Clinical characteristics of maternal mental health service users treated with mood stabilizing or antipsychotic medication.

INTRODUCTION: We aimed to investigate the characteristics of pregnant women who required either mood stabilizer or antipsychotic treatment. These women requiring such treatment are likely to be more mentally unwell and thus carry a higher burden of comorbidities associated with poor pregnancy outcomes. METHODS: This retrospective review investigated the common characteristics of pregnant women who were prescribed with antipsychotics or mood stabilizers under a major city's public maternal mental health service. Demographic data, pregnancy factors and prenatal care, stressors and support, concurrent medical and substance abuse problems, and ongoing maternal mental health issues were recorded. RESULTS: Most pregnancies were unplanned. Commonly, social stressors, medical problems, and substance use were identified. The most common diagnosis was bipolar disorder. DISCUSSION: Pregnant women requiring treatment with mood stabilizers or antipsychotics are a complex clinical population, with multiple risk factors for negative pregnancy outcome, before even considering the potential risk from psychotropic agents and mental illness itself. Obtaining reliable data about substance use and medication compliance remains problematic.

Maternal and Fetal Outcomes After Lamotrigine Use in Pregnancy: A Retrospective Analysis from an Urban Maternal Mental Health Centre in New Zealand.

INTRODUCTION: Pregnancy is a vulnerable period for recurrence of bipolar disorder. Discontinuation of mood stabilisers during pregnancy and the postpartum period can significantly increase the risk of recurrence of bipolar disorder. Lamotrigine is an anti-epileptic drug that has been approved for the maintenance treatment of bipolar disorder. Epilepsy literature has indicated that lamotrigine has a reassuring safety profile in pregnancy but there is little information on its effectiveness and safety in pregnant women with mental disorders. METHOD: We conducted a retrospective review of all pregnant women who presented to an urban maternal mental health centre in Auckland, New Zealand between 2012 and 2014 and were treated with antipsychotics and/or mood stabilisers. Pregnancy outcome, obstetric and perinatal complications, congenital malformations and maternal mental health in the postnatal period were considered. RESULTS: Here, we present the outcomes in the subset of six women who were treated with lamotrigine 100-400 mg/day for the entire pregnancy. Five were diagnosed with bipolar disorder and one with major depression. Three women received additional psychotropic medication during pregnancy. No women needed psychiatric hospitalisation. All babies were live birth after 36 weeks gestation. Two babies had low birth weight and required NICU admissions. Two women required lower segment caesarean section and the other 4 were induced. A trachea-esophageal fistula was noted in one baby. Four babies who were breastfed while their mothers received uninterrupted treatment with lamotrigine, experienced no complications. DISCUSSION: This naturalistic study indicates that lamotrigine can be an effective treatment option for maintenance of bipolar illness in women of childbearing age.

Atypical antipsychotic use and outcomes in an urban maternal mental health service.

Objective Despite many women suffering from psychosis in their childbearing years, limited data exist about the use of atypical antipsychotic agents in pregnancy. Atypical antipsychotic agents are often used to treat bipolar disorder, instead of lithium or valproate because of the known teratogenicity of those agents. As well, atypical antipsychotics are often prescribed in anxiety disorders and depression. This study sought to describe pregnancy outcomes for women prescribed atypical antipsychotics during pregnancy. Methods This retrospective review included all cases treated by Auckland Maternal Mental Health services in which atypical antipsychotic agents were utilized during pregnancy over three years. Results Over the three years, 45 pregnant women were prescribed atypical antipsychotic agents, most commonly quetiapine or olanzapine. Two-fifths (40%) were diagnosed with bipolar disorder and almost one-third (31%) with a psychotic disorder. Two-thirds (64%) were prescribed multiple psychotropic medications during their pregnancy. Instrumental delivery rates were elevated at 38%. A minority (13%) of the women developed gestational diabetes mellitus. Although 7% of infants were born premature, all were born after 35 weeks. Two major malformations were noted, similar to baseline community rates. Conclusions This naturalistic study adds to the limited literature about treatment with atypical antipsychotic agents in pregnancy, though not adequately powered to detect small differences in malformations or obstetrical outcomes. It also highlights the myriad of indications for which pregnant women are prescribed atypical antipsychotics, and the multiple other risk factors seen in this population.