Section VI. Special Populations - Perinatal Flashcards
What is the timeline defined by ‘perinatal depression’?
Unipolar MDE occurring during pregnancy and in the first year postpartum
What % of postpartum MDE begins during pregnancy?
40%
What is the timeline of the DSM-5 specifier, ‘with peripartum onset’?
MDE emerges during pregnancy or in the first 4 weeks after delivery
What % of women have a unipolar MDE during pregnancy? % for minor depression?
Major 7.5%
Minor 18.4%
What % of women experience a unipolar MDE in first 3 months postpartum?
Major 6.5%
Minor 19.2%
What % of pregnancies are unplanned?
50%
What are the risks of untreated MDD during pregnancy?
- poor nutrition
- poor prenatal medical care
- smoking
- recreation drug use
- significant suffering for woman
What are the risks of untreated MDD at delivery [8]?
- increased risk of poor obstetrical outcomes
- small neonates for GA
- NICU
- increased rates of neonatal complications
- impaired mother-baby bonding
- infant sleep difficulty
- mild developmental delay
- cognitive, behavioural, and emotional problems in baby
What are the 1st line recommended treatments for mild to mod depression during pregnancy?
CBT or IPT (level 1 evidence)
What are the 2nd line recommended treatments for mild to mod depression during pregnancy?
Citalopram
Escitalopram
Sertraline
** all level 3 evidence
What are the 3rd line recommended treatments for mild to mod depression during pregnancy?
Level 2: exercise, acupuncture, bright-light therapy
Level 3: Bupropion, Desvenlafaxine, duloxetine, fluoxetine, fluvoxamine; ECT
Level 4: Mirtazepine, TCA (caution with clomipramine), Venlafaxine; psychotherapy (Mindfulness-CBT, internet assisted CBT)
What is the odds ratio for CV malformation if Paroxetine used in 1st trimester?
1.5
Paroxetine = Category D medication
What is the odds ratio of spontaneous abortion when using SSRI?
1.5 (but, result not clinically significant)
At delivery, if fetus has been exposed to SSRI during trimester 3, what qualities might baby exhibit? What % of infants exhibit these qualities? How long does it take for these qualities to resolve?
Poor neonatal adaptation in 15 to 30%:
- jitteriness
- irritability
- tremor
- respiratory distress
- excessive crying
Symptoms likely to resolve in 2-14 days esp with supportive care
What medications are most likely linked with poor neonatal adaptation ‘syndrome’?
Paroxetine, Venlafaxine, Fluoxetine