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.
A clinician asks: "Is there any data on the use of the Emsam patch in pregnancy?"
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:
Choosing whether to maintain or discontinue mood stabilizer treatment during pregnancy requires weighing the risks of teratogenic outcomes associated with exposure to a particular drug against the risks of recurrence of untreated affective illness. However, [...]
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.
Ms. A is a 27-year-old woman who is seven weeks pregnant and is currently taking duloxetine (Cymbalta). She has a history of recurrent major depressive disorder (MDD) and has had a good response to duloxetine at 60 mg per day. She has had four previous episodes of major depressive disorder (most untreated) and has been in remission for one year. Past episodes have lasted up to six months and caused difficulty with functioning at work and in relationships, although she was not diagnosed and treated until one year ago.
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.
