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Chapter 24 - Psychiatric Disorders in Pregnancy

Published online by Cambridge University Press:  26 January 2024

By
Allana Munro  and
Ronald B. George
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Grace Lim
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Grace Lim
Affiliation:
University of Pittsburgh
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Summary

Peripartum psychiatric disorders are common, and it is likely that an obstetric anaesthesiologist will be involved with the care of a patient with one of these disorders. The most common psychiatric disorders encountered in the peripartum period include depression, anxiety, bipolar disorder, post-traumatic stress disorder, and schizophrenia. These conditions are commonly underdiagnosed and undertreated but may have grave maternal and neonatal consequences. Additionally, postpartum psychiatric disorders, specifically anxiety and depression, are common complications of childbirth. The rising prevalence of these disorders in the peripartum period necessitates an understanding of the epidemiology, management, and treatment options. Evidence on how psychiatric disorders and their treatment can affect the mother, baby, and the delivery of anesthesia care is presented. This chapter reviews important anesthesia considerations for pregnant patients with psychiatric disorders and interactions that may occur between anesthesia and the medical management of these disorders. Additionally, interventions and prevention techniques to improve patient care and manage postpartum psychiatric sequelae are explored.

Keywords

Postpartum psychiatric disordersPeripartum psychiatric disordersPostpartum depressionPregnancyLabor analgesiaObstetric AnesthesiaSchizophreniaDepressionAnxietyPTSD
Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 402 - 412
Publisher: Cambridge University Press
Print publication year: 2024

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References

Okagbue, HI, Adamu, PI, Bishop, SA, et al. Systematic review of prevalence of antepartum depression during the trimesters of pregnancy. Open Access Maced J Med Sci 2019;7:1555–1560.CrossRefGoogle ScholarPubMed
Payne, JL, Maguire, J. Pathophysiological mechanisms implicated in postpartum depression. Front Neuroendocrinol 2019;52:165–180.CrossRefGoogle ScholarPubMed
Becker, M, Weinberger, T, Chandy, A, et al. Depression during pregnancy and postpartum. Curr Psychiatry Rep 2016;18:32.Google Scholar
Cohen, LS, Nonacs, RM, Bailey, JW, et al. Relapse of depression during pregnancy following antidepressant discontinuation: a preliminary prospective study. Arch Womens Ment Health 2004;7:217–221.CrossRefGoogle ScholarPubMed
Mitchell, J, Goodman, J. Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: a systematic review. Arch Women’s Ment Health 2018;21:505–516.Google Scholar
Body, R, Bartram, T, Azam, F, et al. Guidelines in Emergency Medicine Network (GEMNet): guideline for the management of tricyclic antidepressant overdose. Emerg Med J 2011;28:347–368.Google Scholar
Kjaersgaard, MI, Parner, ET, Vestergaard, M, et al. Prenatal antidepressant exposure and risk of spontaneous abortion – a population-based study. PLoS One 2013;8:e72095.CrossRefGoogle ScholarPubMed
Palmsten, K, Huybrechts, KF, Michels, KB, et al. Antidepressant use and risk for preeclampsia. Epidemiology 2013;24:682–691. https://doi.org/10.1097/EDE.0b013e31829e0aaaGoogle Scholar
Palmsten, K, Hernández-Díaz, S, Huybrechts, KF, et al. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low-income women in the United States. BMJ 2013;347:f4877. https://doi.org/10.1136/bmj.f4877Google Scholar
Huybrechts, KF, Palmsten, K, Avorn, J, et al. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med 2014;370:2397–2407. https://doi.org/10.1056/NEJMoa1312828CrossRefGoogle ScholarPubMed
Reis, M, Källén, B. Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data. Psychol Med 2010;40:1723–1733.CrossRefGoogle ScholarPubMed
Gentile, S. Tricyclic antidepressants in pregnancy and puerperium. Expert Opin Drug Saf 2014:13:207–225. https://doi.org/10.1517/14740338.2014.869582Google Scholar
van Harten, J. Clinical pharmacokinetics of selective serotonin reuptake inhibitors. Clin Pharmacokinet 1993;24:203–220.Google Scholar
Gao, SY, Wu, QJ, Sun, C, et al. Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births. BMC Med 2018;16:205. https://doi.org/10.1186/s12916-018-1193-5Google Scholar
Byatt, N, Deligiannidis, KM, Freeman, MP. Antidepressant use in pregnancy: a critical review focused on risks and controversies. Acta Psychiatr Scand 2013;127:94–114.Google Scholar
Chisolm, MS, Payne, JL. Management of psychotropic drugs during pregnancy. BMJ 2016;532:h5918. https://doi.org/10.1136/bmj.h5918Google Scholar
Richardson, JL, Martin, F, Dunstan, H, et al. Pregnancy outcomes following maternal venlafaxine use: a prospective observational comparative cohort study. Reprod Toxicol 2019;84:108–113.Google Scholar
Uguz, F. Is there any association between use of antidepressants and preeclampsia or gestational hypertension? A systematic review of current studies. J Clin Psychopharmacol 2017;37:72–77.Google Scholar
Jiang, HY, Xu, LL, Li, YC, et al. Antidepressant use during pregnancy and risk of postpartum hemorrhage: a systematic review and meta-analysis. J Psychiatr Res 2016;83:160–167.CrossRefGoogle ScholarPubMed
Vigran, IM. Dangerous potentiation of meperidine hydrochloride by pargyline hydrochloride. JAMA 1964;187:953–954.Google Scholar
Stack, CG, Rogers, P, Linter, SP. Monoamine oxidase inhibitors and anaesthesia. A review. Br J Anaesth 1988;60:222–227.Google Scholar
Boakes, AJ, Laurence, DR, Teoh, PC, et al. Interactions between sympathomimetic amines and antidepressant agents in man. Br Med J 1973;1(5849):311–315.Google Scholar
Corkeron, MA. Serotonin syndrome – a potentially fatal complication of antidepressant therapy. Med J Aust 1995;163:481–482. https://doi.org/10.5694/j.1326–5377.1995.tb124696.xGoogle Scholar
Grover, S, Sikka, P, Saini, SS, et al. Use of modified bilateral electroconvulsive therapy during pregnancy: a case series. Indian J Psychiatry 2017;59:487–492. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_50_17Google Scholar
Gressier, F, Rotenberg, S, Cazas, O, et al. Postpartum electroconvulsive therapy: a systematic review and case report. Gen Hosp Psychiatry 2015;37:310–314. https://doi.org/10.1016/j.genhosppsych.2015.04.009Google Scholar
Anderson, EL, Reti, IM. ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosom Med 2009;71:235–242.Google Scholar
Bulut, M, Bez, Y, Kaya, MC, et al. Electroconvulsive therapy for mood disorders in pregnancy. J ECT 2013;29:e19–20. https://doi.org/10.1097/YCT.0b013e318277cce2CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5th ed.). Washington, DC: American Psychiatric Association, 2013.Google Scholar
O’Hara, MW, McCabe, JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol 2013;9:379–407.Google Scholar
Hahn-Holbrook, J, Cornwell-Hinrichs, T, Anaya, I. Economic and health predictors of national postpartum depression prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front Psychiatry 2017;8:248. https://doi.org/10.3389/fpsyt.217.00248Google Scholar
Di Florio, A, Forty, L, Gordon-Smith, K, et al. Perinatal episodes across the mood disorder spectrum. JAMA Psychiatry 2013;70:168–1675. https://doi.org/10.1001/jamapsychiatry.2013.279Google Scholar
Cohen, LS, Wang, B, Nonacs, R, et al. Treatment of mood disorders during pregnancy and postpartum. Psychiatr Clin North Am 2010;33:273–293. https://doi.org/10.1016/j.psc.2010.02.001Google Scholar
Van den Bergh, BRH, van den Heuvel, MI, Lahti, M, et al. Prenatal developmental origins of behavior and mental health: the influence of maternal stress in pregnancy. Neurosci Biobehav Rev 2020;117:26–64. https://doi.org/10.1016/j.neubiorev.2017.07.003Google Scholar
Munro, A, MacCormick, H, Sabharwal, A, et al. Pharmacologic labour analgesia and its relationship to postpartum psychiatric disorders: a scoping review. Can J Anesth 2020;67:588–604. https://doi.org/10.1007/s12630-020-01587-7CrossRefGoogle ScholarPubMed
Ding, T, Wang, DX, Qu, Y, et al. Epidural labor analgesia is associated with a decreased risk of postpartum depression: a prospective cohort study. Anesth Analg 2014;119:383–392. https://doi.org/10.1213/ANE.0000000000000107CrossRefGoogle ScholarPubMed
Suhitharan, T, Pham, TP, Chen, H, et al. Investigating analgesic and psychological factors associated with risk of postpartum depression development: a case-control study. Neuropsychiatr Dis Treat 2016;12:1333–1339. https://doi.org/10.2147/NDT.S105918Google Scholar
Liu, ZH, He, ST, Deng, CM, et al. Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: a multicentre, prospective, longitudinal study. Eur J Anaesthesiol 2019;36:745–754. https://doi.org/10.1097/EJA.0000000000001058Google Scholar
Riazanova, OV, Alexandrovich, YS, Ioscovich, AM. The relationship between labor pain management, cortisol level and risk of postpartum depression development: a prospective nonrandomized observational monocentric trial. Rom J Anaesth Intensive Care 2018;25:123–130. https://doi.org/10.21454/rjaic.7518.252.rznGoogle Scholar
Eckerdal, P, Kollia, N, Karlsson, L, et al. Epidural analgesia during childbirth and postpartum depressive symptoms: a population-based longitudinal cohort study. Anesth Analg 2020;130:615–624. https://doi.org/10.1213/ANE.0000000000004292Google Scholar
Munro, A, George, RB, Mackinnon, SP, et al. The association between labour epidural analgesia and postpartum depressive symptoms: a longitudinal cohort study. Can J Anesth 2021;68:485–495. https://doi.org/10.1007/s12630-020-01900-4CrossRefGoogle ScholarPubMed
Orbach-Zinger, S, Heesen, M, Grigoriadis, S, et al. A systematic review of the association between postpartum depression and neuraxial labor analgesia. Int J Obstet Anesth 2021;45:142–149. https://doi.org/10.1016/j.ijoa.2020.10.004Google Scholar
Kountanis, JA, Vahabzadeh, C, Bauer, S, et al. Labor epidural analgesia and the risk of postpartum depression: a meta-analysis of observational studies. J Clin Anesth 2020;61:109658.Google Scholar
Deng, CM, Ding, T, Li, S, et al. Neuraxial labor analgesia is associated with a reduced risk of postpartum depression: a multicenter prospective cohort study with propensity score matching. J Affect Disord 2021;281:342–350. https://doi.org/10.1016/j.jad.2020.12.027CrossRefGoogle ScholarPubMed
Eisenach, JC, Pan, PH, Smiley, R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008;140:87–94. https://doi.org/10.1016/j.pain.2008.07.011Google Scholar
Lim, G, LaSorda, KR, Farrell, LM, et al. Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study. BMC Pregnancy Childbirth 2020;20:240. https://doi.org/10.1186/s12884-020-02943-7Google Scholar
Guglielminotti, J, Li, G. Exposure to general anesthesia for cesarean delivery and odds of severe postpartum depression requiring hospitalization. Anesth Analg 2020;131: 1421–1429. https://doi.org/10.1213/ANE.0000000000004663Google Scholar
Ma, JH, Wang, SY, Yu, HY, et al. Prophylactic use of ketamine reduces postpartum depression in Chinese women undergoing cesarean section. Psychiatry Res 2019:279:252–258. https://doi.org/10.1016/j.psychres.2019.03.026Google Scholar
Meltzer-Brody, S, Colquhoun, H, Riesenberg, R, et al. Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet 2018;392(10152):1058–1070. https://doi.org/10.1016/S0140-6736(18)31551-4Google Scholar
Nakić Radoš, S, Tadinac, M, Herman, R. Anxiety during pregnancy and postpartum: course, predictors and comorbidity with postpartum depression. Acta Clin Croat 2018;57:39–51. https://doi.org/10.20471/acc.2018.57.01.05Google Scholar
Dennis, CL, Falah-Hassani, K, Shiri, R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry 2017;210:315–323. https://doi.org/10.1192/bjp.bp.116.187179Google Scholar
Miller, RL, Pallant, JF, Negri, LM. Anxiety and stress in the postpartum: is there more to postnatal distress than depression? BMC Psychiatry 2006;6:12. https://doi.org/10.1186/1471-244X-6-12Google Scholar
Grigoriadis, S, Graves, L, Peer, M, et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. J Clin Psychiatry 2018;79:17r12011. https://doi.org/10.4088/JCP.17r12011Google Scholar
Fernández-Campos, FJ, Escrivá, D, Palanca, JM, et al. Women’s acute anxiety variations before and after epidural anesthesia for childbirth. J Psychosom Obstet Gynaecol 2017;38:152–158. https://doi.org/10.1080/0167482X.2017.1285902Google Scholar
Floris, L, Irion, O, Courvoisier, D. Influence of obstetrical events on satisfaction and anxiety during childbirth: a prospective longitudinal study. Psychol Health Med 2017;22:969–977. https://doi.org/10.1080/13548506.2016.1258480Google Scholar
Ghanbari-Homayi, S, Fardiazar, Z, Meedya, S, et al. Predictors of traumatic birth experience among a group of Iranian primipara women: a cross-sectional study. BMC Pregnancy Childbirth 2019;19:182. https://doi.org/10.1186/s12884-019-2333-4Google Scholar
Grekin, R, O’Hara, MW. Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev 2014;34:389–401. https://doi.org/10.1016/j.cpr.2014.05.003Google Scholar
Alcorn, KL, O’Donovan, A, Patrick, JC, et al. A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychol Med 2010;40:1849–1859. https://doi.org/10.1017/S0033291709992224Google Scholar
de Graaff, LF, Honig, A, van Pampus, MG, et al. Preventing post-traumatic stress disorder following childbirth and traumatic birth experiences: a systematic review. Acta Obstet Gynecol Scand 2018;97:648–656. https://doi.org/10.1111/aogs.13291Google Scholar
Hernández-Martínez, A, Rodríguez-Almagro, J, Molina-Alarcón, M, et al. Postpartum post-traumatic stress disorder: associated perinatal factors and quality of life. J Affect Disord 2019;249:143–150. https://doi.org/10.1016/j.jad.2019.01.042Google Scholar
Lopez, U, Meyer, M, Loures, V, et al. Post-traumatic stress disorder in parturients delivering by caesarean section and the implication of anaesthesia: a prospective cohort study. Health Qual Life Outcomes 2017;15:118. https://doi.org/10.1186/s12955-017-0692-yGoogle Scholar
Rubinchik, SM, Kablinger, AS, Gardner, JS. Medications for panic disorder and generalized anxiety disorder during pregnancy. Prim Care Companion J Clin Psychiatry 2005;7:100–105. https://doi.org/10.4088/pcc.v07n0304Google Scholar
Stephens, S, Ford, E, Paudyal, P, et al. Effectiveness of psychological interventions for postnatal depression in primary care: a meta-analysis. Ann Fam Med 2016;14:463–472. https://doi.org/10.1370/afm.1967Google Scholar
Rosenberg, L, Mitchell, AA, Parsells, JL, et al. Lack of relation of oral clefts to diazepam use during pregnancy. N Engl J Med 1983;309: 1282–1285. https://doi.org/10.1056/NEJM198311243092103Google Scholar
Janoutová, J, Janáčková, P, Šerý, O, et al. Epidemiology and risk factors of schizophrenia. Neuroendocrinol Lett 2016;37:1–8. www.nel.edu/userfiles/articlesnew/NEL370116R01.pdfGoogle Scholar
McGrath, JJ, Hearle, J, Jenner, L, et al. The fertility and fecundity of patients with psychoses. Acta Psychiatr Scand 1999;99(6):441–446. https://doi.org/10.1111/j.1600-0447.1999.tb00990.xGoogle Scholar
Solari, H, Dickson, KE, Miller, L. Understanding and treating women with schizophrenia during pregnancy and postpartum – Motherisk Update 2008. Can J Clin Pharmacol 2009;16:e23–e32. https://jptcp.com/index.php/jptcp/article/view/294Google Scholar
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association, 2013.Google Scholar
Taylor, CL, Stewart, R, Ogden, J, et al. The characteristics and health needs of pregnant women with schizophrenia compared with bipolar disorder and affective psychoses. BMC Psychiatry 2015;15:1–10. https://doi.org/10.1186/s12888-015-0451-8Google Scholar
Jablensky, AV, Morgan, V, Zubrick, SR, et al. Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. Am J Psychiatry 2005;162:79–91. https://doi.org/10.1176/appi.ajp.162.1.79Google Scholar
Simoila, L, Isometsä, E, Gissler, M, et al. Schizophrenia and pregnancy: a national register-based follow-up study among Finnish women born between 1965 and 1980. Arch Womens Ment Health 2020;23: 91–100. https://doi.org/10.1007/s00737-019-0948-0Google Scholar
Ellman, LM, Huttunen, M, Lönnqvist, J, et al. The effects of genetic liability for schizophrenia and maternal smoking during pregnancy on obstetric complications. Schizophr Res 2007;93:229–236. https://doi.org/10.1016/j.schres.2007.03.004Google Scholar
Vigod, SN, Gomes, T, Wilton, AS, et al. Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population-based cohort study. BMJ 2015;350:h2298. https://doi.org/10.1136/bmj.h2298Google Scholar
Breadon, C, Kulkarni, J. An update on medication management of women with schizophrenia in pregnancy. Expert Opin Pharmacother 2019;20:1365–1376. https://doi.org/10.1080/14656566.2019.1612876Google Scholar
Barnes, TR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2011;25:567–620. https://doi.org/10.1177/0269881110391123CrossRefGoogle ScholarPubMed
Robinson, GE. Treatment of schizophrenia in pregnancy and postpartum. J Popul Ther Clin Pharmacol 2012;19:e380–386. https://www.jptcp.com/index.php/jptcp/article/view/409Google Scholar
Committee on Drugs. American Academy of Pediatrics. Use of psychoactive medication during pregnancy and possible effects on the fetus and newborn. Pediatrics 2000:105:880–887.Google Scholar
Gentile, S. Antipsychotic therapy during early and late pregnancy. a systematic review. Schizophr Bull 2010;36:518–544. https://doi.org/10.1093/schbul/sbn107Google Scholar
McNeil, TF, Kaij, L, Malmquist‐Larsson, A. Women with nonorganic psychosis: mental disturbance during pregnancy. Acta Psychiatr Scand 1984;70:127–139. https://doi.org/10.1111/j.1600-0447.1984.tb01190.xGoogle Scholar
Trixler, M, Gati, A, Tenyi, T. Risks associated with childbearing in schizophrenia. Acta Psychiatr Belg 1995;95:159–162.Google Scholar
Jones, I, Chandra, PS, Dazzan, P, et al. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 2014;384(9956):1789–1799. https://doi.org/10.1016/S0140-6736(14)61278-2Google Scholar
Pearlstein, T. Use of psychotropic medication during pregnancy and the postpartum period. Womens Health (Lond) 2013;9:605–615. https://doi.org/10.2217/WHE.13.54Google Scholar
ACOG. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists No. 92, April 2008. Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol 2008;111:1001–1020. https://doi.org/10.1176/foc.7.3.foc385Google Scholar
Habermann, F, Fritzsche, J, Fuhlbrück, F, et al. Atypical antipsychotic drugs and pregnancy outcome: a prospective, cohort study. J Clin Psychopharmacol 2013;33: 453–462. https://doi.org/10.1097/JCP.0b013e318295fe12CrossRefGoogle ScholarPubMed
Newcomer, JW. Antipsychotic medications: metabolic and cardiovascular risk. J Clin Psychiatry 2007;68(Suppl. 4):8–13.Google Scholar
Newham, JJ, Thomas, SH, MacRitchie, K, et al. Birth weight of infants after maternal exposure to typical and atypical antipsychotics: prospective comparison study. Br J Psychiatry 2008;192:333–337. https://doi.org/10.1192/bjp.bp.107.041541Google Scholar
Gentile, S. Clinical utilization of atypical antipsychotics in pregnancy and lactation. Ann Pharmacother 2004;38:1265–1271. https://doi.org/10.1345/aph.1D485Google Scholar
Kornhuber, J, Weller, M, Riederer, P. Glutamate receptor antagonists for neuroleptic malignant syndrome and akinetic hyperthermic parkinsonian crisis. J Neural Transm Park Dis Dement Sect 1993;6:63–72. https://doi.org/10.1007/BF02252624Google Scholar
Constance, LSL, Lansing, MG, Khor, FK, et al. Schizophrenia and anaesthesia. BMJ Case Rep 2017 (online). https://doi.org/10.1136/bcr-2017-221659Google Scholar
Kudoh, A, Katagai, H, Takase, H, et al. Effect of preoperative discontinuation of antipsychotics in schizophrenic patients on outcome during and after anaesthesia. Eur J Anaesthesiol 2004;21:414–416. https://doi.org/10.1017/S026502150422511XGoogle Scholar
Janowsky, EC, Risch, C, Janowsky, DS. Effects of anesthesia on patients taking psychotropic drugs. J Clin Psychopharmacol 1981;1:14–20. https://doi.org/10.1097/00004714-198101000-00004Google Scholar
Baguley, WA, Hay, WT, Mackie, KP, et al. Cardiac dysrhythmias associated with the intravenous administration of ondansetron and metoclopramide. Anesth Analg 1997;84:1380–1381.Google Scholar
Ganzini, L, Casey, DE, Hoffman, WF, et al. The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders. Arch Intern Med 1993;153:1469–1475. https://doi.org/10.1001/archinte.1993.00410120051007CrossRefGoogle ScholarPubMed
Beck, K, Hindley, G, Borgan, F, et al. Association of ketamine with psychiatric symptoms and implications for its therapeutic use and for understanding schizophrenia: a systematic review and meta-analysis. JAMA Netw Open 2020;3:e204693. https://doi.org/10.1001/jamanetworkopen.2020.4693Google Scholar
Acera Pozzi, R, Yee, LM, Brown, K, et al. Pregnancy in the severely mentally ill patient as an opportunity for global coordination of care. Am J Obstet Gynecol 2014;210:32–37. https://doi.org/10.1016/j.ajog.2013.07.029Google Scholar
Munk-Olsen, T, Laursen, TM, Pedersen, CB, et al. New parents and mental disorders: a population-based register study. JAMA 2006;296:2582–2589. https://doi.org/10.1001/jama.296.21.2582Google Scholar
Viguera, AC, Whitfield, T, Baldessarini, RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry 2007;164:1817–1824. https://doi.org/10.1176/appi.ajp.2007.06101639Google Scholar
Pope, CJ, Sharma, V, Mazmanian, D. Bipolar disorder in the postpartum period: management strategies and future directions. Women’s Health 2014;10:359–371. https://doi.org/10.2217/WHE.14.33Google Scholar
Jones, I, Craddock, N. Bipolar disorder and childbirth: the importance of recognising risk. Br J Psychiatry 2005;186:453–454. https://doi.org/10.1192/bjp.186.6.453Google Scholar
Heron, J, Haque, S, Oyebode, F, et al. A longitudinal study of hypomania and depression symptoms in pregnancy and the postpartum period. Bipolar Disord 2009;11:410–417. https://doi.org/10.1111/j.1399-5618.2009.00685.xGoogle Scholar
Khan, SJ, Fersh, ME, Ernst, C, et al. Bipolar disorder in pregnancy and postpartum: principles of management. Curr Psychiatry Rep 2016;18:13. https://doi.org/10.1017/s11920-015-0658-xGoogle Scholar
Newport, DJ, Viguera, AC, Beach, AJ, et al. Lithium placental passage and obstetrical outcome: implications for clinical management during late pregnancy. Am J Psychiatry 2005;162:2162–2170. https://doi.org/10.1176/appi.ajp.162.11.2162Google Scholar
Nora, JJ, Nora, AH, Toews, WH. Lithium, Ebstein’s anomaly, and other congenital heart defects. Lancet 1974;304(7880):594–595. https://doi.org/10.1016/S0140-6736(74)91918-7Google Scholar
Diav-Citran, O, Shechtman, S, Tahover, E, et al. Pregnancy outcome following in utero exposure to lithium: a prospective, comparative, observational study. Am J Psychiatry 2014;171:785–794. https://doi.org/10.1176/appi.ajp.201412111402Google Scholar
Werler, MM, Ahrens, KA, Bosco, JLF, et al. Use of antiepileptic medications in pregnancy in relation to risks of birth defects. Ann Epidemiol 2011;21:842–850. https://doi.org/10.1016/j.annepidem.2011.08.002Google Scholar
Attri, JP, Bala, N, Chatrath, V. Psychiatric patient and anaesthesia. Indian J Anaesth 2012;56:8–13. https://doi.org/10.4103/0019-5049.93337Google Scholar
Hızlı Sayar, G, Eryılmaz, G, Semieoğlu, S, et al. Influence of valproate on the required dose of propofol for anesthesia during electroconvulsive therapy of bipolar affective disorder patients. Neuropsychiatr Dis Treat 2014;10: 433–438. https://doi.org/10.2147/NDT.S59375Google Scholar

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