated with smoking
Consider high risk