While we have data on the use of lithium use during pregnancy with regard to risk for congenital malformations, there is much less information on the long-term effects of lithium on neurodevelopment. A recent study from the Perinatal Center of the Leiden University Medical Center provides some reassuring data on the long-term effects of lithium exposure.
Earlier this year we reported on a possible association between first trimester exposure to topiramate (Topamax) and increased risk of cleft lip and palate. In a recent study published by the American Journal of Obstetrics and Gynecology, researches drew upon data from two birth defect databases to further delineate the risks associated with topiramate exposure.
Over the past few years, there has been a push to screen women for depression both during pregnancy and the postpartum period. Â Â While there have been various initiatives mandating screening, there remain questions regarding the optimal timing of screening and the best screening tools to use.
Recent reports suggest that people with lower folate levels are at higher risk of major depression or may experience more severe depressive symptoms. Other studies indicate that in folate deficient patients, antidepressants may be less effective or may take longer to take effect. In addition, some clinical trials have shown that folate may have a therapeutic effect on depression, either when taken alone or in combination with an antidepressant.
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 regarding the reproductive safety of these medications.Â
Multiple studies have demonstrated an increased risk of poor neonatal adaptation associated with exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants in late pregnancy. Results in the literature consistently indicate that about 25%-30% of infants exposed to SSRIs late in pregnancy manifest symptoms of poor neonatal adaption, including jitteriness, restlessness, increased muscle tone, rapid breathing. These symptoms are transient, resolving spontaneously with no specific medical intervention.
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. In addition, recent reports have indicated that in utero exposure to valproate may also result in lower IQ.
It is common for women experiencing infertility and undergoing fertility treatment to experience significant emotional distress. Many women, reasoning that their emotional health influences their physical functioning, worry that the stress and anxiety they experience in this context may hinder their ability to become pregnant.
While it is well-established that several of the older anticonvulsants, including valproate (Depakote), carry a significant teratogenic risk, less is known about the reproductive safety of the newer antiepileptic drugs (AEDs). The North American AED Pregnancy Registry was established in 1997 for pregnant women in the United States and Canada at the Massachusetts General Hospital. The purpose of the registry is to obtain and publish information on the frequency of major malformations among infants whose mothers have taken one or more AEDs during pregnancy.
Women with bipolar disorder or history of postpartum psychosis are at high risk for postpartum psychosis; appropriate interventions significantly decrease this risk.
