- immediate referral to hospital or psychiatric care provider
- medications
First option for medication - Answer: Is often Sertraline/Zoloft
No single med is "safest" or "best" for use during pregnancy/postpartum/lactation
Why so much conflicting data on meds in perinatal - Answer: No randomized, double-blind, placebo-
controlled trials
Many studies are retrospective database and case-control studies
- may involve voluntary reporting
, - confounds (esp illness exposure)
Confounding variables in assessing risk - Answer: Other prescription/non-prescription meds
Nutrition
ETOH/cigarettes
Genetics
Obesity
Method of delivery
Environmental toxins
Maternal/paternal age
Length of gestation
Stress
Socioeconomic status
Golden rules of pharmacological tx - Answer: Keep it simple - monotherapy where possible, don't
change what's working
Ask about and document all known exposure to medications/supplements/herbals/OTC
Encourage psychotherapy & social support
Parental concerns around perinatal medication - Answer: Miscarriage
congenital malformation
preterm delivery / low birth weight
NAS - Neonatal Abstinence/Adaptation Syndrome
PPHN - Persistent Pulmonary Hypertension of the Newborn
Long term neurobehavioural effects
Autism
Risk of miscarriage - Answer: not a true risk when adequate controls are utilized - no increased risk with
SSRIs
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