Psychiatric Care During Pregnancy To Be Focus of Forum
Abstract
Clinical treatment decisions during pregnancy mandate careful balancing of risk and benefit. Authors of studies recently published in AJP will give clinical guidance for such decisions.
The American Journal of Psychiatry (AJP) will host a forum titled “Treatment of the Pregnant Woman and Her Child,” chaired by Robert Freedman, M.D., editor in chief of AJP, at APA’s annual meeting in San Francisco. The session will be held Monday, May 20, at 11 a.m.
Researchers say careful balancing of the risks and benefits to both mother and baby of treatment for maternal mental illness is needed.
“We strive to make the journal’s cutting-edge research germane to today’s practicing clinician,” Freedman told Psychiatric News, “and we particularly target clinical situations in which even the most experienced psychiatrists are the most careful in their approach. The care of the psychiatrically ill pregnant woman and her fetus is an area in which all clinicians want to be informed about the latest research that investigates the risk and benefit of treatment.” He added that the forum “will bring together authors of four recently published articles to discuss their research, all of which informs current care and will affect future treatment development.”
But first, Harita Raja, M.D., a psychiatry resident at Medstar Georgetown University Hospital in Washington, D.C., will begin the symposium with a case presentation. She is the author of a recent review article on treatment of maternal depression in the Residents’ Journal, an online publication of the American Journal of Psychiatry.
The first speaker will be Katherine Wisner, M.D., a professor of psychiatry; obstetrics; gynecology; and reproductive sciences and epidemiology at the University of Pittsburgh School of Medicine. Wisner has meticulously characterized the effects of depression and medication treatment for it on the growth and development of the fetus and found independent effects of each, but little evidence that antidepressants cause additional harm to the fetus.
Mallay Occhiogrosso, M.D., an assistant professor of psychiatry at Weill Cornell Medical College, and her colleagues made similar findings about newborn pulmonary hypertension, once thought to be an adverse effect of SSRI treatment during pregnancy (Psychiatric News, May 4, 2012). Their extensive epidemiologic investigations revealed that the effect is small and as likely to be caused by depression itself as by the medications.
Veerle Bergink, M.D., a psychiatrist at the Erasmus Medical Center in Rotterdam, the Netherlands, will present a study of the approach preferred by her clinic for pregnant women with a history of bipolar disorder or postpartum psychosis (Psychiatric News, May 4, 2012). Her clinic’s prophylactic treatment diminishes some but not all risk for subsequent illness during or after pregnancy.
The final speaker, Randal Ross, M.D., a professor in the Department of Psychiatry at the University of Colorado School of Medicine, has developed a physiological indicator of the newborn’s brain development. With this technique, he finds that antidepressant treatment frequently prevents the otherwise deleterious effect of a maternal anxiety disorder and that the nutrient choline may prevent the development of pathological brain dysfunction associated with later mental disorders in the child. ■
