scholarly journals Antipsychotic Use in Pregnancy: Patient Mental Health Challenges, Teratogenicity, Pregnancy Complications, and Postnatal Risks

2022 ◽  
Vol 14 (1) ◽  
pp. 62-74
Author(s):  
Amber N. Edinoff ◽  
Niroshan Sathivadivel ◽  
Shawn E. McNeil ◽  
Austin I. Ly ◽  
Jaeyeon Kweon ◽  
...  
Keyword(s):  
Mental Health ◽  
Pregnant Women ◽  
Antipsychotic Drugs ◽  
Congenital Abnormalities ◽  
Childbearing Age ◽  
Risks And Benefits ◽  
Increased Risk ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Potential Risks

Pregnant women constitute a vulnerable population, with 25.3% of pregnant women classified as suffering from a psychiatric disorder. Since childbearing age typically aligns with the onset of mental health disorders, it is of utmost importance to consider the effects that antipsychotic drugs have on pregnant women and their developing fetus. However, the induction of pharmacological treatment during pregnancy may pose significant risks to the developing fetus. Antipsychotics are typically introduced when the nonpharmacologic approaches fail to produce desired effects or when the risks outweigh the benefits from continuing without treatment or the risks from exposing the fetus to medication. Early studies of pregnant women with schizophrenia showed an increase in perinatal malformations and deaths among their newborns. Similar to schizophrenia, women with bipolar disorder have an increased risk of relapse in antepartum and postpartum periods. It is known that antipsychotic medications can readily cross the placenta, and exposure to antipsychotic medication during pregnancy is associated with potential teratogenicity. Potential risks associated with antipsychotic use in pregnant women include congenital abnormalities, preterm birth, and metabolic disturbance, which could potentially lead to abnormal fetal growth. The complex decision-making process for treating psychosis in pregnant women must evaluate the risks and benefits of antipsychotic drugs.

scholarly journals Pharmacological treatment of depression and bipolar disorder in children and adolescents

2010 ◽  
Vol 16 (6) ◽  
pp. 402-412 ◽  
Author(s):  
Bernadka Dubicka ◽  
Paul Wilkinson ◽  
Raphael G. Kelvin ◽  
Ian M. Goodyer
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Treatment Guidelines ◽  
Evidence Base ◽  
Current Treatment ◽  
Risks And Benefits ◽  
Treatment Of Depression ◽  
Increased Risk ◽  
Potential Risks ◽  
Considerable Morbidity

SummaryMajor depression and bipolar disorder in children and adolescents are serious conditions associated with considerable morbidity as well as increased risk of suicide. The treatment of depression in young people is currently controversial and this article reviews the evidence base and potential risks and benefits of antidepressants. Although the diagnosis of bipolar disorder is also controversial, medication is the first-line treatment of choice in cases that meet diagnostic criteria. The limited evidence base in children and adolescents is presented, along with current treatment guidelines. Despite the controversies in this field, this article concludes that medication remains an important part of the treatment approach for both disorders, although the risks and benefits of pharmacotherapy need to be carefully assessed in each patient.

scholarly journals Perceptions, Uses of, and Interests in Complementary Health Care Approaches in Depressed Pregnant Women

2016 ◽  
Vol 22 (1) ◽  
pp. 81-95 ◽  
Author(s):  
Jennifer Matthews ◽  
Jennifer L. Huberty ◽  
Jenn A. Leiferman ◽  
Darya McClain ◽  
Linda K. Larkey
Keyword(s):  
Mental Health ◽  
Pregnant Women ◽  
Lifestyle Behaviors ◽  
Health And Wellness ◽  
Physical And Mental Health ◽  
Unhealthy Lifestyle ◽  
Complementary Health Approaches ◽  
Increased Risk ◽  
Women’S Perceptions ◽  
Study Participants

Depression affects up to 23% of pregnant women and is associated with adverse physical/mental health outcomes for both the mother and baby. Depressed pregnant women may be more likely to engage in unhealthy lifestyle behaviors that contribute to an increased risk for chronic disease. Little is known regarding depressed pregnant women’s perceptions, uses of, and interests in complementary health approaches. Study participants (mean age 28.7 ± 6.8; n = 1032) included pregnant women ≥8 weeks gestation who responded to a survey assessing physical and mental health and wellness practices. Of those completing the survey, depressed pregnant women (n = 272) had significantly higher levels of anxiety ( P < .001) and stress ( P < .001) and had poorer sleep quality ( P < .001), mindfulness ( P < .001), and social support ( P < .001) compared to nondepressed pregnant women (n = 760). A majority (84%) of depressed pregnant women would consider using a complementary health approach for weight and/or stress management during pregnancy, and more than 50% were interested in yoga.

scholarly journals Selective serotonin reuptake inhibitors and pregnancy: A review of maternal, fetal and neonatal risks and benefits

2013 ◽  
Vol 6 (4) ◽  
pp. 155-158 ◽  
Author(s):  
Zbigniew Marchocki ◽  
Noirin E Russell ◽  
Keelin O’ Donoghue
Keyword(s):  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Childbearing Age ◽  
Pharmacological Interventions ◽  
Risks And Benefits ◽  
Potential Risks ◽  
Psychiatric Conditions ◽  
In Pregnancy

Depression is common in women of childbearing age. Whereas non-pharmacological interventions are recommended as first line interventions, pharmacological treatment may be required. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants in pregnancy. Ideally, discussion of the risks and benefits of SSRI use in pregnancy should occur prior to pregnancy. The potential risks of psychotropic medications need to be balanced against the risks associated with untreated psychiatric conditions and the discontinuation of necessary medications.

Potential Risks and Benefits of Mental Health Screening of Physicians

JAMA ◽  
2018 ◽  
Vol 320 (24) ◽  
pp. 2527 ◽  
Author(s):  
Matthew L. Goldman ◽  
Carol A. Bernstein ◽  
Richard F. Summers
Keyword(s):  
Mental Health ◽  
Health Screening ◽  
Mental Health Screening ◽  
Risks And Benefits ◽  
Potential Risks

Consumer Assessment of Safety and Date Labeling Statements on Ready-to-Eat Meat and Poultry Products Designed To Minimize Risk of Listeriosis

2008 ◽  
Vol 71 (1) ◽  
pp. 70-76 ◽  
Author(s):  
JENNA LENHART ◽  
PATRICIA KENDALL ◽  
LYDIA MEDEIROS ◽  
JESSICA DOORN ◽  
MARY SCHROEDER ◽  
...  
Keyword(s):  
Food Safety ◽  
Pregnant Women ◽  
Information Needs ◽  
Safety Information ◽  
Age Groups ◽  
Meat Products ◽  
Childbearing Age ◽  
Poultry Products ◽  
Increased Risk ◽  
Point Of Purchase

Point-of-purchase safety-based labeling guidance on the proper storage and handling of refrigerated ready-to-eat (RTE) meat and poultry products could help reduce the risk of listeriosis. Seniors and pregnant women are two population groups at increased risk of listeriosis due to suppressed or compromised immune systems. We conducted 11 focus groups with senior-aged women and women of childbearing age in Colorado and Ohio to assess consumer awareness of Listeria, storage practices of RTE meat products, perceptions regarding the acceptability and usefulness of common date and potential food safety labeling statements on RTE meat and poultry products, and food safety information needs. Storage times for opened and unopened RTE products varied widely, with opened products often being stored longer than recommended. Women in both age groups paid attention to date labels on packages but varied highly in their interpretation of the statements. “Use by” statements were considered clearer and more helpful than “Sell by” or “Best if used by” labels. Proposed food safety–based labeling statements listing “antilisterial” agents used in RTE products were not well received. However, labels giving consumers instructions on how long they could keep RTE products and when to discard them after opening were considered helpful and well received. Participants indicated the need for further information about Listeria and its control. Educational information at point-of-purchase and where seniors and pregnant women congregate are suggested. Manufacturers are encouraged to provide more complete information on the safe storage and use of ready-to-eat meat and poultry products on package labels.

scholarly journals Screening and Management of Gestational Diabetes Mellitus after Bariatric Surgery

Nutrients ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 1479 ◽  
Author(s):  
Katrien Benhalima ◽  
Caro Minschart ◽  
Dries Ceulemans ◽  
Annick Bogaerts ◽  
Bart Van Der Schueren ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Bariatric Surgery ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Screening Tests ◽  
Oral Glucose ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Increased Risk

Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. This is partly due to the increasing prevalence of obesity in women of childbearing age. Since bariatric surgery is currently the most successful way to achieve maintained weight loss, increasing numbers of obese women of childbearing age receive bariatric surgery. Bariatric surgery performed before pregnancy significantly reduces the risk to develop GDM but the risk is generally still higher compared to normal weight pregnant women. Women after bariatric surgery therefore still require screening for GDM. However, screening for GDM is challenging in pregnant women after bariatric surgery. The standard screening tests such as an oral glucose tolerance test are often not well tolerated and wide variations in glucose excursions make the diagnosis difficult. Capillary blood glucose measurements may currently be the most acceptable alternative for screening in pregnancy after bariatric surgery. In addition, pregnant women after bariatric surgery have an increased risk for small neonates and need careful nutritional and foetal monitoring. In this review, we address the risk to develop GDM after bariatric surgery, the challenges to screen for GDM and the management of women with GDM after bariatric surgery.

scholarly journals COVID-19 in pregnant women with heart diseases. Adverse maternal and fetal outcomes. Case series from InCor registry of Pregnancy and Heart Disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M R Kirschbaum ◽  
M S Devido ◽  
E Azeka ◽  
L M M F Demarchi ◽  
J S Santos ◽  
...  
Keyword(s):  
Heart Disease ◽  
Pregnant Women ◽  
Heart Diseases ◽  
Case Series ◽  
Childbearing Age ◽  
Fetal Outcomes ◽  
Worst Case ◽  
Increased Risk ◽  
Co Morbidity ◽  
Pregnancy And Heart Disease

Abstract Background Heart disease is the leading non-obstetric cause of maternal death during pregnancy. In this field, the emergence of pandemic COVID-19 has caused the worst-case scenario considering that pregnant women are more susceptible to viral infections, and preexisting cardiac disease is the most prevalent co-morbidity among COVID-19 deaths. Purpose To assess the maternal and fetal outcomes of COVID-19 during pregnancy of women with heart diseases. Methods During the year 2020, among 82 pregnant women with heart disease followed consecutively at the Instituto do Coração-InCor, seven of them with an average age of 33.2 years had COVID-19 during their pregnancies. The underlying heart diseases were rheumatic valve disease (5 pt), congenital heart disease (1 pt) and one case with acute myocarditis, without preexisting cardiopathy. The prescription (antibiotics, inotropes, corticosteroids and others) used was according to the clinical conditions required for each patient, however subcutaneous or intravenous heparin was used in all patients. Results Only one case had an uneventful maternal-fetal course, the other six women required hospitalization / ICU for an average of 25.3 days, including the need for mechanical ventilation in two of them. Serious complications were related to respiratory failure (ADRS), recurrent atrial flutter with hemodynamic instability, acute pulmonary edema, and cardiogenic shock associated with sepsis which caused two maternal deaths. There were two emergency mitral valve interventional, percutaneous balloon valvuloplasty and valve bioprosthesis replacement, respectively. There were five premature births with an average gestational age of 34.2 weeks of gestation, which resulted in one stillbirth. Pathological findings of three placental and the six-months follow-up of the babies did not confirm vertical transmission of COVID-19. Conclusions The uncertain evolution given of the overlapping complications of three conditions – COVID-19, pregnancy, and heart disease – implies an increased risk for women with heart diseases of childbearing age, for whom pregnancy should be discouraged and planned after vaccination FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Pertussis Infections Among Pregnant Women in the United States, 2012–2017

2020 ◽  
Author(s):  
Tami H Skoff ◽  
Amanda E Faulkner ◽  
Jennifer L Liang ◽  
Meghan Barnes ◽  
Kathy Kudish ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Respiratory Infections ◽  
Population Data ◽  
Complete Information ◽  
The United States ◽  
Similar Proportion ◽  
Childbearing Age ◽  
Increased Risk ◽  
Pregnancy Status ◽  
Pertussis Epidemiology

Abstract Background Little is known about pertussis among pregnant women, a population at increased risk for severe morbidity from respiratory infections such as influenza. We used the Centers for Disease Control and Prevention’s Enhanced Pertussis Surveillance (EPS) system to describe pertussis epidemiology among pregnant and nonpregnant women of childbearing age. Methods Pertussis cases in women aged 18–44 years with cough onset between 1 January 2012 and 31 December 2017 were identified in 7 EPS states. Surveillance data were collected through patient and provider interviews and immunization registries. Bridged-race, intercensal population data and live birth estimates were used as denominators. Results We identified 1582 pertussis cases among women aged 18–44 years; 5.1% (76/1499) of patients with a known pregnancy status were pregnant at cough onset. Of the pregnant patients with complete information, 81.7% (49/60) reported onset during the second or third trimester. The median ages of pregnant and nonpregnant patients were 29.0 and 33.0 years, respectively. Most pregnant and nonpregnant patients were White (78.3% vs. 86.4%, respectively; P = .09) and non-Hispanic (72.6% vs. 77.3%, respectively; P = .35). The average annual incidence of pertussis was 7.7/100000 among pregnancy women and 7/3/100000 among nonpregnant women. Compared to nonpregnant patients, more pregnant patients reported whoop (41.9% vs. 31.3%, respectively), posttussive vomiting (58.1% vs. 47.9%, respectively), and apnea (37.3% vs. 29.0%, respectively); however, these differences were not statistically significant (P values &gt; .05 for all). A similar proportion of pregnant and nonpregnant patients reported ever having received Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine; 31.6% vs. 32.7%, respectively; P = .84). Conclusions Our analysis suggests that incidence of pertussis and clinical characteristics of disease are similar among pregnant and nonpregnant women. Continued monitoring is important to further define pertussis epidemiology in pregnant women.

scholarly journals Dengue, Zika and chikungunya during pregnancy: pre- and post-travel advice and clinical management

2019 ◽  
Vol 26 (8) ◽  
Author(s):  
Manon Vouga ◽  
Yen-Chi Chiu ◽  
Léo Pomar ◽  
Sara V de Meyer ◽  
Sophie Masmejan ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Zika Virus ◽  
Mosquito Control ◽  
Post Partum ◽  
Infectious Agent ◽  
Control Measures ◽  
Childbearing Age ◽  
Maternal Complications ◽  
Tropical Areas ◽  
Potential Risks

Abstract Rationale for review Young adults of childbearing age and pregnant women are travelling more frequently to tropical areas, exposing them to specific arboviral infections such as dengue, zika and chikungunya viruses, which may impact ongoing and future pregnancies. In this narrative review, we analyse their potential consequences on pregnancy outcomes and discuss current travel recommendations. Main findings Dengue virus may be associated with severe maternal complications, particularly post-partum haemorrhage. Its association with adverse fetal outcomes remains unclear, but prematurity, growth retardation and stillbirths may occur, particularly in cases of severe maternal infection. Zika virus is a teratogenic infectious agent associated with severe brain lesions, with similar risks to other well-known TORCH pathogens. Implications of chikungunya virus in pregnancy are mostly related to intrapartum transmission that may be associated with severe neonatal infections and long-term morbidity. Travel recommendations Few agencies provide specific travel recommendations for travelling pregnant patients or couples trying to conceive and discrepancies exist, particularly regarding Zika virus prevention. The risks significantly depend on epidemiological factors that may be difficult to predict. Prevention relies principally on mosquito control measures. Couples trying to conceive and pregnant women should receive adequate information about the potential risks. It seems reasonable to advise pregnant women to avoid unnecessary travel to Aedes spp. endemic regions. The current rationale to avoid travel and delay conception is debatable in the absence of any epidemic. Post-travel laboratory testing should be reserved for symptomatic patients.

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