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Women's Health (London, England) Nov 2013Women with active psychiatric disorders who become pregnant face treatment dilemmas. Although results from studies are inconsistent, small but significant, risks on... (Review)
Review
Women with active psychiatric disorders who become pregnant face treatment dilemmas. Although results from studies are inconsistent, small but significant, risks on birth outcomes occur with exposure to untreated disorders, as well as to psychotropic medications. Prenatal antidepressant medication exposure may increase the risk for spontaneous miscarriage, preterm birth, cardiac malformations, persistent pulmonary hypertension of the newborn and postnatal adaptation syndrome. The use of valproate is contraindicated during pregnancy due to teratogenicity and neurocognitive delay and deficits. This review of selected studies will highlight some of the current issues with the use of psychotropic medications during pregnancy and the postpartum period.
Topics: Abortion, Spontaneous; Antidepressive Agents; Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Breast Feeding; Congenital Abnormalities; Depression, Postpartum; Depressive Disorder; Female; Humans; Infant, Newborn; Mental Disorders; Persistent Fetal Circulation Syndrome; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal Exposure Delayed Effects; Psychotic Disorders; Psychotropic Drugs; Puerperal Disorders
PubMed: 24161312
DOI: 10.2217/whe.13.54 -
Behavioural and Cognitive Psychotherapy May 2011It has been suggested that the perinatal period is a period of increased risk for the development and/or exacerbation of OCD and that postpartum OCD (ppOCD) presents a... (Comparative Study)
Comparative Study Review
BACKGROUND
It has been suggested that the perinatal period is a period of increased risk for the development and/or exacerbation of OCD and that postpartum OCD (ppOCD) presents a distinct clinical picture. This raises the possibility that ppOCD might be a distinct subtype of OCD. This review examines this contention.
METHOD
A search using Ovid (Medline, PsycINFO and Embase), EBSCO, Cochrane Library, Web of Science (ISI), Pubmed databases and Google Scholar was carried out using the key words: "obsessive compulsive disorder" (and derivatives), "perinatal", "pregnancy", "postnatal", "postpartum", "mothers" (and derivatives), "anxiety disorders" and "subtypes." These articles and their references were reviewed.
RESULTS
The majority of studies reviewed were retrospective, which makes it impossible to infer causality. Two prospective studies found a higher incidence of OCD in the postpartum period. These were carried out in Turkey and Brazil and, as such, may be limited in their applicability to other cultural groups.
CONCLUSION
The concept of ppOCD as a specific subtype has not been robustly demonstrated. The evidence that OCD is more prevalent in the postpartum period is mixed. The evidence that OCD in the postpartum period presents a distinctive clinical picture with specific symptomatology and course is more compelling. In view of the impact of culture and religion on the expression of OCD, collaborative, international, prospective studies that take into account the methodological and definitional issues raised in this review are necessary to provide clarification.
Topics: Cross-Cultural Comparison; Cross-Sectional Studies; Female; Humans; Obsessive-Compulsive Disorder; Pregnancy; Pregnancy Complications; Puerperal Disorders; Risk
PubMed: 21208486
DOI: 10.1017/S1352465810000718 -
Tidsskrift For Den Norske Laegeforening... Jan 2011Pharmacological treatment and prophylaxis of bipolar disorders during pregnancy and in the postpartum period imply complicated clinical assessments. (Review)
Review
BACKGROUND
Pharmacological treatment and prophylaxis of bipolar disorders during pregnancy and in the postpartum period imply complicated clinical assessments.
MATERIAL AND METHOD
This article is based on a non-systematic search in PubMed and the authors' clinical experience.
RESULTS
If a woman is already using a prophylactic drug at the time of pregnancy, she can in general continue to do so during pregnancy, with the exception of valproate. If the disorder starts during pregnancy; lithium, lamotrigine or second generation antipsychotic drugs are suitable alternatives. In general, drugs used during pregnancy can also be used in the postpartum period, although some require special precautions if the mother wishes to breast-feed. If treatment is initiated after delivery, the mother's wish to breast-feed should be taken into consideration when choosing a drug.
INTERPRETATION
Although existing studies have weaknesses, there is sufficient evidence to give qualified advice regarding choice of medication for bipolar disorder during pregnancy and in the postpartum period.
Topics: Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Contraindications; Female; Humans; Lactation; Lamotrigine; Lithium Compounds; Pregnancy; Pregnancy Complications; Puerperal Disorders; Risk Factors; Triazines; Valproic Acid
PubMed: 21267028
DOI: 10.4045/tidsskr.09.1411 -
BMJ Case Reports Nov 2012Idiopathic granulomatous mastitis (IGM) is a rare chronic benign disease of the breast. Histologically, the disease presents as an inflammatory reaction with...
Idiopathic granulomatous mastitis (IGM) is a rare chronic benign disease of the breast. Histologically, the disease presents as an inflammatory reaction with non-caseating granulomas considered characteristic for IGM. IGM is often confused with breast cancer or mastitis with abcedations, and is treated with surgery which involves mutilation of the breast. Although no consensus exists on the best treatment modality, the use of low-dose oral and topical steroids has proven efficacy.
Topics: Adult; Anti-Inflammatory Agents; Biopsy, Fine-Needle; Breast Feeding; Diagnosis, Differential; Female; Granulomatous Mastitis; Humans; Magnetic Resonance Imaging; Mammography; Methylprednisolone; Puerperal Disorders; Recurrence; Reoperation; Ultrasonography, Mammary
PubMed: 23188836
DOI: 10.1136/bcr-2012-006187 -
BMC Pregnancy and Childbirth Nov 2012The incidence of severe maternal morbidity is increasing in high-income countries as a consequence, in part, of increased obstetric intervention and increasingly complex... (Review)
Review
BACKGROUND
The incidence of severe maternal morbidity is increasing in high-income countries as a consequence, in part, of increased obstetric intervention and increasingly complex medical needs of women who become pregnant. Access to emergency obstetric care means that for the majority of women in these countries, an experience of severe maternal morbidity is unlikely to result in loss of life. However, little is known about the subsequent impact on postnatal psychological health resulting in an evidence gap to support provision of appropriate care for these women. There has recently been increasing recognition that childbirth can be a cause of post-traumatic stress disorder (PTSD). The combination of experiencing a life-threatening complication and its management may culminate in psychological trauma. This systematic review examined the association between women's experience of severe maternal morbidity during labour, at the time of giving birth or within the first week following birth, and PTSD and its symptoms.
METHODS
Relevant literature was identified through multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index, Web of Science, Cochrane library and the British Library, using predetermined search strategies. The search terms included "post-traumatic stress disorder", "PTSD", "stress disorders, post-traumatic", "maternal morbidity", "pregnancy complications" "puerperal disorders", "obstetric labo(u)r complication", "postpartum h(a)emorrhage", "eclampsia". Studies identified were categorised according to pre-defined inclusion and exclusion criteria. The quality of included studies was assessed using the relevant CASP appraisal tools.
RESULTS
Eleven primary studies met review criteria. Evidence of a relationship between severe maternal morbidity and PTSD/PTSD symptoms was inconsistent and findings varied between studies. Nevertheless, there is some evidence that severe pre-eclampsia is a risk factor for PTSD and its symptoms, an association possibly mediated by other factors such as fetal/neonatal condition.
CONCLUSIONS
Despite the absence of robust evidence regarding the relationship between severe maternal morbidity and PTSD/PTSD symptoms, it is crucially important that clinicians and policy makers are aware of a potential higher risk of PTSD among women who experience severe morbidity. Further studies are now needed to confirm this risk as well as to understand underlying mechanisms in order to minimise the longer term psychiatric impact of severe maternal morbidity.
Topics: Eclampsia; Female; Humans; Obstetric Labor Complications; Parturition; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Puerperal Disorders; Severity of Illness Index; Stress Disorders, Post-Traumatic
PubMed: 23140343
DOI: 10.1186/1471-2393-12-125 -
BMJ (Clinical Research Ed.) Jan 2008Pregnancy can complicate an eating disorder as changes in body shape may increase anxiety about weight gain. Pregnant women with eating disorders need enhanced... (Review)
Review
Pregnancy can complicate an eating disorder as changes in body shape may increase anxiety about weight gain. Pregnant women with eating disorders need enhanced monitoring and postnatal support
Topics: Breast Feeding; Feeding and Eating Disorders; Female; Humans; Infertility, Female; Mother-Child Relations; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care; Puerperal Disorders
PubMed: 18187726
DOI: 10.1136/bmj.39393.689595.BE -
Cardiology Journal 2022
Topics: Cardiomyopathies; Female; Humans; Incidence; Peripartum Period; Puerperal Disorders; Sweden
PubMed: 34642918
DOI: 10.5603/CJ.a2021.0127 -
Annali Dell'Istituto Superiore Di Sanita 2021Australia is at the forefront of developing screening practices, interventions and national public health policy for perinatal women with depression and anxiety. For the... (Review)
Review
An Australian perspective on treating perinatal depression and anxiety: a brief review of efficacy and evidence-based practice in screening, psychosocial assessment and management.
Australia is at the forefront of developing screening practices, interventions and national public health policy for perinatal women with depression and anxiety. For the last two decades Australian mental health experts and public health administrators have conducted population-wide feasibility studies on screening and incorporated these in national guidelines. This chapter outlines the wider evidence base supporting current Australian practice. Key recommendations include use of the Edinburgh Postnatal Depression Scale or the Patient Health Questionnaire-9 early in pregnancy and at 6-12 weeks postpartum, followed by psychosocial assessment. Positive depression screens need to be followed by diagnostic assessment, and clear treatment pathways must be available. Milgrom and colleagues' cognitive behavioural treatment is the only Australian program with a solid evidence base demonstrating its effectiveness for depression and associated anxiety. The face-to-face treatment has been further developed into an online program, MumMoodBooster, funded by the Federal government and available to Australian women.
Topics: Anxiety; Australia; Depression; Depression, Postpartum; Evidence-Based Practice; Female; Humans; Mass Screening; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Puerperal Disorders; Treatment Outcome
PubMed: 33797404
DOI: 10.4415/ANN_21_01_07 -
Malawi Medical Journal : the Journal of... Sep 2023This report of five cases of peripartum cardiomyopathy (PPCM) treated at Daeyang Luke Hospital in Lilongwe, Malawi, illustrates presentation and treatment of this...
AIM
This report of five cases of peripartum cardiomyopathy (PPCM) treated at Daeyang Luke Hospital in Lilongwe, Malawi, illustrates presentation and treatment of this increasingly commonly recognized medical condition.
METHODS
Information including history, physical examination, and imaging studies were collected from five cases of peripartum women who presented to the hospital over an 18-month period.
RESULTS
A summary of recommended treatment is included in table form, and a flow chart proposing a care pathway for managing PPCM in Malawi, beginning at the district hospital level, is presented.
CONCLUSION
Clinical recognition, appropriate diagnostic modalities, and informed treatment of PPCM in Malawi will improve care of peripartum woman and reduce maternal morbidity and mortality.
Topics: Female; Humans; Peripartum Period; Malawi; Cardiomyopathies; Puerperal Disorders
PubMed: 38362291
DOI: 10.4314/mmj.v35i3.10 -
Archives of Dermatology Aug 2009
Topics: Abortion, Spontaneous; Adult; Dermatomyositis; Estrogens; Female; Humans; Pregnancy; Progesterone; Puerperal Disorders; Skin
PubMed: 19687439
DOI: 10.1001/archdermatol.2009.159