Pregnancy and Mood Stabilizing Drugs - Essay Example

 Current information on the use of mood-stabilisers during pregnancy reveal that risks for negative teratogenic effects and foetal malformation such as preterm birth, microcephaly, craniofacial abnormalities and cardiac defects are increased compared to infants of women without mental health issues or not using medications during pregnancy (Bodén, et al., 2012; Galbally, Roberts, & Buist, 2010; James, et al., 2009; Viguera, 2008; Yonkers, Vigod, & Ross, 2012). However, there were trends observed in finding out which mood-stabilising drugs have greater influences on foetal growth and development, wherein certain drugs have higher risk rates compared to others. Drugs commonly prescribed for patients with depression or to bipolar disorder patients include valproate, carbamazepine, lamotrigine and lithium carbonate, all of which pose risks for the growing foetus. Based on various studies, it was found out that sodium valproate and carbamazepine pose highest risks for malformation or defects, reaching up to 7.2% increase in risks (Galbally, et al., 2010; James, et al., 2009). Despite the possibilities for birth defects, most studies support the idea of continuing mood-stabilising medications all throughout pregnancy to reduce the likelihood of relapse or recurrence of manic or depressive episodes (Yonkers, et al., 2012). This is because the benefits of using medications outweigh greater risks of psychotic episodes for the mother, resulting to suicidal attempts or infanticide, as well as bonding and attachment issues between the infant and the mother (Bodén, et al., 2012; Viguerra, 2008). Due to these, it is highly-recommended by psychiatrists that women of child bearing-age diagnosed with bipolar disorder or other related disorders regardless of relationship status or plans of getting pregnant must be well-informed of the risks in taking mood-stabilising medications and other prescriptions during pregnancy (Bodén, et al., 2012). In order to successfully achieve these goals, it is imperative that psychiatrists must strike a balance between medication use and outweighing the risks for foetal and infant malformation in women taking prescription drugs. Current Information on Teratogenic Effects of Mood-Stabilising Drugs Studies conducted during the 1970’s when psychotropic drugs were still subjected to tests revealed that the use of such drugs caused birth defects in infants, whose mothers were using medications while pregnant. These defects included Ebstein’s anomaly, neural tube defects, cardiovascular malformations, microcephaly, cognitive defects among others, all of which are associated with the use of any or the combination of the use of four commonly-used mood-stabilising drugs: lithium, valproate, carbamazepine or limotrigine (Bodén, et al., 2012; Galbally, et al., 2010; James, et al., 2009). In particular, lithium increases risks for cardiac defects such as heart and ventricle malformation issues such as those found in Ebstein’s anomalies, valproate increases risks for neural tube defects and cognitive impairment, carbamazepine increases risks for macrocephaly and cognitive development issues, while limotrigine is accounted for neural defects and other malformations such as craniofacial defects (Galbally, et al., 2010; James, et al., 2009; Yonkers, et al., 2012). Other issues associated with mood-stabiliser drug use include macrocephaly, abnormal foetal growth, preterm birth, infants with small size for gestational age, drug withdrawal and neonatal hypoglycaemia (Bodén, et al., 2012; Galbally, et al., 2010; James, et al., 2009). Due to these pre-determined risks for the growing foetus women under mood-stabilising drugs tend to stop medications once they learned about their pregnancies, in order to prevent the progression of possible birth defects. However, during the earlier years of using anti-psychotic drugs there were only a few studies available to draw in acceptable conclusions, and due to the few number of experiments on cohorts the sample sizes affected the applicability of the conclusions to the general populations and even caused some studies to end up with inconclusive results to the use of medications. Also, some recent studies did not recommend total cessation of medications due to other possible effects to the pregnant women’s mental health. Additional Information on Pregnancy Risks of Women under Mood-Stabilising Drugs Immediate cessation of the use of mood-stabilising drugs among pregnant women with mental health disorders were associated with high rates of relapse during the pregnancy and post-partum by as much as 50-85% recurrence rates, with the effects reported to be worse than previous recurrences (Galbally, et al., 2010; Viguera, 2008; Yonkers, et al., 2012). In turn, these recurrences could also affect the infant in the long run due to the mother facing issues such as anxieties, manic or depressive episodes, hypomania, suicidal tendencies, or post-partum psychosis that could lead to infanticide (Bodén, et al., 2012; James, et al., 2009; Viguera, 2008). These mental health issues recurring either in equal intensities or worse could affect how an infant forms attachment to the mother, which could affect the said infant’s psychological well-being. In lieu of the possible side-effects of immediate medication cessation among mothers, these results may further outweigh the risks involved in using mood-stabilising drugs after certain studies linked genetic mental health issues such as epilepsy with higher occurrences of birth defects among infants. Previous studies that reported high rates of infant or neonatal birth defects mostly involved the use of mood-stabilising drugs along with the use of anti-epileptic drugs, reported to be administered in higher doses compared to individuals without epilepsy but with other disorders such as bipolar or depressive disorders (Bodén, et al., 2012; Galbally, et al., 2010). In relation to these results, apart from the actual high rates of birth defects associated with valproate and carbamazepine, due to the few number of studies that solidify the teratogenic effects of lithium and lamotrigine to malformation in preterm infants or foetuses as well as the ties of decreased folate levels among mood-stabiliser users, it is suggested that these drugs are much safer to use during pregnancy and that additional folate intake could mitigate potential birth defects (James, et al., 2009). There were also reports showing that there were non-significant differences in birth defect rates between women taking mood-stabilising drugs and those not taking these medications. In a Swedish cohort study by Bodén and colleagues (2012) they reported that despite higher risks for the formation of foetal birth defects to women with bipolar disorder using mood-stabilisers during pregnancy, the differences between them and the women who stopped the medications completely showed that the presence of bipolar disorder itself was already a risk for birth defects, and as such the differences between medication takers and non-medicating women were not significant enough to warrant the increased risks for neonates. These results indicate that aside from the low-folate levels due to medications, the malformation and other defects were more likely tied to the mother’s physical state and the genetic or inherited factors, along with the higher doses given to epileptic patients and not solely to the use of such medications. In following these results, additional implications such as the use of much safer drugs such as lithium may be endorsed since there were no observed differences between women treated and untreated with mood-stabilisers. As such, the fact that it is still possible to allow women to continue with the mood-stabilising medications to maintain proper mental health while bearing a child. This entails the adjustment of medication dosage or changing the prescriptions to accommodate the pregnancy without the recurrence of manic or depressive episodes. In conclusion, despite the increased risks for birth defects among pregnant women taking mood-stabilising drugs it is recommended to maintain medication use since 1) the risks previously-reported were tied to epileptic patients using anti-epileptic drugs and the hereditary factors for birth defects, 2) the higher doses for these patients may have contributed to the observed birth defects, 3) there are other available drugs that have lower risks for birth defects and are thus safer to use, 4) folate-intake can be increased in order to mitigate the effects of the drugs, and 5) the potential psychological issues that can arise from problems with mother-child attachment due to unstable moods during pregnancy and post-partum outweigh the risks for birth defects resulting from mood-stabilising drugs. References Bodén, R., Lundgren, M., Brandt, L., Reutfors, J., Andersen, M., & & Kieler, H. (2012). Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ: British Medical Journal, 345, doi: 10.1136/bmj.e7085. Galbally, M., Roberts, M., & Buist, A. (2010). Mood stabilizers in pregnancy: a systematic review. Australian and New Zealand Journal of Psychiatry, 44(11), 967-977. James, L., Paton, C., Lelliott, P., Barnes, T., & Taylor, D. (2009). Mood stabilizers and teratogenicity - prescribing practice and awareness amongst practising psychiatrists. Journal of Mental Health, 18(2), 137-13. Viguera, A. (2008). Discontinuing mood stabilizers during pregnancy increases risk of recurrence. The Brown University Psychopharmacology Update, 19(2), 1-5. Yonkers, K. A., Vigod, S., & Ross, L. E. (2012). Diagnosis, pathophysiology, and management of mood disorders in pregnant and postpartum women. FOCUS: The Journal of Lifelong Learning in Psychiatry, 10(1), 51-66. Read More