Medication in Pregnancy and the Postpartum Period

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Medication in Pregnancy and the Postpartum Period

• Katie Leon
• Visiting Nurse Services
• Based on Lecture by Jane Engeldinger, M.D.
• Department of Obstetrics and Gynecology
• University of Iowa Carver College of Medicine

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TREATMENT OPTIONS

• No treatment
• Psychotherapy
• Psychotropic drugs
• Electroconvulsive therapy

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RISKS ASSOCIATED WITH NO TREATMENT DURING PREGNACY

• Poor self-care
• Inadequate nutrition
• Poor prenatal care
• Suicide/homicide
• Impulsivity
• Accident-prone

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Risk Associated With No Treatment (cont.)

• Disease relapse
• Treatment resistance
• Poor obstetrical outcome

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ADVERSE OUTCOMES OF PSYCHOTROPIC DRUGS DURING
PREGNANCY

• Perinatal Complications
• Poor obstetrical outcome.
• Prematurity.
• Low birth weight.
• Neonatal toxicity/
• Withdrawal symptoms

• Behavioral
• Teratogenicity
• Developmental delays.
• Learning disabilities.
• Neurologic deficits.

Teratogen a substance which can cause birth
defects.
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Placental Drug Transfer

• Almost all drugs cross the placenta
• Maternal physiologic changes affect
  bioavailability

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RISKS ASSOCIATED WITH NO TREATMENT IN DEPRESSED
POSTPARTUM WOMEN

• Neonatal withdrawal
• Adverse effects on maternal relationships
• Lasting effects on maternal mental health
• Impaired maternal infant bonding
• Adverse developmental effects

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GENERAL GUIDELINES FOR USAGE OF PSYCHOTROPIC
DRUGS WHILE BREASTFEEDING

• Obtain a thorough pediatric assessment
• Use minimal effective dose
• Use short acting drugs
• Nurse before taking drugs
• Obtain infant serum levels
• Choose drugs with data

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General Guidelines For Usage of Psychotropic
Drugs While Breastfeeding

• Use one drug when possible
• Use familiar drugs
• Use drug of prior response
• Keep infant well hydrated
• Follow infant with blood tests as would with
  mother

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To Medicate or Not To Medicate

• In consultation with her physicianthe woman must
  weigh/balance the risks associated with treated
  vs. untreated depression