Gebelik ve Postpartum Dönemde Psikiyatrik Hastalıklar
Özet
Gebelik ve postpartum dönem, kadınlar için psikiyatrik hastalıkların alevlenebileceği veya yeni semptomların ortaya çıkabileceği stresli süreçlerdir. Doğum sonrası ilk haftada görülen annelik bunalımı (annelik hüznü), genellikle iki hafta içinde kendiliğinden gerileyen geçici bir duygusal labilite durumudur. Prevalansı yaklaşık %10 olan postpartum depresyon ise çökkün duygudurum, anksiyete ve intihar düşünceleri ile seyretmekte olup, en önemli risk faktörü geçirilmiş majör depresyon öyküsüdür; tedavisinde hafif vakalarda psikoterapi, ciddi durumlarda ise SSRI grubu antidepresanlar tercih edilir. Antenatal dönemde de sık rastlanan majör depresyonun taranmasında Edinburg Doğum Sonrası Depresyon Ölçeği kullanılır. Gebelikte ilaç kullanımında lityum, valproik asit ve karbamazepin gibi duygudurum düzenleyiciler yüksek teratojenite ve nöral tüp defekti riski taşırken, lamotrijin görece daha güvenli kabul edilmektedir. Antipsikotik ilaçların birinci ve ikinci kuşak temsilcilerinin major doğum defekti riskini belirgin artırmadığı gösterilmiştir. Yaygın anksiyete ve panik bozukluk gibi anksiyete bozukluklarında semptomatik tedavi için kullanılan benzodiazepinlerin kronik kullanımı ise yenidoğanda çekilme sendromuna yol açabileceğinden kısa etkililer tercih edilmelidir. Nadir görülen postpartum psikoz ve kronik bir hastalık olan şizofreni durumlarında ise relaps riskini önlemek adına yakın takip ve tedavi sürekliliği büyük önem taşır.
Pregnancy and the postpartum period are stressful phases for women where psychiatric disorders may exacerbate or new symptoms may emerge. Maternity blues, seen in the first week after birth, is a temporary emotional lability that usually subsides spontaneously within two weeks. Postpartum depression, with a prevalence of around 10%, manifests with depressed mood, anxiety, and suicidal ideation, with the most significant risk factor being a history of major depression; its treatment involves psychotherapy for mild cases and SSRI antidepressants for severe conditions. The Edinburgh Postnatal Depression Scale is utilized to screen for major depression, which is also common in the antenatal period. Regarding medication use during pregnancy, mood stabilizers such as lithium, valproic acid, and carbamazepine carry high risks of teratogenicity and neural tube defects, whereas lamotrigine is considered relatively safer. First and second-generation antipsychotics have not been shown to significantly increase the risk of major birth defects. Chronic use of benzodiazepines, which are used for symptomatic treatment in anxiety disorders like generalized anxiety and panic disorder, can cause neonatal withdrawal syndrome; thus, short-acting ones should be preferred. In cases of rare postpartum psychosis and schizophrenia, close monitoring and continuity of treatment are of paramount importance to prevent the risk of relapse.
Referanslar
Cantwell R, Cox J. Psychiatric disorders in pregnancy and the puerperium. Current Obstetrics & Gynaecology. 2006;16(1):14-20.
Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam K, Åström M. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. American journal of obstetrics and gynecology. 2003;189(1):148-54.
Comtois KA, Schiff MA, Grossman DC. Psychiatric risk factors associated with postpartum suicide attempt in Washington State, 1992-2001. American journal of obstetrics and gynecology. 2008;199(2):120. e1-. e5.
Levin BL, Becker MA. A public health perspective of women’s mental health: Springer; 2010.
O'Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best practice & research Clinical obstetrics & gynaecology. 2014;28(1):3-12.
Miller LJ. Postpartum depression. Jama. 2002;287(6):762-5.
Hapgood CC, Elkind GS, Wright JJ. Maternity blues: phenomena and relationship to later post partum depression. Australian and New Zealand Journal of Psychiatry. 1988;22(3):299-306.
Sacher J, Wilson AA, Houle S, Rusjan P, Hassan S, Bloomfield PM, et al. Elevated brain monoamine oxidase A binding in the early postpartum period. Archives of general psychiatry. 2010;67(5):468-74.
Doornbos B, Fekkes D, Tanke MA, de Jonge P, Korf J. Sequential serotonin and noradrenalin associated processes involved in postpartum blues. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2008;32(5):1320-5.
Banti S, Mauri M, Oppo A, Borri C, Rambelli C, Ramacciotti D, et al. From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the Perinatal Depression–Research & Screening Unit study. Comprehensive psychiatry. 2011;52(4):343-51.
Baker R, Orton E, Kendrick D, Tata LJ. Maternal depression in the 5 years after childbirth among women with and without perinatal depression: a population-based cohort study. The Lancet. 2015;386:S22.
Wisner KL, Moses-Kolko EL, Sit DK. Postpartum depression: a disorder in search of a definition. Archives of women's mental health. 2010;13(1):37-40.
O'hara MW, McCabe JE. Postpartum depression: current status and future directions. Annual review of clinical psychology. 2013;9:379-407.
Practice CoO. The American College of Obstetricians and Gynecologists Committee opinion no. 630. Screening for perinatal depression. Obstetrics and gynecology. 2015;125(5):1268-71.
, Association. AP. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)2013.
Gaillard A, Le Strat Y, Mandelbrot L, Keïta H, Dubertret C. Predictors of postpartum depression: prospective study of 264 women followed during pregnancy and postpartum. Psychiatry research. 2014;215(2):341-6.
Milgrom J, Gemmill AW. Screening for perinatal depression. Best Practice & Research Clinical Obstetrics & Gynaecology. 2014;28(1):13-23.
Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane database of systematic reviews. 2013(2).
Health NCCfM, editor Antenatal and postnatal mental health: Clinical management and service guidance: Updated edition2014: British Psychological Society.
O'Connor E RR, Henninger M, et al. . Screening for Depression in Adults: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force (US) AfHRaQ, editor2016 Jan.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. The British journal of psychiatry. 1987;150(6):782-6.
Depression P, Causes AT. Heterogeneity of postpartum depression: a latent class analysis. The Lancet Psychiatry. 2015;2(1):59-67.
Yonkers KA, Vigod S, Ross LE. Diagnosis, pathophysiology, and management of mood disorders in pregnant and postpartum women. Focus. 2012;10(1):51-66.
Stuart S, Koleva H. Psychological treatments for perinatal depression. Best practice & research Clinical obstetrics & gynaecology. 2014;28(1):61-70.
Stewart DE, Vigod S. Postpartum depression. New England Journal of Medicine. 2016;375(22):2177-86.
Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry. 2015;49(12):1087-206.
Ko JY, Farr SL, Dietz PM, Robbins CL. Depression and treatment among US pregnant and nonpregnant women of reproductive age, 2005–2009. Journal of women's health. 2012;21(8):830-6.
Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Archives of general psychiatry. 2008;65(7):805-15.
Fisher J, Mello MCd, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review. Bulletin of the World Health Organization. 2012;90:139-49.
Vigod SN, Wilson CA, Howard LM. Depression in pregnancy. Bmj. 2016;352.
Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. Risk factors for and perinatal outcomes of major depression during pregnancy: a population-based analysis during 2002–2010 in Finland. BMJ open. 2014;4(11):e004883.
Stewart DE, Vigod SN. Postpartum depression: pathophysiology, treatment, and emerging therapeutics. Annual review of medicine. 2019;70:183-96.
Orsolini L, Bellantuono C. Serotonin reuptake inhibitors and breastfeeding: a systematic review. Hum Psychopharmacol. 2015;30(1):4-20.
Alwan S, Reefhuis J, Rasmussen SA, Olney RS, Friedman JM. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. New England Journal of Medicine. 2007;356(26):2684-92.
Malm H, Sourander A, Gissler M, Gyllenberg D, Hinkka-Yli-Salomäki S, McKeague IW, et al. Pregnancy complications following prenatal exposure to SSRIs or maternal psychiatric disorders: results from population-based national register data. American Journal of Psychiatry. 2015;172(12):1224-32.
Huybrechts KF, Palmsten K, Avorn J, Cohen LS, Holmes LB, Franklin JM, et al. Antidepressant use in pregnancy and the risk of cardiac defects. New England Journal of Medicine. 2014;370(25):2397-407.
Louik C, Lin AE, Werler MM, Hernández-Díaz S, Mitchell AA. First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. New England Journal of Medicine. 2007;356(26):2675-83.
Grigoriadis S, VonderPorten EH, Mamisashvili L, Roerecke M, Rehm J, Dennis C-L, et al. Antidepressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta-analysis of the best evidence. The Journal of clinical psychiatry. 2013;74(4):903.
Bar-Oz B, Einarson T, Einarson A, Boskovic R, O'Brien L, Malm H, et al. Paroxetine and congenital malformations: meta-analysis and consideration of potential confounding factors. Clinical therapeutics. 2007;29(5):918-26.
Ban L, Gibson JE, West J, Fiaschi L, Sokal R, Smeeth L, et al. Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population‐based cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2014;121(12):1471-81.
Yang A, Ciolino JD, Pinheiro E, Rasmussen-Torvik LJ, Sit DK, Wisner KL. Neonatal discontinuation syndrome in serotonergic antidepressant-exposed neonates. The Journal of clinical psychiatry. 2017;78(5):0-.
Ross LE, Grigoriadis S, Mamisashvili L, VonderPorten EH, Roerecke M, Rehm J, et al. Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA psychiatry. 2013;70(4):436-43.
Stephansson O, Kieler H, Haglund B, Artama M, Engeland A, Furu K, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of stillbirth and infant mortality. Jama. 2013;309(1):48-54.
Palmsten K, Huybrechts KF, Michels KB, Williams PL, Mogun H, Setoguchi S, et al. Antidepressant use and risk for preeclampsia. Epidemiology (Cambridge, Mass). 2013;24(5):682.
Palmsten K, Hernández-Díaz S, Huybrechts KF, Williams PL, Michels KB, Achtyes ED, 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.
Moses-Kolko EL, Bogen D, Perel J, Bregar A, Uhl K, Levin B, et al. Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications. Jama. 2005;293(19):2372-83.
Grigoriadis S, VonderPorten EH, Mamisashvili L, Eady A, Tomlinson G, Dennis C-L, et al. The effect of prenatal antidepressant exposure on neonatal adaptation: a systematic review and meta-analysis. The Journal of clinical psychiatry. 2013;74(4):5650.
Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. General hospital psychiatry. 2009;31(5):403-13.
Ng QX, Venkatanarayanan N, Ho CYX, Sim WS, Lim DY, Yeo W-S. Selective serotonin reuptake inhibitors and persistent pulmonary hypertension of the newborn: an updated meta-analysis. Journal of Women's Health. 2019;28(3):331-8.
Huybrechts KF, Bateman BT, Palmsten K, Desai RJ, Patorno E, Gopalakrishnan C, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. Jama. 2015;313(21):2142-51.
Bulbul F, Copoglu US, Alpak G, Unal A, Demir B, Tastan MF, et al. Electroconvulsive therapy in pregnant patients. General hospital psychiatry. 2013;35(6):636-9.
Miller LJ. Use of electroconvulsive therapy during pregnancy. Psychiatric Services. 1994;45(5):444-50.
Marcus S, Barry K, Flynn H, Tandon R, Greden J. Treatment guidelines for depression in pregnancy. International Journal of Gynecology & Obstetrics. 2001;72(1):61-70.
Anderson EL, Reti IM. ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosomatic Medicine. 2009;71(2):235-42.
Craddock N, Jones I. Genetics of bipolar disorder. Journal of medical genetics. 1999;36(8):585-94.
Barnett JH, Smoller JW. The genetics of bipolar disorder. Neuroscience. 2009;164(1):331-43.
Lichtenstein P, Yip BH, Björk C, Pawitan Y, Cannon TD, Sullivan PF, et al. Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. The Lancet. 2009;373(9659):234-9.
Bergink V, Bouvy PF, Vervoort JS, Koorengevel KM, Steegers EA, Kushner SA. Prevention of postpartum psychosis and mania in women at high risk. American Journal of Psychiatry. 2012;169(6):609-15.
Chessick CA, Dimidjian S. Screening for bipolar disorder during pregnancy and the postpartum period. Archives of women's mental health. 2010;13(3):233-48.
Viguera AC, Whitfield T, Baldessarini RJ, Newport DJ, Stowe Z, Reminick A, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. American Journal of Psychiatry. 2007;164(12):1817-24.
Terp IM, Mortensen PB. Post-partum psychoses: clinical diagnoses and relative risk of admission after parturition. The British Journal of Psychiatry. 1998;172(6):521-6.
Videbech P, Gouliaev G. First admission with puerperal psychosis: 7–14 years of follow‐up. Acta Psychiatrica Scandinavica. 1995;91(3):167-73.
Munk-Olsen T, Laursen TM, Meltzer-Brody S, Mortensen PB, Jones I. Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Archives of general psychiatry. 2012;69(4):428-34.
Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V. Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. American Journal of Psychiatry. 2016;173(2):117-27.
Blackmore ER, Rubinow DR, O'Connor TG, Liu X, Tang W, Craddock N, et al. Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis. Bipolar disorders. 2013;15(4):394-404.
Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. The Lancet. 2014;384(9956):1789-99.
Bergink V, Rasgon N, Wisner KL. Postpartum psychosis: madness, mania, and melancholia in motherhood. American Journal of Psychiatry. 2016;173(12):1179-88.
Beck CT. Postpartum Depression: It isn’t just the blues. AJN The American Journal of Nursing. 2006;106(5):40-50.
Erdem Ö. Doğum sonrası psikoz. Konuralp Medical Journal. 2014;6(1):74-7.
McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiologic reviews. 2008;30(1):67-76.
Kringlen E. Twin studies in schizophrenia with special emphasis on concordance figures. American Journal of Medical Genetics. 2000;97(1):4-11.
Stefansson H, Rujescu D, Cichon S, Pietiläinen OP, Ingason A, Steinberg S, et al. Large recurrent microdeletions associated with schizophrenia. nature. 2008;455(7210):232-6.
Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. International review of psychiatry. 2010;22(5):417-28.
Strauss JS. The diagnosis and understanding of schizophrenia. Part III. Speculations on the processes that underlie schizophrenic symptoms and signs. Schizophr Bull. 1974;11:61-9.
Strauss JS, Carpenter WT. Expanded perspectives for describing and comparing schizophrenic patients: II. Schizophrenia Bulletin. 1974;1(11):50-60.
Carpenter WT, Jr., Strauss JS, Bartko JJ. The diagnosis and understanding of schizophrenia. Part I. Use of signs and symptoms for the identification of schizophrenic patients. Schizophr Bull. 1974(11):37-49.
Solari H, Dickson KE, Miller L. Understanding and treating women with schizophrenia during pregnancy and postpartum. Journal of Population Therapeutics and Clinical Pharmacology. 2009;16(1).
Bennedsen B, Mortensen PB, Olesen AV, Henriksen TB. Preterm birth and intra-uterine growth retardation among children of women with schizophrenia. The British Journal of Psychiatry. 1999;175(3):239-45.
Jablensky AV, Morgan V, Zubrick SR, Bower C, Yellachich L-A. Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. American Journal of Psychiatry. 2005;162(1):79-91.
Newport DJ, Viguera AC, Beach AJ, Ritchie JC, Cohen LS, Stowe ZN. Lithium placental passage and obstetrical outcome: implications for clinical management during late pregnancy. American Journal of Psychiatry. 2005;162(11):2162-70.
Cohen LS. Treatment of bipolar disorder during pregnancy. Journal of Clinical Psychiatry. 2007;68(9):4.
ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111(4):1001-20.
Pinelli JM, Symington AJ, Cunningham KA, Paes BA. Case report and review of the perinatal implications of maternal lithium use. American journal of obstetrics and gynecology. 2002;187(1):245-9.
Eberhard-Gran M, Eskild A, Opjordsmoen S. Use of psychotropic medications in treating mood disorders during lactation. CNS drugs. 2006;20(3):187-98.
Excellence. NIfHaC. Antenatal and postnatal mental health: clinical management and service guidance. December 2014. ;NICE clinical guideline 192.
Drugs Co. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108(3):776-89.
Woody JN, London WL, Wilbanks Jr GD. Lithium toxicity in a newborn. Pediatrics. 1971;47(1):94-6.
Stothers J, Wilson D, Royston N. Lithium toxicity in the newborn. British medical journal. 1973;3(5873):233.
Tomson T, Battino D. Teratogenic effects of antiepileptic drugs. The Lancet Neurology. 2012;11(9):803-13.
Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Perucca E, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry. The Lancet Neurology. 2018;17(6):530-8.
Stahl MM, Neiderud J, Vinge E. Thrombocytopenic purpura and anemia in a breast-fed infant whose mother was treated with valproic acid. The Journal of pediatrics. 1997;130(6):1001-3.
Rosa FW. Spina bifida in infants of women treated with carbamazepine during pregnancy. New England journal of medicine. 1991;324(10):674-7.
Organization WH. Breastfeeding and maternal medication: recommendations for drugs in the eleventh WHO model list of essential drugs. 2002.
Cunnington M, Weil J, Messenheimer J, Ferber S, Yerby M, Tennis P. Final results from 18 years of the International Lamotrigine Pregnancy Registry. Neurology. 2011;76(21):1817-23.
Holmes LB, Hernandez‐Diaz S. Newer anticonvulsants: lamotrigine, topiramate and gabapentin. Birth Defects Research Part A: Clinical and Molecular Teratology. 2012;94(8):599-606.
Newport DJ, Pennell PB, Calamaras MR, Ritchie JC, Newman M, Knight B, et al. Lamotrigine in breast milk and nursing infants: determination of exposure. Pediatrics. 2008;122(1):e223-e31.
Einarson A, Boskovic R. Use and safety of antipsychotic drugs during pregnancy. Journal of Psychiatric Practice®. 2009;15(3):183-92.
Newport DJ FS, Juric S, Stowe ZN. . Psychopharmacology during pregnancy and lactation. In: The American Psychiatric Publishing Textbook of Psychopharmacology. Fourth Edition ed. Schatzberg AF NC, editor. Washington, D.C. : American Psychiatric Publishing; 2009.
McKenna K, Koren G, Tetelbaum M, Wilton L, Shakir S, Diav-Citrin O, et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. Journal of Clinical Psychiatry. 2005;66(4):444-9.
Sadowski A, Todorow M, Brojeni PY, Koren G, Nulman I. Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study. BMJ open. 2013;3(7):e003062.
McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. Journal of Psychopharmacology. 2017;31(5):519-52.
Fortinguerra F, Clavenna A, Bonati M. Psychotropic drug use during breastfeeding: a review of the evidence. Pediatrics. 2009;124(4):e547-e56.
Klinger G, Stahl B, Fusar-Poli P, Merlob P. Antipsychotic drugs and breastfeeding. Pediatric endocrinology reviews: PER. 2013;10(3):308-17.
Uguz F. Second-generation antipsychotics during the lactation period: a comparative systematic review on infant safety. Journal of clinical psychopharmacology. 2016;36(3):244-52.
Wikner BN, Källén B. Are hypnotic benzodiazepine receptor agonists teratogenic in humans? Journal of clinical psychopharmacology. 2011;31(3):356-9.
Dolovich LR, Addis A, Vaillancourt JR, Power JB, Koren G, Einarson TR. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. Bmj. 1998;317(7162):839-43.
Wikner BN, Stiller CO, Bergman U, Asker C, Källén B. Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations. Pharmacoepidemiology and drug safety. 2007;16(11):1203-10.
Kelly LE, Poon S, Madadi P, Koren G. Neonatal benzodiazepines exposure during breastfeeding. The Journal of pediatrics. 2012;161(3):448-51.
Soussan C, Gouraud A, Portolan G, Jean-Pastor M-J, Pecriaux C, Montastruc J-L, et al. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. European journal of clinical pharmacology. 2014;70(11):1361-6.
