Some psychotropic medications pass into breast milk. In most cases, however, levels are very low or undetectable. Efects may be transient irritability, sleep disturbances, and colic.
Electroconvulsive Therapy. This form of depression treatment is occasionally necessary during pregnancy for women with major mood disorders unresponsive to pharmacotherapy. Women undergoing electroconvulsive therapy (ECT) should be fasting for at least 6 hours. hey are given a rapid-acting antacid before the procedure, and their airway is protected to decrease the likelihood of aspiration. Ater midpregnancy, a wedge is placed under the right hip to prevent sudden maternal hypotension from aortocaval compression. Other important preparatory steps include assessment of the cervix, discontinuation of nonessential anticholinergic medication, uterine and fetal heart rate monitoring, and intravenous hydration. During the procedure, excessive hyperventilation is avoided. In most cases, maternal and fetal heart rate and maternal blood pressure and oxygen saturation remain normal throughout the procedure.
With proper preparation, the risks to both mother and fetus appear to be reasonable (Pinette, 2007). hat said, adverse maternal and perinatal outcomes have followed ECT. Balki and associates (2006) reported a pregnancy in which fetal brain damage likely was caused by sustained maternal hypotension associated with treatment of status epilepticus stimulated by ECT.
At least two extensive reviews have evaluated ECT outcomes in pregnancy. In the earlier one, Miller (1994) found 300 cases and reported complications in 10 percent. These included fetal arrhythmias, vaginal bleeding, abdominal pain, and self-limited contractions. Women not adequately prepared had increased risks for aspiration, aortocaval compression, and respiratory alkalosis. In the more recent review, Andersen and Ryan (2009) described 339 cases, undoubtedly with some homology with the earlier study. In most cases, ECT therapy was done to treat depression, and it was 78-percent efective. hey reported a 5-percent maternal ECT -related complication rate. here was a 3-percent associated perinatal complication rate, which included two fetal deaths. For all of these reasons, we agree with Richards (2007) that ECT in pregnancy is not "low risk" and that it should be reserved for women whose severe depression is resistant to intensive pharmacotherapy.
According to the National Institute of Mental Health (2010), the lifetime prevalence for manic-depression illness is 3.9 percent. he prevalence of bipolar disorder does not vary between gravidas and nonpregnant reproductive-aged women (Yonkers, 2011). It has a strong genetic component and has been linked to possible mutations on chromosomes 16 and 8 (Jones, 2007). The risk that monozygotic twins are both afected is 40 to 70 percent, and the risk for first-degree relatives is 5 to 10 percent (Muller-Oerlinghausen, 2002).
Periods of depression last at least 2 weeks. At other times, patients are manic, in which mood is abnormally raised, expan sive, or irritable. Potential organic causes of mania include substance abuse, hyperthyroidism, and central nervous system (CNS) tumors. hese are all excluded during an acute event.
Importantly, pregnancy frequently prompts medication dis continuation, which poses a twofold increased risk for relapse (Viguera, 2007). Afected women are considered high risk, and as many as 20 percent of patients with manic-depression illness commit suicide.