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Proposed by the EPA Section on Women, Gender and Mental Health -The risk of new onsets and recurrences of affective psychosis and bipolar disorder is increased in the peripartum period, and in the first weeks after childbirth it is the highest than at any other time in a woman’s life. The first speaker will present recent findings from his and other research groups on the biological and psychosocial causation of this phenomenon. The second speaker will present recent data from a population study examining the strength of the association of parental mental illness and risk of injury to the offspring. Findings will be reported not only for maternal but also paternal mental illness, for common and severe mental disorders and for children in the first year of life versus older age groups. Increasing evidence shows that pregnancy has differential effects on the pharmacokinetics of psychotropic drugs. Large drops of plasma levels have been reported for some agents, potentially placing some pregnant women with severe mental illness at a greater risk of recurrence. The third speaker will discuss current pharmacokinetic and clinical research and make recommendations for therapeutic drug monitoring in the preconception, pregnancy and early postnatal period. Although suicide attempts in the perinatal period can lead to significant complications for pregnancy and child outcomes, they have received little attention in research. The fourth speaker will present recent findings on the prevalence of suicide attempts in pregnancy and the postnatal period and the profiles of risk factors from a large sample of women treated in mother and baby inpatient units.
S0161 - Are the Risk Factors for Postpartum Psychosis and Bipolar Disorder Purely Biological?
S0162 - Parental Mental Disorder and Risk of Injury in Children Less than One Year Old
S0163 - Should We Monitor Psychotropic Drug Levels in Pregnancy and the Postpartum?
Pregnancy is associated with profound changes in pharmacokinetic processes. This is an important - and until recently neglected - area of research since the majority of women take drugs during pregnancy in addition to vitamin and dietary supplements. Recent evidence has emerged that the changes do not only include absorption, distribution and excretion but also drug metabolism, such as modifications in the regulation of hepatic metabolism and conjugation.
Oestradiol is known to have an important role in the expression of cytochrome P450 isoenzymes and glucuronosyltransferase that are involved in the metabolism of psychotropic drugs. Recent studies of different psychotropic drug classes have shown that this can result in profound changes of plasma concentrations that commence early in pregnancy and gradually increase towards delivery.
In this presentation pregnancy-induced metabolic changes that have been found so far for several psychotropic drugs will be discussed and the question addressed whether and how we should monitor plasma levels in our pregnant patients.
S0164 - Suicide Attempts in Women with Severe Mental Illness in the Perinatal Period
Suicide is one of the leading causes of perinatal maternal mortality (1). Maternal suicidality has a negative impact on the mother-baby relationship and child development. However, little is known about specific risk factors for perinatal suicide attempts in women with severe mental illness.
In a sample of 1439 women with severe mental illness in the perinatal period and jointly admitted with their baby in a mother and baby unit, 154 (11.7%) attempted suicide, 49 in pregnancy (3.7%) and 105 (8.0%) in the post-partum period (2).
Suicide attempt in pregnancy was related to alcohol use, smoking during pregnancy and a history of miscarriage, and in the post-partum period to major depressive episode or recurrent depression and younger age.
Women who attempt suicide either in pregnancy or in the postnatal period could have different psychopathological and environmental profiles. Past obstetric history and addictive behaviours during pregnancy are essential elements to explore. In addition, depressive symptoms should be assessed in all women to treat major depression, as a means of preventing suicide attempt. Special attention to risk of suicide is needed during the perinatal period for women with severe mental illness.
For women suffering from an acute psychiatric disorder, or a history of mental illness, multi-disciplinary management should be implemented.
1. Oates M. Suicide: the leading cause of maternal death. Br J Psychiatry. 2003;183:279-81.
2. Gressier F et al. Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J Psychiatr Res. 2017;84:284-291.