Week 9: Prescribing for Pregnant Women. Introduction The purpose of this discussion is to review FDA-approved medication, off-label medications, and nonpharmacological i

Week 9: Prescribing for Pregnant Women.

Introduction

The purpose of this discussion is to review FDA-approved medication, off-label medications, and nonpharmacological interventions for the treatment of pregnant women. Elucidate the risk evaluation employed to guide treatment decision-making, the hazards and advantages of the FDA-approved medication, and the hazards and advantages of the off-label pharmaceutical. Clarify the presence of clinical practice guidelines for this disease and employ them to substantiate the suggestions, and if none is listed, specify the necessary information that should be considered.

Symptoms of depression such as feelings of sadness, irritability, or emptiness, along with physical and mental changes such as difficulty concentrating, inability to experience pleasure, feelings of hopelessness, loss of appetite, disrupted sleep, and thoughts of suicide, greatly impair a person’s ability to function. Antenatal depression is the occurrence of depression during pregnancy. The prevalence of depression during pregnancy and postpartum is significant. Women with a preexisting history of depression are very likely to experience depression again during pregnancy. Obstetricians, gynecologists, and physicians should conduct a screening for prenatal depression using a standardized test at least once throughout pregnancy (Jahan N, et al., 2021).

FDA-approved, off-label drug, and nonpharmacological intervention

According to Hardy, L. T., & Reichenbacker, O. L. (2019), when formulating treatment recommendations, it is crucial to consider the potential consequences of not treating or inadequately treating mental illness during this period. Clinicians and patients typically experience dread and discomfort when considering the use of psychiatric drugs during the perinatal period. As an initial approach, nonpharmacologic psychotherapy is the option for pregnant women experiencing mild to moderate depression. Interpersonal psychotherapy and behavioral activation therapy along with a recommendation for consultation with a psychologist are evidence-based psychotherapies that have demonstrated effectiveness in the treatment of perinatal depression. Behavioral activation therapy has demonstrated a considerable reduction in depression symptoms and an improvement in remission rates when compared to normal treatment.

Risk assessment for the treatment decision-making

The occurrence of depression during pregnancy can have substantial ramifications for both maternal and fetal well-being. Prenatal depression has been associated with negative consequences, such as delayed fetal development, miscarriage, underweight newborns, premature labor, maternal anemia, diabetes, hypertensive disorders such as preeclampsia, cesarean sections, and postpartum depression. Offspring born to moms experiencing prenatal depression frequently exhibit heightened irritability, less activity, and an elevated probability of enduring developmental delays. Additionally, prenatal depression increases the likelihood of experiencing postpartum depression and can negatively impact the health and development of the newborn if the mother is depressed for a prolonged duration. Both professionals and patients need to carefully consider the trade-off between the hazards of untreated psychiatric illness and the potential negative consequences of medication exposure on the well-being of the fetus (Hardy, L. T., & Reichenbacker, O. L. 2019). 

Prioritizing the selection of a prompt and efficient therapy with less or no negative effects on the mother or infant is of utmost importance in medical care. When assessing the risk-benefit ratio of treating prenatal depression, multiple aspects are considered. Firstly, the drug should be administered at the most effective dose that yields the best response while keeping side effects manageable for the woman. Secondly, regular assessment of symptoms is necessary, as adjustments may be needed to maintain optimal antidepressant effectiveness due to changes in how the body processes the drug during pregnancy. Lastly, after giving birth, the dosage should be adjusted to accommodate the woman’s transition from pregnancy to the nonpregnant state while considering breastfeeding (Maureen S et al., 2020).

Risks and benefits of the FDA-approved medicine.

The baby is at risk of experiencing birth deformities, heart problems, and other abnormalities caused by pharmacological treatments. According to Betcher H. & Wisner K. (2020), the Pregnancy and Lactation Labeling Rule by the Food and Drug Administration (FDA) requires practitioners to evaluate the dangers of untreated sickness and the possible negative effects of medication on pregnancy and the health of the infant. Perinatal outcomes encompass miscarriage, significant congenital abnormalities, premature birth, stillbirth, indicators of neonatal adjustment, and behavioral and developmental consequences. Psychiatric diseases and the drugs used to treat them affect these domains. Olanzapine and quetiapine have been associated with an increased likelihood of developing gestational diabetes. Drug doses may require adjustment during pregnancy to maintain effectiveness, as pregnancy causes significant physiological changes and increased hepatic metabolism. SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft) were frequently classed as Category C, suggesting that their safety during pregnancy had not been thoroughly proven and that their usage during pregnancy would depend on the situation (Fedrizzi S, A. 2023).  

Risks and benefits of the off-label drug

Off-label prescriptions involve the use of medications in ways that are not officially approved or indicated by regulatory authorities. This might include repurposing drugs for different uses, as well as using different dosages or durations than what is prescribed. Antipsychotics are used off-label during pregnancy for treatment as antiemetics or for sleep purposes. Cessation of off-label antipsychotic medications during pregnancy heightens the likelihood of relapse in depression and bipolar (McDonald M, & Alhusen J. A 2022).

Clinical guidelines for prenatal depression

According to McDonald M, & Alhusen J. A (2022), Perinatal depression affects around 1 in 7 women and is recognized as the most prevalent consequence of pregnancy and childbirth. A study revealed that maternal depression during pregnancy is correlated with an increased likelihood of preterm birth, small for gestational age, stillbirth, low birth weight, and maternal morbidity, which includes perinatal problems, higher rates of surgical delivery, and postpartum depression. To avoid these negative consequences, it is important to conduct screenings for depression, closely monitor individuals, and effectively manage the condition while taking into account the balance between potential risks and benefits. Addressing this problem during pregnancy is a multifaceted matter, necessitating healthcare providers to meticulously evaluate the advantages and drawbacks of medication.

Healthcare practitioners should consider prevalent obstacles to treatment, such as insufficient screening and societal prejudice. Identifying and treating this issue can decrease the prevalence of suicides among perinatal women experiencing depression, as well as mitigate the potential negative impacts of untreated maternal depression on their child’s cognitive and behavioral growth. screening all pregnant and postpartum women for perinatal depression is now considered a reimbursable medical cost. Regular counseling sessions can effectively prevent perinatal depression in certain patients. Recently authorized parenteral drugs provide quick relief for symptoms in cases of mild to severe illness. Studies suggest that biomarkers, specifically epigenetically changed genes, could potentially be used to predict prenatal depression (Fedrizzi S, A. 2023).

Food and Drug Administration developed a system that determines the teratogenic risk of drugs by considering the quality of data from animal and human studies. The FDA divides all medications taken during pregnancy into five groups: A, B, C, D, and X. Pregnancy is not advised in any circumstance to use category X products; category A is thought to be the safest category. This gives the clinician therapeutic direction. After controlling for confounding variables related to underlying psychiatric disease, SSRI drugs are not linked to greater incidents of birth abnormalities or long-term impairments in mental development. During pregnancy, SSRIs such as fluoxetine (Prozac), escitalopram (Lexapro), sertraline (Zoloft), and citalopram (Celexa) can be used as antidepressants. Premature birth and high blood pressure in the expectant mother are among the risks. These are not very big dangers. Throughout your prenatal care, your healthcare team keeps an eye out for these (Fedrizzi S, A. 2023). 

Conclusion

Early identification and intervention are crucial in addressing antenatal depression due to the potential risks it poses, including perinatal problems, heightened likelihood of surgical delivery, and the development of postpartum depression, which can adversely affect maternal well-being. The objective of perinatal mental health treatment is to effectively provide medication to alleviate the physical and psychological challenges caused by mothers’ psychiatric disorders. Engaging in regular monitoring of symptoms during pregnancy and after giving birth, as well as making necessary adjustments to medication dosage to maintain effectiveness, is considered a commendable approach.

Depression during pregnancy is a prevalent condition, however, it is frequently not recognized due to the tendency to attribute its symptoms to the pregnancy itself. It is advisable to utilize selective serotonin reuptake inhibitor antidepressants, specifically fluoxetine, as they have not been linked to causing birth defects. Additionally, non-pharmacological treatments including psychotherapy, mindfulness, and aerobic exercise should be used. Providing education to healthcare providers will enhance their ability to accurately diagnose and treat this illness.

References

Betcher HK, & Wisner KL (2020). Psychotropic Treatment During Pregnancy: Research Synthesis and Clinical Care Principles. J Womens Health (Larchmt). 2020 Mar;29(3):310-318. doi: 10.1089/jwh.2019.7781. Epub 2019 Dec 3. PMID: 31800350; PMCID: PMC7207058.

Fedrizzi S, A. (2023). Benefits and Risks of Antidepressant Drugs During Pregnancy: A Systematic Review of Meta-analyses. Pediatric Drugs. 2023 May;25(3):247-265. doi: 10.1007/s40272-023-00561-2. Epub 2023 Feb 28. PMID: 36853497.

Hardy, L. T., & Reichenbacker, O. L. (2019). . Archives of Psychiatric Nursing, 33(3), 254–266.

Jahan N, et al (2021). Untreated Depression During Pregnancy and Its Effect on Pregnancy Outcomes: A Systematic Review. Cureus. 2021 Aug 17;13(8):e17251. doi: 10.7759/cureus.17251. PMID: 34540477; PMCID: PMC8448270.

Maureen S et al., (2020). “Perinatal Depression: A Review.” Cleveland Clinic Journal of Medicine, vol. 87, no. 5, May 2020, pp. 273–277, www.ccjm.org/content/ccjom/87/5/273.full.pdf, .

McDonald M, & Alhusen J. A (2022). Review of Treatments and Clinical Guidelines for Perinatal Depression. J Perinat Neonatal Nurs. 2022 Jul-Sep 01;36(3):233-242. doi: 10.1097/JPN.0000000000000661. PMID: 35894719.