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Psychotherapy: 114b - Psychopharmacology of Pregnancy

Psychology8 CardsCreated about 2 months ago

This flashcard set reviews key considerations when using psychiatric medications during pregnancy, including neonatal adaptation syndrome, a self-limited condition linked to SSRIs, benzodiazepines, and antipsychotics. It also highlights risperidone as the antipsychotic associated with fetal malformations at higher doses and outlines benzodiazepine-related risks, such as neonatal withdrawal and transient developmental delays. Despite these risks, treating maternal psychiatric illness remains a priority.

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What is neonatal adapatation syndrome?

Which medications is it associated with?

Uncomfortable infant: fussy, gittery, stiff, tremulous, feeding/breathing concerns

Generally does not require a higher level of care or delay discharge post-partum

  • SSRIs

  • Benzos

  • Antipsychotics

In gneral, it is best to treat maternal depression, anxiety, and/or psychosis and accept risk of neonatal adaptation syndrome

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Key Terms

Term
Definition

What is neonatal adapatation syndrome?

Which medications is it associated with?

Uncomfortable infant: fussy, gittery, stiff, tremulous, feeding/breathing concerns

Which antipsychotic is associated with fetal malformations

Risperidone (at ≥ 2mg/day)

Which concerns for benzos in pregnancy are supported by evidence?

  • Increased risk of neonatal adaptation syndrome

  • Behavioral development ...

Which concerns for SSRIs in pregnancy are supported by evidence?

  • Neonatal adaptation syndrome
    Known association with SSRI, but generally does not require a higher level of ca...

Which concerns for Lithium in pregnancy are supported by evidence?

  • Increased risk of cardiac malformation (Ebstein’s anomoly)
    But lower than perviously thought

Which concerns for antipsychotics in pregnancy are supported by evidence?

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Psychotherapy: 114b - Psychopharmacology of Pregnancy
TermDefinition

What is neonatal adapatation syndrome?

Which medications is it associated with?

Uncomfortable infant: fussy, gittery, stiff, tremulous, feeding/breathing concerns

Generally does not require a higher level of care or delay discharge post-partum

  • SSRIs

  • Benzos

  • Antipsychotics

In gneral, it is best to treat maternal depression, anxiety, and/or psychosis and accept risk of neonatal adaptation syndrome

Which antipsychotic is associated with fetal malformations

Risperidone (at ≥ 2mg/day)

Which concerns for benzos in pregnancy are supported by evidence?

  • Increased risk of neonatal adaptation syndrome

  • Behavioral development may be delayed at first, but caught up by 2 years

  • Withdrawal symptoms
    But no seizures

  • Risk for sedation due to transfer to breast milk

Which concerns for SSRIs in pregnancy are supported by evidence?

  • Neonatal adaptation syndrome
    Known association with SSRI, but generally does not require a higher level of care or delay discharge post-partum

  • Slight increase in mild persistent pulmonary hypertension in babies exposed to SSRIs during 3rd trimester

No evidence for association with cardiac malformation, autism, pre-term delivery

In general, risks of untreated maternal depression are much higher than those associated with SSRIs

Which concerns for Lithium in pregnancy are supported by evidence?

  • Increased risk of cardiac malformation (Ebstein’s anomoly)
    But lower than perviously thought

    • Can continue at lowest effective dose, supplement with folate

Which concerns for antipsychotics in pregnancy are supported by evidence?

  • Maternal weight gain, metabolic changes
    Increased risk of gestational diabetes

  • Neonatal adaptation syndrome

  • Slower neuromotor development at first, but catch up by 2 years

Exception: risperidone has a higher risk of cardiac malformation; not first line in pregnancy

How would you advise mothers who are breastfeeding and taking psychotropic medications?

  • Most do transfer to breast milk, bu tth erelative infant dose is much lower than maternal dose

  • If taking Li, monitor breast milk levels

  • Monitor babies for weiht concerns, agitation, sleep issues

  • Milk supply will not be impacted

Levels of which psychotropic medication should be monitored in breastmilk, if breastfeeding?

Lithium

Others do not need to be monitored unless concern for weight, agitation, sleep issues in the infant