Managing Depression during Pregnancy and Lactation

by Melissa Garvey, ACNM Writer and Editor

Between shifts at the information booth and shadowing the photographer, I was lucky enough to sample a few of the great education sessions on tap at this year’s ACNM Annual Meeting. I was most looking forward to meeting fellow bloggers Mary Murry, Amie Newman, and Amy Romano, but I also managed to slip into “Psychiatric Medications in Pregnant and Breastfeeding Women: Risks and Benefits,” which was taught by Beth Conover, MS, APRN, CGC, from the Nebraska Teratology Information Service.

Beth addressed a number of psychiatric conditions and medications, and designed her presentation for health care providers. But, as a health care consumer, the information on managing depression struck me the most. Did you know that during pregnancy, symptoms of depression affect 10 – 20% of women? Here’s what I learned, which I suspect is relevant to many of my fellow midwifery care consumers out there.

According to Beth, untreated depression may increase a woman’s risk for miscarriage, pregnancy-induced high blood pressure, preterm delivery, or low birth weight. There are numerous lifestyle adjustments and therapy options that may be sufficient to keep depression at bay. However, some women require medication to treat their depression. Untreated depression during pregnancy carries risks; medication during pregnancy carries risks. In fact, just by being human, every woman has a 3% chance of having a baby born with a congenital anomaly (aka something unusual or different at birth). There are no zero-risk options.

The good news is that there are low-risk, relatively safe options proven to help women with depression cope and even thrive through their preconception, pregnancy, and postpartum experience. If you’re interested in the specific risks and benefits of a particular psychiatric medication during pregnancy and breastfeeding, Beth recommended perusing the Organization of Teratology Information Specialists’ FAQ sheets in English and Spanish (and, as always, you should consult your health care provider).

Another tip Beth gave is not to rely solely on the FDA codes that rank medications as category A, B, C, D, or X. Risk classifications are based on the best data available, which are often results from studies on animals. They don’t always accurately reflect risk status either. For example, birth control pills are in category X not because they are likely to cause serious harm to a developing fetus, but because they aren’t prescribed during pregnancy. (If a woman is pregnant, why would she need birth control?) It can also take a long time for a medication to move to the category that best reflects the current available scientific evidence.

Now it’s your turn. What sessions did you attend? Which were your favorites?