Hypertension in pregnancy is generally defined as a diastolic blood pressure of 90 mm Hg or greater or a systolic pressure at or above 140 mm Hg. Preeclampsia is defined as the development of hypertension with proteinuria or edema induced by pregnancy, generally in the second half of gestation. It is more common in women who have not carried a previous pregnancy beyond 20 weeks and in women at the extremes of the reproductive years.
The lifetime prevalence rate of obsessive-compulsive disorder (OCD) has been consistently estimated to be 2%-3% in the general adult population throughout the world, making OCD one of more common psychiatric diagnoses; however research on OCD in pregnancy and peurperium has been limited.
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.
Women with bipolar disorder are at increased risk for recurrence of illness during pregnancy. Therefore, many women with bipolar disorder elect to continue treatment with medications during pregnancy after weighing the risks and benefits of various treatment options with their physicians. Lamotrigine (Lamictal) is an anticonvulsant used to treat bipolar disorder. While the safety data on this relatively new anticonvulsant in pregnancy is limited, pregnancy registry data suggests that lamotrigine may pose less of a risk to the developing fetus than with older anticonvulsants, such as valproate (Depakote). With lamotrigine emerging as an effective and relatively safe treatment for pregnant women with bipolar disorder, more attention is now being paid to the effects of pregnancy on lamotrigine levels.
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.
Over the last several years, a number of studies have indicated that exposure to antidepressants near the time of delivery may be associated with poor neonatal outcomes. A recent prospective study from Dubnov-Raz and colleagues published in the journal Pediatrics found an association between QTc interval prolongation in neonates and antenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants. The QT interval is a measurement of the heart's electrical cycle from ventricular depolarization to the end of ventricular polarization. It is determined from an electrocardiogram (ECG) and is corrected for heart rate.
As more research is conducted within the field of women's mental health, there are times when recommendations may change depending on the available data. We will discuss a case here to illustrate this point.
Maguire and Mody's report, GABAA R Plasticity during Pregnancy: Relevance to Postpartum Depression, in the July 2008, Neuron, provides evidence that an abnormal Gamma-aminobutyric acid (GABAA) receptor subunit in pregnant mice may be a useful model for postpartum depression. The report describes how GABAA receptors, specifically, the delta-subunit-containing GABA receptor, are a preferred target for neurosteroids. They designed a study to identify functional changes in these receptors during pregnancy and postpartum and then looked at possible behavioral correlates in the mice.
Our Perinatal and Reproductive Psychiatry team often discusses clinical cases in Rounds, a confidential forum in which we can get advice and consultation from peers who also work in the area of Women's Mental Health. We discussed a patient's situation recently that highlighted the controversial area about how to prevent mood episodes in a woman planning for pregnancy.
A study published in the Archives of General Psychiatry shows that children of women who experience the death of a close relative may have an increased risk of developing schizophrenia later in life. This study was conducted with records of children born in Denmark between 1973 and 1995, which were then linked to the central registry containing inpatient and outpatient treatment records. It consisted of 1.38 million individuals, including 21,978 children whose mothers experienced death of a close relative during the pregnancy, and 14,206 children of mothers who experienced illness of a close relative during the pregnancy.
