Dr. Angelika Wieck, MD, FRCPsych

About the author

The pharmacological management of mood disorders and psychosis in pregnancy and lactation

CME Course

Course level: advanced

Educational objectives

 After the course the participants should be able to

  1. Interpret research on the reproductive safety of psychotropics
  2. Apply knowledge and insights in clinical scenarios in regard to
    • the effect of childbearing on mood disorders and psychosis
    • recent evidence on the reproductive safety of the main psychotropic drugs
    • other factors determining obstetric and infant outcome
    • current influential guidelines

The management of childbearing mothers with mental illness is challenging, requiring the clinician to maintain maternal wellbeing during pregnancy, whilst preventing postnatal recurrences and avoiding harm to the child.

The course will cover the use of antidepressants, antipsychotics, lithium, anti-epileptic drugs and sleep-inducers in pregnant and breastfeeding mothers. Recent evidence on potential teratogenic risks of these agents arising from early pregnancy exposure will be outlined as well as effects on obstetric and infant outcome following later pregnancy exposure. Adverse effects on neonatal health will be reviewed and the current knowledge on drug transfer from the mother to the infant during breastfeeding discussed. This evidence will be related to current pharmacological guidelines for childbearing women.

An important consideration in the management of childbearing women is that risks to the child do not only arise from the use of psychotropic medication. There is increasing evidence that maternal mental illness by itself and associated lifestyle and social factors can alter infant outcomes. Although there are no optimal solutions, a thoughtful and informed approach to the evidence, consideration of the woman’s own history and preferences, and maximizing benefits of non-pharmacological treatment approaches can improve individual outcomes.

Preconception consultations for women who have psychosis or severe mood disorders and are planning a pregnancy, are highlighted as a means of optimizing maternal and child outcomes.

Prerequisite knowledge

General knowledge of severe mental illnesses and experience in their clinical management

Course Methods and Material

Presentation; slides; participant discussion in small groups; vignettes; debate; handouts.

List of recommended readings

  • Bromley R et al (2014) Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child. Cochrane Database Syst Rev. 2014;10:CD010236.
  • Grigoriadis et al (2013) Antidepressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta-analysis of the best evidence. J Clin Psychiatry. 2013 Apr;74(4):e293-308
  • Huybrechts et al (2016) Antipsychoticuse in pregnancy and risk for congenital malformations. Jama Psychiatry, 73(9):938–946.
  • Jones I et al (2014) Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet. 2014 Nov 15;384(9956):1789–99
  • Källén B. The problem of confounding in studies of the effect of maternal druguse on pregnancy outcome. ObstetGynecol Int. 2012;2012:148616.
  • McAllister-Williams et al (2017) British Association for Psychopharmacology consensus guidance
  • on the use of psychotropic medication preconception, in pregnancy and postpartum J Psychopharmacol. 2017;31(5):519–552
  • NICE (2014). Antenatal and postnatal mental health. CG192; http://www.guidance.nice.org.uk/cg192
  • Patorno et al (2017). Lithium use in pregnancy and the risk of cardiac malformations. N Engl J Med 376; 23
  • Veroniki et al (2017) Comparative safety of anti-epileptic drugs during pregnancy: a systematic review and network meta-analysis of congenital malformations and prenatal outcomes.BMC Med. 2017 May 5;15(1):95.
  • Wieck A, Reis M (2016) Pharmacological treatment of mental health problems in pregnancy and lactation. In: Comprehensive Women’s Mental Health (DJ Castle and KM Abel, eds). Cambridge University Press, Cambridge.
  • Wieck A, Abel KMA (2016) Sexual, reproductive and antenatal care of women with mental illness. In: Comprehensive Women’s Mental Health (DJ Castle and KM Abel, eds). Cambridge University Press, Cambridge.

Workshop leader

Dr. Angelika Wieck, University of Manchester

Address:
Department of Psychiatry
Laureate House
Wythenshawe Hospital
Manchester M239LT

Workshop leader’s experience in education

I have been director of EPA Academia course for several years and have held Master Classes in reproductive psychopharmacology for the British Association of Psychopharmacology for several years. I am lecturing widely on this and other topics in perinatal mental health at other local, national and international educational events

Workshop leader’s other experience

I have extensive experience in general adult, specialist affective services, and perinatal psychiatry. In recent years I worked exclusively in the perinatal mental health service in Manchester which provides specialist mother and baby inpatient and outpatient care for the North West of England.

Recommended training