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.
Wouldn’t it be nice if we could identify women who were at risk for postpartum depression (PPD)? Maybe if we could do that, we could actually prevent the depression from occurring. Or at least, we could intervene in some way so that the depression would not significantly affect the mother and her family.
3,4-methylenedioxymethamphetamine (MDMA) or “Ecstasy” is one of the most widely used illicit recreational drugs among young adults. This report indicates that infants exposed to Ecstasy ad other recreational drugs may have delays in their motor development.
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:
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.
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.
Reduced birth length and weight, microcephaly, and characteristic facial deformities (smooth philtrum and thin vermillion border) are associated with alcohol exposure during the second half of the first trimester and are dose-related. In this prospective study including 992 subjects, there was no evidence of a threshold, indicating that women should be advised to abstain from alcohol consumption from conception throughout pregnancy.
We want to thank those of you who have continued to subscribe to our blog and who have visited our website. Some have written noting particular interest in the research conducted at the MGH Center for Women's Mental Health, including the National Pregnancy Registry for Atypical Antipsychotics.
