Pregnancy and Medications: A Personal Essay from Dr. Helen Kim in JAMA
In this essay published in the Journal of the American Medical Association, Dr. Helen Kim (an alumna of the CWMH) discusses the challenges of treating women with severe psychiatric illness during pregnancy:
Exposure to Antidepressants During Pregnancy and Risk of ADHD in the Offspring
Antenatal exposure to Wellbutrin (bupropion) does not appear to be associated with an increased risk of malformations in the exposed infant; however, it is not known if exposure to Wellbutrin during pregnancy has any effect on the child’s neurobehavioral development. In a study from Figueroa and colleagues published in 2010, insurance claims data from 38,704 children and their families were analyzed, using information obtained from the beginning of pregnancy until age 5. Outcomes were assessed in mothers taking selective serotonin reuptake inhibitors (SSRIs) or Wellbutrin before, during or after the pregnancy. This study sought to determine the risk of ADHD in exposed infants. Children up to the age of 5 were identified as having ADHD if they had an outpatient or inpatient claim with a primary or secondary diagnosis of ADHD or a prescription claim for stimulants.
Breastfeeding and Benzodiazepines: Good News
Clinically significant anxiety symptoms are common during the postpartum period and frequently complicate the treatment of postpartum depression. Â Â While SSRIs are indicted for the treatment anxiety symptoms, especially when they co-occur with depression, many women may need to use a benzodiazepine for managing more severe symptoms of anxiety or insomnia.Â
Prenatal Antipsychotic Exposure and Neuromotor Performance
While a handful of studies have assessed the risk for congenital malformations in infants exposed to antipsychotic agents, there is even less information regarding neonatal outcome in this population. In 1992, it was first reported that infants exposed to first-generation antipsychotic medications exhibited increased muscle tone, tremulousness, and poor motor functioning when assessed within a few days of delivery.
NAMS Supports the Use of Hormone Therapy in Perimenopausal and Recently Postmenopausal Women
The North American Menopause Society (NAMS) has updated its 2010 recommendations regarding the use of postmenopausal hormone therapy (HT) based on evidence accumulated subsequent to the previous report. In the decade since the first publication of the results from the Women's Health Initiative, we have accumulated evidence to indicate that multiple factors influence the effects of hormone therapy, including the type of estrogen used, the way the hormones are given, and the age and recency of menopause of the woman taking the medication. These factors also determine the risks associated with hormone therapy.Â
Katherine Stone Visits MGH
At MGH, we have Rounds weekly. For 2-3 hours per week, we discuss clinical cases, papers that come out in our field, and discuss our research. We have a relatively large group of perinatal psychiatrists, all of whom do clinical work, as well as social workers and a psychologist who regularly join us.Â