Women with bipolar disorder are vulnerable to postpartum illness, and it is generally recommended that mothers continue treatment with a mood stabilizer throughout the postpartum period to reduce their risk of relapse; however, this recommendation is complicated by the all mood stabilizers are secreted into the breast milk, although their concentrations appear to vary considerably (Chaudron and Jefferson, 2000).
Atypical antipsychotic medications are commonly used for the treatment of schizophrenia and bipolar disorder. Despite the increasing use of these medications in women of child-bearing age, there is still relatively little data addressing the reproductive safety of these medications.
Although the risks of smoking tobacco while pregnant are well documented and well publicized to the general population, women continue to smoke cigarettes during pregnancy. Smoking cigarettes is known to increase a woman's risk of having a low-birth weight baby and increases the risk of preterm delivery. While clinicians often ask about and discourage tobacco use during pregnancy, much less attention has been devoted to the use of marijuana during pregnancy, despite the fact that marijuana is the most commonly consumed illicit drug among pregnant women.
Anxiety often results in the activation of the sympathetic nervous system. This activation is commonly known as the “fight or flight response”; symptoms may include increased heart rate, shortness of breath, perspiration, chest pain, and nausea or diarrhea. Activation of the fight or flight response is also associated with the activation of numerous other responses in the body, including the production of various stress hormones, including cortisol.
In 2006, Chambers and colleagues published an article linking SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (PPHN). Since that time, several other reports have been published which have examined the association between SSRI antidepressants and PPHN. Here is a summary of the findings to date:
While anticonvulsants, such as lamotrigine (Lamictal), topiramate (Topamax), and gabapentin (Neurontin), are being used with increasing regularity for the treatment of women with bipolar disorder, we have limited information with respect to the reproductive safety of the newer anticonvulsant agents. In 2006, we reported on preliminary data indicating an increased risk of oral clefts among infants exposed to lamotrigine during the first trimester of pregnancy.
There have been multiple studies suggesting that depression during pregnancy increases the risk for preterm labor. Most studies do not attribute this increase in risk to antidepressant exposure, but to the effects of the depression itself. The mechanism is believed to be related to increased levels of corticotropin releasing hormone (CRH) which is triggered by stress. Elevated levels of CRH have been shown to be a predictor of preterm birth.
About 15% of women suffer from depression during pregnancy, and many reports have suggested that depression during pregnancy may have negative effects on the fetus. A new study from researchers at the University of Michigan indicates a link between depression during pregnancy and infant sleep problems.
There have long been concerns regarding the use of the anticonvulsant valproate (Depakote) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart, limbs, and genitals. A recent report published in the New England Journal of Medicine indicates that in utero exposure to valproate may also result in lower IQ.
Atypical antipsychotics are increasingly used to treat psychiatric disorders such as bipolar disorder or schizophrenia. In spite of the important role they play for many patients in treating serious psychiatric disorders, atypicals have been associated with negative side effects that may worsen a patient's cardiovascular health profile. This includes a greater risk for weight gain, glucose dysregulation/diabetes, and dyslipidemia (elevated triglycerides/cholesterol).
