Therapy in Pregnancy
- All mood stabilizers are teratogenic
- Lithium lower risk (Ebstein’s anomaly, 0.1%)
- Tricuspid valve displacement
- If illness not that severe, consider planned pregnancy without meds
- 4 week medication-free period pre-conception
- ECT, SSRI, Neuroleptics all lower risk in 1st trimester
sodium valproate in Pregnancy
- (sodium valproate) much more problematic
- Neural tube defects may increase to 5%
- Try to avoid in women of child bearing age, especially weeks 1-10.
- Can use folic acid 5 mg. PO OD
- Can do serial ultrasounds examining the neural tube
Lamotrigine in Pregnancy
- Cleft lip and palate
- Possible less teratogenic
Dosage in Pregnancy
- May need to increase dose
- Especially lithium during this time
- Then decrease dose after delivery (re: GFR)
- Post partum has >50% risk of an episode
- Recommend re-start therapy after delivery
- All secreted through breast milk
- Data suggests no immediate risk
- No data regarding later behavioural effects