Women

Question 1

What happens to plasma levels of methadone in late pregnancy?

Answer 1

During pregnancy, absorption is variable and methadone metabolism is accelerated due to
consistently and significantly increased CYP3A. With advancing gestational age, plasma levels of
methadone progressively decrease and clearance increases. The half-life of methadone falls from
an average of 22 to 24 hours in nonpregnant women to 8.1 hours in pregnant women

Question 2

Management of opioid use in pregnancy

Answer 2

American College of Obstetricians and Gynecologists (ACOG) concluded that the available evidence supports the use of buprenorphine (and methadone) as first-line medication for
pregnant opioid-dependent women who are new to treatment
● Note that Suboxone is not used in pregnant women (due to the naloxone)

Question 3

Biggest risk factor for postpartum psychosis

Answer 3

Bipolar is

associated with 100 x the risk of postpartum psychosis vs. the risk of the general population

Question 4

Risk factors for postpartum psychosis

Answer 4

• primiparity
• low social support
• sleep deprivation
• stressful events
• prematurity
• female infant
• obstetric complications (c/s, pre-eclampsia)
• family history of PPP, psychosis, +/- bipolar disorder
• past history of PPP**
• bipolar disorder**

Question 5

Lithium and breastfeeding?

Answer 5

No- drug is found in mother’s breast milk -possibly at full therapeutic levels
- **recommended either to discontinue drug or bottle feed

Question 6

Valproic acid and breastfeeding

Answer 6

some drug found in breast milk
- **generally considered safe to breastfeed while taking valproate
- infant should be monitored for adverse effects -if infant shows signs of irritability or
sedation, drug may need to be discontinued

Question 7

Biggest risk factor for postpartum depression

Answer 7

Hx of unipolar depression, MDD or PDD

Question 8

Is depression a risk factor for postpartum psychosis

Answer 8

No