Previous studies have suggested that prenatal stress may be associated with a spectrum of adverse pregnancy outcomes, including preterm birth and low birth weight (reviewed in Hobel et al, 2008). A recent study from Danish researchers has investigated the impact of psychological stress on risk for stillbirth.
If a woman does not breastfeed following delivery, prolactin levels decrease and fertility returns to normal, and pregnancy is possible. Even if a woman decides to breastfeed, she should still use some form of contraception, as prolactin levels vary depending on individual breastfeeding styles. Women may be fertile and become pregnant even before the resumption of their menstrual cycles.
We commonly see women in our consultation service who have histories of depression and are planning pregnancy. They frequently have questions about alternative treatments for depression while pregnant. Given that many women are taking omega-3 fatty acids prior to pregnancy, the question arises whether they should discontinue them during pregnancy. An additional question is whether omega-3 fatty acids can be used instead of antidepressants for the treatment of depression during pregnancy.
The Melanie Blocker Stokes MOTHERS Act — named for an Illinois woman who committed suicide three months after giving birth — was approved by the House of Representatives in October. This article from the North Jersey Record reports that the legislation has been held up in the Senate Health, Education, Labor and Pensions committee.
It has been postulated that psychological stress in the mother, if present at a critical time of brain development, can permanently alter a child's response to stress and may have long-term negative consequences. In response to stress, blood flow to the uterus is restricted and the fetus receives fewer nutrients, which may result in lower birth weight. Several studies have demonstrated an association between maternal stress and low birth weight, and it is felt that low birth weight is a marker for stressful intrauterine conditions.
While genetic factors are clearly important in determining a child’s risk for attention deficit hyperactivity disorder (ADHD), recent studies have investigated the link between exposure to certain maternal behaviors during pregnancy, such as smoking and alcohol use, and the risk of developing behavioral problems related to attention deficit hyperactivity disorder in childhood. While multiple studies have indicated a greater risk of ADHD symptoms among children whose mothers smoked during pregnancy, contradictory findings were reported in studies focusing on exposure to alcohol. Results from studies investigating the impact of psychological stress during pregnancy have been inconsistent but suggest a possible contribution to ADHD symptoms int he offspring.
Depression during pregnancy is common. While concerns have been raised regarding the potential teratogenic and long-term neurobehavioral effects of psychotropic drug use during pregnancy, what is often overlooked is the fact that untreated maternal depression may also put the unborn baby at risk.
As many of the traditional mood stabilizers used to treat bipolar disorder, including lithium and valproic acid, carry some teratogenic risk and the reproductive safety of other medications, including the atypical antipsychotic agents, has not been well-characterized, many women with bipolar disorder decide to discontinue their treatment during pregnancy. A new study from Dr. Adele Viguera and her colleagues at the Massachusetts General Hospital and the Emory University School of Medicine helps to better define the risks associated with discontinuing treatment during pregnancy.
Epidemiologic studies suggest that about 10% to 15% of women suffer from clinically significant depressive symptoms during pregnancy. Little is known, however, about the prevalence of depression among women with high risk pregnancies. A recent study published online in the Journal of Clinical Psychiatry suggests that this population may be at significant risk for antenatal depression.
At our clinic we have the opportunity to see patients at various stages of pregnancy. When we evaluate a patient while she is still in the planning stages, we may recommend changing medications to those that have a better studied safety profile during pregnancy and see how she does on those medications prior to conception. If that same patient came into our clinic for an evaluation, but was already pregnant, we may make different recommendations than if she was in the planning stages.
