Fer­til­ity Q&A

Your Pregnancy - - Contents - YP Dr Kwena Khoele

Q:I suf­fer from de­pres­sion and I’ve been on med­i­ca­tion for it for years. My hus­band and I would like to start a fam­ily soon and I’m not sure how to pro­ceed. Should I go off the meds be­fore I get preg­nant? And then stay off them? Or should I con­tinue with the med­i­ca­tion?

A:Kwena an­swers: Women of­ten face dif­fi­cult treat­ment de­ci­sions for de­pres­sion or any psy­chi­atric dis­or­ders dur­ing preg­nancy. Treat­ment dur­ing preg­nancy in­volves a thought­ful weigh­ing of the risks and ben­e­fits of pro­posed meth­ods and the doc­u­mented and the­o­ret­i­cal risks as­so­ci­ated with un­treated psy­chi­atric dis­or­ders such as de­pres­sion. It is very im­por­tant to dis­cuss your treat­ment op­tions with your psy­chi­a­trist and to get in­for­ma­tion on the risks of tak­ing or not tak­ing med­i­ca­tion dur­ing preg­nancy. There is in­creas­ing ev­i­dence of high rates of the ill­ness re-sur­fac­ing af­ter med­i­ca­tion is dis­con­tin­ued and other data de­scribes new-on­set psy­chi­atric ill­ness dur­ing preg­nancy. The value of psy­chi­atric con­sul­ta­tion dur­ing preg­nancy and af­ter de­liv­ery is in­tu­itive. Moth­ers who stop treat­ment dur­ing preg­nancy are at risk of poor preg­nancy out­comes such as: • Preterm births. • Low birth weight (ba­bies small for ges­ta­tional age). • Poor nu­tri­tion. • In­abil­ity to care for self. • Sub­stance use or abuse. • Ter­mi­na­tion of preg­nancy. • Post­par­tum de­pres­sion. An­tide­pres­sants have dif­fer­ent ef­fects on the in­fant, which makes it very im­por­tant to dis­cuss with the psy­chi­a­trist the choice with min­i­mum ef­fects. The risks on the in­fant in moth­ers who stop treat­ment, or who are not treated, for de­pres­sion in preg­nancy out­weigh the risks of med­i­ca­tion side ef­fects on the in­fant. Most side ef­fects of the an­tide­pres­sants on the in­fant are treat­able and man­age­able, es­pe­cially with close mon­i­tor­ing by the doc­tors. Some of the doc­u­mented med­i­ca­tion side ef­fects in­clude the fol­low­ing, re­ferred to as neona­tal be­havioural syn­drome or poor neona­tal adap­ta­tion. • Res­pi­ra­tory dis­tress. • Low Ap­gar scores. • Feed­ing prob­lems. • Jit­ters. • Al­tered mus­cle tone. • Ag­i­ta­tion. • Ir­ri­tabil­ity. • In­creased cry­ing. Other side ef­fects in­clude still­birth or neona­tal death and con­gen­i­tal ab­nor­mal­i­ties. How­ever, th­ese are very rare. Most of the side ef­fects are ex­plained by the rapid de­crease of med­i­ca­tion lev­els in the new­born (with­drawal symp­toms). An­tide­pres­sant ex­po­sure in the third trimester in­creases the risk for neona­tal be­havioural syn­drome three-fold. Preg­nant moth­ers with de­pres­sion need close mon­i­tor­ing by their psy­chi­a­trists and ob­ste­tri­cians to re­duce poor preg­nancy out­comes. In­creases in blood vol­ume in a preg­nant woman may re­quire med­i­ca­tion dose ad­just­ments. It is best to pro­vide care­ful clin­i­cal mon­i­tor­ing of ba­bies with an­tide­pres­sant ex­po­sure or ba­bies born to de­pressed moth­ers im­me­di­ately at birth and con­tinue with this in the first few months of life.

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Epi-max Baby & Ju­nior Cream Tub R62, Cream Tube R25, Lo­tion R42, and Bathe R40, re­tail­ers and chemists

The Tots 3-piece Muslin Square, R649, Ham­ley’s Baby Di­vi­sions and takealot.com

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