4 - (SYM 33) Pharmacologic Considerations in the Peripartum Period

In the United States, an estimated 500,000 pregnant individuals annually experience a mental health disorder either prior to or during pregnancy (Gavin et al., 2005; Fawcett et al., 2019). An even higher proportion of individuals experience mental health difficulties postpartum. Anxiety disorders and major depressive disorder are the most common perinatal psychiatric conditions (Fairbrother et al., 2015; Van Niel et al., 2020). Although less prevalent, bipolar disorder, substance use disorders, obsessive–compulsive disorder, psychotic disorders, and eating disorders are associated with significant medical and psychosocial consequences (Howard et al., 2020). Suicide accounts for approximately 5%–20% of maternal deaths and together with overdose represents the leading causes of death among childbearing individuals in the first year postpartum (Kendig et al., 2017a; Davis et al., 2019a). Pregnant individuals with psychiatric illness are more likely to engage in behaviors detrimental to health, such as substance use, inadequate sleep, poor nutrition, and to experience difficulties with maternal–infant bonding and breast/chestfeeding (Betcher et al., 2020; Dagher et al., 2021). Untreated perinatal mental health disorders are linked to adverse outcomes, including high-risk pregnancies and increased complications for both the pregnant individual and fetus (Dagher et al., 2021). Despite these risks, treatment rates remain low, with up to 75% of affected pregnant individuals receiving no care (Byatt et al., 2015). Barriers include limited provider training, concerns regarding medication safety and liability, stigma, financial and access constraints, fragmented care coordination, and insufficient perinatal-specific education and resources (CHCF, 2019; Jackson, 2020; Dagher et al., 2021).

This talk will provide an overview of pharmacologic considerations for the most common psychiatric conditions during the peripartum period. Topics to be covered include concerns about medication safety during pregnancy and postpartum, considerations for starting or continuing medications during pregnancy and postpartum, and resources to improve early detection and timely access to care.