PMH-C Medications Questions With 100% Correct Answers!!
There are two patients Answer - Treatment can benefit both mom and baby
No treatment poses risk to both mom and baby
"Exposure always occurs, be it to treatment or illness"
Prevalence Answer - 13% of pg women were prescribed antidepressants
50% of pregnancies are unplanned - early exposure has often occurred
PMAD tx guidelines (APA & ACOG) Answer - Mild - moderate:
- psychotherapy first line
- continue meds if needed
Severe/Recurrent
- continue meds
Suicidal/Psychotic
- immediate referral to hospital or psychiatric care provider
- medications
First option for medication Answer - Is often Sertraline/Zoloft
No single med is "safest" or "best" for use during pregnancy/postpartum/lactation
Why so much conflicting data on meds in perinatal Answer - No randomized, double-blind, placebo-controlled trials
Many studies are retrospective database and case-control studies
- may involve voluntary reporting
- confounds (esp illness exposure)
Confounding variables in assessing risk Answer - Other prescription/non-
prescription meds
Nutrition
ETOH/cigarettes
Genetics
Obesity
Method of delivery
Environmental toxins Maternal/paternal age
Length of gestation
Stress
Socioeconomic status
Golden rules of pharmacological tx Answer - Keep it simple - monotherapy where possible, don't change what's working
Ask about and document all known exposure to medications/supplements/herbals/OTC
Encourage psychotherapy & social support
Parental concerns around perinatal medication Answer - Miscarriage
congenital malformation
preterm delivery / low birth weight
NAS - Neonatal Abstinence/Adaptation Syndrome
PPHN - Persistent Pulmonary Hypertension of the Newborn
Long term neurobehavioural effects
Autism
Risk of miscarriage Answer - not a true risk when adequate controls are utilized - no
increased risk with SSRIs
Risk of congenital abnormalities Answer - SSRIs -> no consistent fetal malformations
General population risk is 3% - SSRIs don't increase this
SSRIs/SNRIs are not teratogenic
Contraindicated medications Answer - VALPROIC ACID (Epival, Depakene, Depakote) in pregnancy
(Commonly used for Bipolar + epilepsy/migraine)
LITHIUM in breastfeeding (Commonly used for Bipolar and MDD)
Paxil was thought to produce a risk of cardiac malformation but this has been refuted
Preterm/Low birth weight Answer - Slight increased risk - same as untreated depression
~average = 5-7 early
- less than 97grams below average
NAS Answer - 10-30% incidence
sx: jitters, irritability, hypertonia, feeding difficulties, tremor, GI/Sleep disturbance, high pitched cry, tachypnea
sx are transient/self-limited, last ≤2 wks
BFing may be protective
Not dose dependent
*No benefit in changing does or discontinuing meds in 3T
PPHN Answer - Very low increased risk
There are two patients Answer - Treatment can benefit both mom and baby
No treatment poses risk to both mom and baby
"Exposure always occurs, be it to treatment or illness"
Prevalence Answer - 13% of pg women were prescribed antidepressants
50% of pregnancies are unplanned - early exposure has often occurred
PMAD tx guidelines (APA & ACOG) Answer - Mild - moderate:
- psychotherapy first line
- continue meds if needed
Severe/Recurrent
- continue meds
Suicidal/Psychotic
- immediate referral to hospital or psychiatric care provider
- medications
First option for medication Answer - Is often Sertraline/Zoloft
No single med is "safest" or "best" for use during pregnancy/postpartum/lactation
Why so much conflicting data on meds in perinatal Answer - No randomized, double-blind, placebo-controlled trials
Many studies are retrospective database and case-control studies
- may involve voluntary reporting
- confounds (esp illness exposure)
Confounding variables in assessing risk Answer - Other prescription/non-
prescription meds
Nutrition
ETOH/cigarettes
Genetics
Obesity
Method of delivery
Environmental toxins Maternal/paternal age
Length of gestation
Stress
Socioeconomic status
Golden rules of pharmacological tx Answer - Keep it simple - monotherapy where possible, don't change what's working
Ask about and document all known exposure to medications/supplements/herbals/OTC
Encourage psychotherapy & social support
Parental concerns around perinatal medication Answer - Miscarriage
congenital malformation
preterm delivery / low birth weight
NAS - Neonatal Abstinence/Adaptation Syndrome
PPHN - Persistent Pulmonary Hypertension of the Newborn
Long term neurobehavioural effects
Autism
Risk of miscarriage Answer - not a true risk when adequate controls are utilized - no
increased risk with SSRIs
Risk of congenital abnormalities Answer - SSRIs -> no consistent fetal malformations
General population risk is 3% - SSRIs don't increase this
SSRIs/SNRIs are not teratogenic
Contraindicated medications Answer - VALPROIC ACID (Epival, Depakene, Depakote) in pregnancy
(Commonly used for Bipolar + epilepsy/migraine)
LITHIUM in breastfeeding (Commonly used for Bipolar and MDD)
Paxil was thought to produce a risk of cardiac malformation but this has been refuted
Preterm/Low birth weight Answer - Slight increased risk - same as untreated depression
~average = 5-7 early
- less than 97grams below average
NAS Answer - 10-30% incidence
sx: jitters, irritability, hypertonia, feeding difficulties, tremor, GI/Sleep disturbance, high pitched cry, tachypnea
sx are transient/self-limited, last ≤2 wks
BFing may be protective
Not dose dependent
*No benefit in changing does or discontinuing meds in 3T
PPHN Answer - Very low increased risk
