Psychotropic Medication In Pregnancy Research Articles

Safety of psychotropic medications in pregnancy: an umbrella review.

Weighing risks and benefits of the use of psychotropic medications during pregnancy remains a challenge worldwide. We systematically assessed the strength of associations between psychotropic medication use in pregnant people with mental disorders and various adverse health outcomes in both pregnant people and foetuses. Systematic reviews with meta-analyses of observational studies investigating the association between exposure to psychotropic medication in pregnancy and any adverse health outcomes were included. Credibility was graded into convincing, highly suggestive, suggestive, weak or not significant. Quality of the meta-analyses and of individual studies were assessed with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) the Newcastle-Ottawa Scale (NOS), respectively. We considered 21 meta-analyses encompassing 17,290,755 participants (AMSTAR 2 high = 1, low = 12, or critically low = 8). Evidence was suggestive for: (1) preterm birth in pregnant people with either any mental disorder (equivalent odds ratio 1.62 (95% confidence interval 1.24-2.12) or depression (1.65 [1.34-2.02]) receiving antidepressants during any trimester of pregnancy; (2) small for gestational age for pregnant people with depression receiving a SSRI during any trimester of pregnancy (1.50 [1.19-1.90]); and (3) major congenital malformation (1.24 [1.09-1.40]) or cardiac malformations (1.28 [1.11-1.47]) in babies for pregnant people with depression or anxiety receiving paroxetine during first trimester of pregnancy. Additional associations were supported by weak evidence, or were not statistically significant.This umbrella review found no convincing or highly suggestive level of evidence of adverse health outcomes associated with psychotropic medication use in pregnant people with mental disorders.

The use of psychotropic medication in the perinatal period

Key content: The perinatal period confers an elevated risk of both relapses and new onset of mental illness. Suboptimal treatment can have a profound impact on maternal mortality and morbidity, neonatal outcomes and longer term child development. Most psychotropic medication can be used safely in pregnancy, with some notable exceptions. While decisions on the use of psychotropic medications in pregnancy are often complex and should be multidisciplinary, it is imperative that obstetricians and gynaecologists familiarise themselves with current literature to provide evidence‐based counselling and care. Existing guidelines on the use of psychotropic medication are largely aimed at psychiatrists, and to date there has been a lack of concise, digestible information with a focus on core knowledge for obstetricians and gynaecologists. We summarise existing evidence on the use of antidepressants, antipsychotics, mood stabilisers and sedatives in the perinatal period. For each drug class we describe the teratogenicity, impact on pregnancy, breastfeeding and the newborn. Learning objectives: To be familiar with common psychotropic medication used in pregnancy and the postpartum period. To understand key evidence on the safety profile of psychiatric medication in the perinatal period and apply this to individualised counselling.

Psychotropic medication in pregnancy – An unexpected outcome

Psychotropic medication in pregnancy – An unexpected outcome

Psychotropic medication in pregnancy and lactation and early development of exposed children.

There is still limited knowledge about alterations of blood concentrations of psychotropic drugs during pregnancy, the transfer of psychotropic drugs into breastmilk and the effects on exposed children. We investigated changes in concentrations of psychopharmacological medication during pregnancy and lactation in serum and breastmilk at different time points in a naturalistic sample of 60 mothers and observed the development of the exposed children in the first 12 months. We found a decrease in serum concentrations from the first to the second trimester of amitriptyline, duloxetine, escitalopram, quetiapine and sertraline. Citalopram stayed rather stable during pregnancy, sertraline levels interestingly increased again from the second to the third trimester. High concentration-by-dose ratios in breastmilk were found for venlafaxine as well as lamotrigine, low for quetiapine and clomipramine. Similarly, clomipramine and quetiapine showed low milk/serum-penetration ratios. Regarding the birth outcome measures in children, we found no significant differences between in utero exposed compared to nonexposed newborns. There were no significant differences in the development in the first 12 months. Psychotropic medication in the peripartum needs a balancing of risks and benefits and a continuous therapeutic drug monitoring can be a guidance for clinicians to monitor drug alteration patterns, which are likely to occur due to physiological pregnancy-associated changes in pharmacokinetics. Accordingly, therapeutic drug monitoring can optimize a medication in pregnancy and lactation with the lowest effective dose.

Prescribing of Psychiatric Drugs in Pregnancy: A Review of Current Practice in a Community Mental Healthcare Setting

AimsPrescribing of psychotropic medications in pregnancy is still considered a ‘grey area’ in clinical practice. National Institute for Health and Care Excellence (NICE) in the UK suggests that the decisions should be person-specific, considering the risks to both the mother and unborn child, and the patient is supported to make an informed decision. It is important to explore the use of psychotropic medications during pregnancy, or lack of it, and its subsequent impact on maternal mental health. It was intended to review the decisions expectant mothers are making regarding taking psychiatric medications during pregnancy, and the associated clinical outcomes. Their mental capacity for taking decisions was also checked.MethodsA retrospective audit of case notes of patients (n = 16) known to community psychiatric team (CMHT) and specialist perinatal mental health (PNS) services in Wolverhampton, who notified their pregnancy between December 2020 and December 2021. Demographic and clinical data were collected from the electronic records.ResultsThe sample had a mean age of 28.8 ± 6.3 years (range: 19 to 39 years), and 68.8% of them were Caucasian. A wide range of psychiatric diagnoses were present, most (62.5%) had comorbid diagnoses; and 25% had substance use, most commonly cannabis. Mean duration of gestation at the review following notification of pregnancy was 14.5 ± 7.7 (range: 6 to 29) weeks. It was observed that 25% were not taking psychiatric medications prior to pregnancy, 43.8% stopped taking their medication prior to the psychiatric review, most stopping abruptly, and 31.2% had continued their medication. The medications included aripiprazole, olanzapine, quetiapine, venlafaxine, sertraline and promethazine. Following the review, only 18.8% continued their medications. Of the 13 (81.3%) patients who were not taking medications, 9 (69.2%) had adverse mental health outcomes, with 2 (15.4%) patients requiring inpatient care. However, later 8 (61.5%) started taking medications whilst under the care of PNS. All of them had mental capacity to decide regarding their psychiatric treatment at the review.ConclusionMost psychiatric patients avoided taking psychotropic medications initially during pregnancy, however, a considerable proportion restarted their medications following review with the perinatal psychiatry team. The majority of patients who did not take medications had negative mental health consequences. It is important to develop an evidence base about the use of psychiatric medications in pregnancy and the associated short and long-term outcomes that may help the quality of information shared with patients.

Psychotropic Medications for Bipolar Disorder in Pregnancy

Women with bipolar disorder are at high risk for relapse throughout pregnancy and in the postpartum period, especially when mood stabilizer medication is discontinued. Postpartum disruption of circadian rhythms, immune dysregulation, and abrupt fluctuation of reproductive hormones can precipitate postpartum psychosis, a psychiatric emergency with an increased risk of suicide and a 4% risk of infanticide. Fortunately, effective treatments exist for managing bipolar disorder in pregnancy, with the aim of preventing episode recurrence and maintaining function. Risks associated with psychotropic medication in pregnancy must be balanced against risks of untreated bipolar illness. In this review, we present risk profiles of existing treatments for bipolar disorder in pregnancy and breast-feeding, concluding with key evidence-based resources for clinicians and patients. [ Psychiatr Ann. 2019;49(9):392–398.]

Women's Psychiatry.

Brain disorders and mental diseases, in particular, are common and considered as a top global health challenge for the twenty-first century. Interestingly, women suffer more frequently from mental disorders than men. Moreover, women may respond to psychotropic drugs differently than men, and, through their lifespan, they endure sex-orientated social stressors. In this chapter, we present how women may differ in the development and manifestation of mental health issues and how they differ from men in pharmacokinetics and pharmacodynamics. We discuss issues in clinical trials regarding women participation, issues in the use of psychotropic medications in pregnancy, and challenges that psychiatry faces as a result of the wider use of contraceptives, of childbearing at older age, and of menopause. Such issues, among others, demand further women-oriented psychiatric research that can improve the care for women during the course of their lives. Indeed, despite all these known sex differences, psychiatry for both men and women patients uses the same approach. Thereby, a modified paradigm for women's psychiatry, which takes into account all these differences, emerges as a necessity, and psychiatric research should take more vigorously into account sex differences.

567: Co-prescription of opioids and psychotropics among commercially insured US pregnant women and adverse pregnancy outcome

Both opioid or psychotropic prescription during pregnancy are independently associated with adverse pregnancy outcomes; however, the impact of co-prescription of opioids and psychotropics is not known. Our objective was to estimate the association between co-prescription of opioid and psychotropic medications in pregnancy and perinatal outcomes, including preterm birth (PTB) <37 weeks’ gestation, cesarean delivery, and duration of hospitalization for delivery, compared to opioids only, psychotropics only, and no prescription. A retrospective observational study of the 2001-2015 MarketScan database, a nationwide de-identified population of commercial insurance beneficiaries. Our primary exposure was outpatient co-prescription of both opioids and psychotropics during pregnancy compared to 1) psychotropic only, 2) opioids only, and 3) neither. Our primary outcome was PTB <37 weeks, and, secondarily, PTB<34 weeks, cesarean delivery and duration of delivery hospitalization. We used multivariable logistic regression modeling, adjusting for maternal age, insurance type, dependent children, diagnosis codes of alcohol, tobacco, or illicit drug use, and US region to determine the association between co-prescription and pregnancy outcomes. Among 958,274 assessed pregnant women, 94,588 (9.9%) had only an opioid prescription, 55,285 (5.8%) had only a psychotropic prescription, and 19,884 (2.1%) had both. Women with opioids and psychotropics co-prescription during pregnancy were more likely to have a PTB compared to those who were prescribed opioids only (11.5% vs. 8.7%; AOR: 1.33; 95% CI: 1.26-1.40), psychotropics only (9.1%; AOR: 1.32; 95% CI: 1.25-1.39), and no prescription (7.0%; AOR: 1.70; 95% CI: 1.62-1.78). Women with co-prescriptions were generally more likely to have a PTB<34 weeks, deliver via cesarean delivery, and have a longer hospitalization duration for both vaginal and cesarean deliveries compared to women with prescriptions for opioids only, psychotropics only, and no prescription (Table 1). Among commercially insured US pregnant women, co-prescription of opioids and psychotropics increases risk for PTB, as well as cesarean delivery and duration of delivery hospitalization, compared to prescription to either alone or no prescription. Further studies are needed to understand the relationship between opioids and psychotropics in pregnancy and adverse pregnancy outcomes.

Psychotropic medication use during pregnancy

AbstractGlobally, mental health‐related issues are a growing concern. Pregnant women with mental health‐related illnesses present a unique challenge to health professionals. During pregnancy, the decision to withhold, modify or continue psychotropic medication requires consideration of both maternal and infant outcomes. Health professionals must be aware withdrawal of these medications during pregnancy can often lead to symptom relapse. Decisions around medication management during pregnancy can be challenging due to the lack of data and occasionally conflicting data regarding safety. It is essential that women do not receive conflicting information from health professionals because this can lead to confusion and both intentional and unintentional non‐adherence. Recently, it has been suggested that pharmacists may help optimise medication management and patient outcomes in perinatal care. This review outlines the use of psychotropic medications in pregnancy and discusses key considerations for those involved in providing clinical care to pregnant women with mental illness.

Recommendations for the use of ECT in pregnancy: literature review and proposed clinical protocol.

Psychiatric disorders are common in pregnancy, affecting 15-29% of pregnant women. Untreated depression has negative health consequences for mother and fetus. Electroconvulsive therapy (ECT) is an effective option for the treatment of severe depression, high suicide risk, catatonia, medication-resistant illness, psychotic agitation, severe physical decline, and other life-threatening conditions. To our knowledge, however, there is no literature that consolidates all the evidence on maternal and fetal risks associated with untreated depression, medications, and ECT then translating it into one cohesive protocol that could serve as a management guide and a source of reassurance to health-care providers involved in such practice. Hoping to facilitate ECT access to perinatal patients, the authors combined their multidisciplinary clinical experience (in perinatal psychiatry, neuropsychiatry and neuromodulation, and anesthesiology) at three different centers in the USA (Brigham and Women's Hospital/Harvard Medical School, The University of Chicago, and Brown University) with a careful and critical literature review and propose guidelines for the administration of ECT in pregnancy. A comprehensive review of the relevant literature regarding both ECT and psychotropic medications in pregnancy was performed, including meta-analyses of randomized controlled trials published in general medicine, anesthesiology, psychiatry, and obstetrics journals and guidelines. The indication and appropriateness of ECT in pregnancy must be carefully weighed against the risks of untreated maternal illness and those of alternative treatment options. The safety of ECT in pregnancy has been documented over the last 50years. The adverse effects in pregnancy are similar to the risks of ECT in any individual. The most common risk to the mother is premature contractions and preterm labor, which occur infrequently and are not clearly caused by ECT. The rates of miscarriages were not significantly different from that of the general population. There have been no associations of ECT with congenital anomalies, either morphologic or behavioral, and no neurocognitive disturbances in the child. ECT is a reasonably safe and effective treatment alternative for management of many psychiatric disorders in pregnant patients. The authors provide recommendations for treatment modifications in pregnancy-based physiologic changes that occur during that period and consolidate them into a protocol that can assist clinicians in improving access and safety of ECT for pregnant patients.

Risks associated with psychotropic drugs during pregnancy

Unplanned pregnancies in women with psychiatric illness are common and result in exposure of the fetus to multiple psychotropics during the first trimester. Literature reveals that olanzapine may rarely cause major malformations and selective serotonin reuptake inhibitors may be associated with primary pulmonary neonatal hypertension. We present a rare case of 39-year-old (middle-aged) female Gravida 4 para 2 abortion 1 live 2, with bipolar affective disorder with gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) presenting in the third trimester of her pregnancy. The patient continued 5 mg olanzapine and 150 mg sertraline throughout pregnancy unsupervised. Ultrasonographic findings revealed multiple congenital anomalies in the fetus, and emergency cesarean was conducted in the 32nd week of pregnancy, which was followed by neonatal complications including bradycardia, gasping, absent birth cry and reflexes, and weak gross motor activity and early neonatal death. The anomalies observed in the fetus are similar to the anomalies that have been observed and discussed with psychotropics in the past. Thus, we report this case to understand in naturalistic setting – the complications and risks associated with psychotropic medications in pregnancy along with other physical morbidities including GDM and PIH in the female suffering from bipolar disorder.

British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017.

Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records.

Although many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant. (1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy. Retrospective cohort studies. Primary care. Women treated for psychosis who became pregnant, and their children. Treatment with antipsychotics, lithium or anticonvulsant mood stabilisers. Discontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders. Clinical Practice Research Datalink database and The Health Improvement Network primary care database. Prescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy. A few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage. Psychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics. Future research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs. The National Institute for Health Research Health Technology Assessment programme.

Managing Your Own Mood Lability: Use of Mood Stabilizers and Antipsychotics in Pregnancy.

The management of psychiatric disorders during the perinatal period can be difficult; psychiatric decompensation during pregnancy can affect not only the mother but also the fetus and neonate. It is imperative that psychiatric providers proactively discuss pregnancy planning, and be able to thoughtfully weigh the risks of untreated psychiatric illness and psychotropic medications in pregnancy and breast-feeding. With the exception of valproate and carbamazepine, several mood stabilizers and antipsychotics can be utilized during pregnancy with minimal risk to the fetus and neonate in terms of major malformations; there is a growing body of evidence regarding the risk profile of use of these medications in pregnancy. Key Points Preconception planning is very helpful when it can be done; consider discussion and documentation of risks at time of administration of psychotropic medications for any reproductive-aged women, regardless of plans for conception. Continued psychiatric stability through the perinatal period is imperative; the risks of an untreated psychiatric disorder are just as important, if not more so important, than the risks of psychotropic medication exposure. Exposure to one psychotropic medication is safer than exposure to multiple medications. Utilize lowest effective dose of medication; most risks are not dose dependent, therefore would typically prefer higher dose of medication, rather than emergence of psychiatric symptoms, in order to avoid exposure of the fetus to both psychotropic medications and psychiatric symptoms. General recommendations are to avoid valproate and carbamazepine in reproductive-aged women. With close monitoring, lithium can be safely utilized in pregnancy. Preliminary data regarding use of atypical antipsychotics is reassuring in regards to major malformations; however, larger numbers of participants are needed to provide more complete reproductive safety data with this class. Clearly document risks of an untreated psychiatric illness as well as risks of psychotropic medication management to the mother and developing fetus/neonate.

Psychopharmacology and pregnancy

The editors of this book undertook to provide an overview of the current state of knowledge concerning the use of psychotropic medication in pregnancy, with a second stated aim of producing clinical guidelines for practitioners. The historical reluctance to include pregnant women in research, and the need to consider the interests of both mother and baby, makes this a Herculean task. Here, the task is well-accomplished, with noted researchers from the field presenting us with an excellent and concise summary. The initial chapters set out the unique challenges in perinatal mental health, an understanding of which is essential when counselling a pregnant woman about the options available to her. These include the ethics of informed consent and the difficulties of interpreting a flawed evidence base. They also include explanations of how the interaction of maternal, fetal, genetic and environmental factors may mediate the effects on babies of perinatal exposure to maternal mental illness and associated medicines. Later chapters consider in turn the major categories of perinatal mental illness, in most cases providing itemised guidelines for clinicians at their conclusion. A minor criticism is that the presentation of these guidelines varies between chapters. This tends to reduce the ease of use of the book as a ‘quick reference guide’. More difficult topics such as borderline personality disorder, eating disorders and substance abuse have been included. There is a chapter on the impact of popularly used complementary and alternative treatments. Another deals with the use of ECT, a treatment with high efficacy from which pregnant women may find themselves unfairly excluded. Clinicians unfamiliar with the topic will be able to find some quick, wise pointers by turning immediately to the guideline sections. Those seeking a deeper understanding of the literature will also be rewarded.

Psychotropic Medications in Pregnancy and the Postpartum Period

Many pregnant women suffer from mental health conditions while pregnant. As providers and patients make decisions about risks of the conditions and treatments during pregnancy, information to populate those discussions is needed. Taking into account the physiologic changes in pregnancy, we may need to optimize medication therapy. This article reviews and summarizes some of the most common mental health conditions suffered in pregnancy: depression, bipolar disorder, anxiety, and psychosis. It further discusses the different medications used to treat them, as well as risks associated with these medications.

Psychotropic medication in pregnancy

Medical Journal of AustraliaVolume 199, Issue 10 p. 661-661 Letter Psychotropic medication in pregnancy Roisin N Worsley, Corresponding Author Roisin N Worsley Endocrinologist [email protected] Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC.Correspondence: [email protected]Search for more papers by this authorHeather Gilbert, Heather Gilbert Senior Research Nurse Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC.Search for more papers by this authorJayashri Kulkarni, Jayashri Kulkarni Professor of Psychiatry Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC.Search for more papers by this author Roisin N Worsley, Corresponding Author Roisin N Worsley Endocrinologist [email protected] Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC.Correspondence: [email protected]Search for more papers by this authorHeather Gilbert, Heather Gilbert Senior Research Nurse Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC.Search for more papers by this authorJayashri Kulkarni, Jayashri Kulkarni Professor of Psychiatry Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC.Search for more papers by this author First published: 18 November 2013 https://doi.org/10.5694/mja13.10719Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume199, Issue10November 2013Pages 661-661 RelatedInformation

Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication

To identify factors that predict the expression of neonatal abstinence syndrome (NAS) in infants exposed to methadone or buprenorphine in utero. Multi-site randomized clinical trial in which infants were observed for a minimum of 10 days following birth, and assessed for NAS symptoms by trained raters. A total of 131 infants born to opioid dependent mothers, 129 of whom were available for NAS assessment. Generalized linear modeling was performed using maternal and infant characteristics to predict: peak NAS score prior to treatment, whether an infant required NAS treatment, length of NAS treatment and total dose of morphine required for treatment of NAS symptoms. Of the sample, 53% (68 infants) required treatment for NAS. Lower maternal weight at delivery, later estimated gestational age (EGA), maternal use of selective serotonin re-uptake inhibitors (SSRIs), vaginal delivery and higher infant birthweight predicted higher peak NAS scores. Higher infant birthweight and greater maternal nicotine use at delivery predicted receipt of NAS treatment for infants. Maternal use of SSRIs, higher nicotine use and fewer days of study medication received also predicted total dose of medication required to treat NAS symptoms. No variables predicted length of treatment for NAS. Maternal weight at delivery, estimated gestational age, infant birthweight, delivery type, maternal nicotine use and days of maternal study medication received and the use of psychotropic medications in pregnancy may play a role in the expression of neonatal abstinence syndrome severity in infants exposed to either methadone or buprenorphine.

E.03.03 Methodological design and limitations of current studies on psychotropic medication in pregnancy

E.03.03 Methodological design and limitations of current studies on psychotropic medication in pregnancy

Detection and management of mood disorders in the maternity setting: The Australian Clinical Practice Guidelines

Mood disorders arising in the perinatal period (conception to the first postnatal year), occur in up to 13% of women. The adverse impact of mood disorders on mother, infant and family with potential long-term consequences are well documented. There is a need for clear, evidence-based, guidelines for midwives and other maternity care providers. To describe the process undertaken to develop the Australian Clinical Practice Guidelines for Depression and Related Disorders in the Perinatal Period and to highlight the key recommendations and their implications for the maternity sector. Using NHMRC criteria, a rigorous systematic literature review was undertaken synthesising the evidence used to formulate graded guideline recommendations. Where there was insufficient evidence for recommendations, Good Practice Points were formulated. These are based on lower quality evidence and/or expert consensus. The quality of the evidence was good in regards to the use of the Edinburgh Postnatal Depression Scale and psychological interventions, but limited as regards medication use and safety perinatally. Recommendations were made for staff training in psychosocial assessment; universal screening for depression across the perinatal period; and the use of evidence based psychological interventions for mild to moderate depression postnatally. Good Practice Points addressed the use of comprehensive psychosocial assessment--including risk to mother and infant, and consideration of the mother-infant interaction--and gave advice around the use and safety of psychotropic medications in pregnancy and breastfeeding. In contrast to their international counterparts, the Australian guidelines emphasize a more holistic, woman and family centred approach to the management of mental health and mood disorders in the perinatal setting. The development of these Guidelines is a first step in translating evidence into practice and providing Australian midwives and other maternity care providers with clear guidance on the psychosocial management of women and families.