Insomnia pregnancy second trimester12/5/2023 ![]() Peripartum depression is common and an estimated 1 in 7 women experience an episode during pregnancy or in the first several weeks postpartum. Summary information for mood stabilizers, antipsychotics, stimulants, benzodiazepines, and sleep aids is also provided. We review medications by class with an emphasis on antidepressants. Research and statistical methods required to interpret this literature are discussed. In this study, recent research on the use of common psychotropic medications in perinatal women is reviewed. Large, well-designed studies that include management of confounding variables are particularly important in establishing the validity of associations between drugs and outcomes. These domains are impacted by both psychiatric disorders and the medications used to treat them. Perinatal outcomes include miscarriage, major birth defects, preterm birth, stillbirth, neonatal adaptation signs, and behavioral and developmental effects. Food and Drug Administration (FDA) Pregnancy and Lactation Labeling Rule, 10 clinicians must assess the risks of untreated illness as well as potential adverse effects of pharmacotherapy with respect to pregnancy and infant outcomes. 9 A well-intentioned focus on limiting harm to the fetus/infant has resulted in a public health inequity of limited data regarding the drug treatment of maternal diseases.Ĭonsistent with the aim of the 2015 U.S. However, pregnant women have been labeled “the last therapeutic orphans” with respect to pharmacotherapy due to a dearth of research to guide care. Medications and psychotherapy are both evidence-based approaches to the treatment of peripartum depression. 8 Assessment and treatment for perinatal psychiatric disorders results in better outcomes for the woman, her fetus/infant, and family. 5–7 Pregnant women with untreated mental illness also are more likely to engage in high-risk behaviors, such as indiscriminate sex and exposure to sexually transmitted infections, smoking, alcohol and drug use, less prenatal care, and poor nutrition. Maternal mental illness during pregnancy has been associated with adverse perinatal outcomes, including placental abnormalities, small-for-gestational-age fetuses, fetal distress, preterm delivery, neonatal hypoglycemia, adverse neurodevelopmental outcomes, and disordered attachment. Preventive Services Task Force, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics have recommended screening women for mood and anxiety symptoms during pregnancy and postpartum and either treating (in the role of primary care physician) or referring for psychiatric treatment. 1 With increasing recognition of the public health impact of perinatal illness, organizations such as the U.S. Suicide remains a leading cause of mortality in the postpartum period and accounts for 20% of maternal deaths in the first year after birth. The perinatal period is a high-risk time for the occurrence of maternal mental illnesses such as major depressive disorder (MDD), bipolar disorder, and anxiety disorders. Regular symptom monitoring during pregnancy and postpartum and medication dose adjustments to sustain efficacy constitutes good practice. Untreated maternal psychiatric illness also carries substantial risks for the mother, fetus, infant, and family.Ĭonclusions: The goal of perinatal mental health treatment is to optimally provide pharmacotherapy to mitigate the somatic and psychosocial burdens of maternal psychiatric disorders. Due to the dramatic physiological changes of pregnancy and enhanced hepatic metabolism, drug doses may need to be adjusted during pregnancy to sustain efficacy. Antipsychotics, other than risperidone and potentially paliperidone, have not been associated with an increase in birth defects olanzapine and quetiapine have been linked with an elevated risk of gestational diabetes. Lithium exposure is associated with an increased risk for fetal cardiac malformations, but this risk is lower than previously thought (absolute risk of Ebstein's anomaly 6/1,000). Results: Selective serotonin reuptake inhibitors or serotonin–norepinephrine reuptake inhibitor medications are not associated with higher rates of birth defects or long-term changes in mental development after adjustment for confounding factors associated with underlying psychiatric illness. The evidence on exposure to common psychotropics during pregnancy and breastfeeding is reviewed. Methods: The scope of the public health problem of perinatal mental disorders is discussed followed by an examination of the specific research methods utilized for the study of birth and developmental outcomes associated with maternal mental illness and its treatment. The perinatal period is a particularly high-risk time for depression, bipolar, and anxiety disorders. Background: Psychiatric illnesses are common in women of childbearing age.
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