Importantly, neonatal effects have been reported with both untreated mood and anxiety disorders, as well as with medication, and limited studies have adequately teased out these variables. While this information is reassuring, it is far from definitive, and larger studies are required to provide more information about the reproductive safety of these medications. Concerns regarding fetal exposure to lithium, have typically been based on early reports of higher rates of cardiovascular malformations (e.g., Ebstein’s anomaly) following prenatal exposure to this drug. In one report, the use of an SSRI antidepressant after the 20th week of gestation was significantly associated with a six-fold greater risk of PPHN. Results indicated no significant differences in IQ, temperament, behavior, reactivity, mood, distractibility, or activity level between exposed and non-exposed children followed up to 7 years of age. One prospective study of 531 infants with first trimester exposure to SSRIs (mostly citalopram, n=375) did not demonstrate an increased risk of organ malformation. While this may signal a potential problem associated with exposure to antipsychotic medications, it does not yield accurate information regarding the prevalence of an adverse event. These recommendations were derived from adverse event reporting. As part of the Women’s Wellness during Pregnancy and Beyond Program, experts in maternal-fetal medicine at Brigham and Women’s Hospital work closely with specialists in the Women's Mental Health Program at BWH and Brigham and Women's Faulkner Hospital to meet the unique needs of women with depression, anxiety, and other mental health problems during pregnancy and at other stages of life. Prenatal exposure to valproic acid has also been associated with characteristic craniofacial abnormalities, cardiovascular malformation, limb defects and genital anomalies, as well as other central nervous system structural abnormalities. Are you pregnant? Although pregnancy has typically been considered a time of emotional well-being, recent studies suggest that up to 20% of women suffer from mood or anxiety disorders during pregnancy. The U.S. Food and Drug Administration (FDA) recently updated labels for the entire class of antipsychotic drugs to include warnings regarding the use of antipsychotic drugs (both the typical and atypical agents) during pregnancy. Other data from the North-American Anti-Epileptic Drug Registry indicates the prevalence of major malformations in a total of 564 children exposed to lamotrigine monotherapy was 2.7%; however, five infants had oral clefts, indicating a prevalence rate of 8.9 per 1000 births. In a recent study which prospectively followed a group of women with histories of major depression across pregnancy, of the 82 women who maintained antidepressant treatment throughout pregnancy, 21 (26%) relapsed compared with 44 (68%) of the 65 women who discontinued medication. Essential Reads:  Is there a Role for Omega-3 Fatty Acids in Women at Risk for Perinatal Depression? Your care team should … Although data accumulated over the last 30 years suggest that some medications may be used safely during pregnancy, knowledge regarding the risks of prenatal exposure to psychotropic medications is incomplete. Pregnancy stress and mood swings are normal; however, strong mood swings and stress with constant nervousness or sadness are serious. A more recent report from the same group that followed a cohort of children exposed to fluoxetine or tricyclic antidepressants for the entire duration of the pregnancy yielded similar results. Essential Reads: SSRI Antidepressants Do Not Increase Risk of Miscarriage. Nonetheless, the likelihood that a woman exposed to benzodiazepines during the first trimester will give birth to a child with this congenital anomaly, although significantly increased, remains less than 1%. Others may develop mental health issues during or after pregnancy due to changes … Another concern has been that maternal SSRI use may be associated with a higher than expected number of cases of persistent pulmonary hypertension of the newborn (PPHN). Women who have had these illnesses have a high risk of becoming unwell after birth. In addition to the atypical antipsychotic medications described above, recent studies have not demonstrated teratogenic risk associated with high-or medium-potency neuroleptic medications; however, a recent meta-analysis of the available studies noted a higher risk of congenital malformations after first trimester exposure to low-potency neuroleptic agents. Women and men can both experience mental health issues during the pregnancy (the ‘antenatal’ period), as well as after the birth (the ‘postnatal’ period). Davidson adds that these findings provide a compelling foundation for exploring the impact of interventions to cultivate well-being during pregnancy on babies’ neurodevelopment after birth and later in life. Monitoring mental health can also be an important part of pregnancy. Your health and safety remain our top priority: Learn about our Safe Care Commitment | Use our Prescreen app before arrival for faster entry | Read the COVID-19 Vaccine FAQs. If you are taking psychiatric medications and are pregnant or thinking about becoming pregnant, it is important to speak with your doctor about the safety of medications during pregnancy. However, other registries have not demonstrated such a significant increase in risk for oral clefts. A retrospective cohort study including over 1200 infants exposed to bupropion during the first trimester did not reveal an increased risk of malformations in the bupropion-exposed group of infants nor did it demonstrate an increased risk for cardiovascular malformations. Brigham and Women’s Hospital partners with Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) to prevent, identify, and manage depression in pregnant and postpartum women. Scant information is available regarding the reproductive safety of monoamine oxidase inhibitors (MAOIs), and these agents are generally not used in pregnancy as they may produce a hypertensive crisis when combined with tocolytic medications, such as terbutaline. Screening the mental health of pregnant women is therefore vital. 7 things I learnt about my mental health while pregnant. Atypical antipsychotic agents (discussed in greater detail below) are commonly used often to manage the acute symptoms of bipolar illness, as well as for maintenance treatment. When evaluated on an individual basis and when pooled, these studies do not indicate a significant association between fetal exposure to TCAs and risk for any major congenital anomaly. Welcoming a new baby is typically an exciting time for any family, but a new report finds pregnant women and new moms are struggling with their mental health during the pandemic. Copyright 2018 MGH Center for Women's Mental Health | All Rights Reserved | Site Developed by, Perinatal and Reproductive Psychiatry Program, A Neurosteroid Intervention for Menopausal and Perimenopausal Depression, UPWARD & UPWARD(S) – Preventing Depressive Relapse in Pregnant Women, National Pregnancy Registry for Psychiatric Medications ©, Perinatal Body Image and Eating Behaviors Survey, Suicide Prevention and Awareness Resources, January 2021 – Online Course for ‘Enhanced Approaches’, up to 20% of women suffer from mood or anxiety disorders during pregnancy, many criticized this system of classification. These studies deserve careful consideration, yet one of the major shortcomings is that most have failed to use raters blinded to the mother’s treatment status. Mothers should not reduce or discontinue medications on their own. Ideally, medication adjustments and planning are started before or early in the pregnancy. 185 Cambridge St Suite 2200 It is estimated that at least 500 to 600 exposures must be collected to demonstrate a two-fold increase in risk for a particular malformation over what is observed in the general population. Severe mental illness (bipolar affective disorder, severe depression, psychosis) may worsen during pregnancy and postpartum, so women with these illnesses should consider having a … For the latest information on psychiatric disorders during pregnancy, please visit our blog. We use cookies and other tools to enhance your experience on our website and Empower yourself. Pregnancy complications related to maternal depression and anxiety in late pregnancy have also been described, including an increased risk for having pre-eclapsia, operative delivery, and infant admission to a special care nursery for a variety of conditions including respiratory distress, hypoglycemia, and prematurity. Since the initial report on this topic, three studies have found no association between antidepressant use during pregnancy and PPHN, and one study showed a much lower risk than the 1% originally reported. Healthcare providers are often the most frequent medical contact with the potential for early detection of these. In an effort to improve the accuracy and usefulness of information regarding the safety of medications used during pregnancy and breastfeeding, the FDA proposed a newly designed system on June 30th 2015. Maternal mental health and child’s telomeres A new study published in the American Journal of Psychiatry in … 617-732-5500, Back to Care for Medical Conditions in Pregnancy, Psychiatric Conditions Arising During and After Pregnancy, Optimal Care for Psychiatric Conditions and Pregnancy, Women’s Wellness During Pregnancy and Beyond, Having Your Baby at Brigham and Women’s Hospital, Massachusetts Child Psychiatry Access Project (MCPAP), Center for Fetal Medicine and Prenatal Genetics, Anesthesiology, Perioperative and Pain Medicine, Reactions to prior pregnancy loss or traumatic birth, Other issues, such as eating disorders and substance abuse, Reactions to pregnancy, pregnancy loss or complications. Several recent studies have suggested that exposure to SSRIs near the time of delivery may be associated with poor perinatal outcomes. This risk– if it exists — is calculated to be 0.7%, approximately a ten-fold increase in risk for oral cleft over that observed in the general population. High rates of relapse have also been observed in women with bipolar disorder. Depression and anxiety during pregnancy have been associated with a variety of adverse pregnancy outcomes. Because neuronal migration and differentiation occur throughout pregnancy and into the early years of life, the central nervous system (CNS) remains particularly vulnerable to toxic agents throughout pregnancy. Approximately one in eight women suffers from perinatal depression, and there are many women without a history of depression who develop symptoms during pregnancy. In another report, there were no differences in malformation rates among women who took mirtazapine (Remeron) (n=104) during pregnancy as compared to women who took other antidepressants or controls exposed to known nonteratogens. When pregnant, it's easy to feel run down, and hard to prioritize mental and physical health, … In fact, many women feel overwhelmed, sad, or anxious at different times during their pregnancy and even after the … This represents a 3.9% risk of congenital malformation that is consistent with what is observed in women with no known teratogen exposure. Most of the formation of the heart and great vessels takes place from four to nine weeks after conception, although the entire first trimester is often considered pertinent. In these cases, it is very important that a team of specialists in multiple disciplines – including maternal-fetal medicine, psychiatry, psychology, and social work – be closely involved in the care of both the mother and the baby.