Lithium Medication in Pregnancy and Breastfeeding—A Case Series

Lithium salts are the first-line prophylaxis treatment for bipolar disorder in most guidelines. The majority of bipolar women are treated with mood stabilizers at the time they wish to get pregnant. One reason for this is the rising average age at first childbirth, at least in the high-income countries, which increases in general the likelihood of a medication with psychotropic drugs. Previously, lithium exposition during pregnancy was thought to strongly increase the risk of severe cardiac malformation. However, recent studies only point to a low teratogenic risk, so nowadays an increasing number of women are getting pregnant with ongoing lithium treatment. Regarding lithium medication during breastfeeding, there is evidence that lithium transfers to the breastmilk and can also be detected in the infants’ serum. The influence on the infant is still a largely understudied topic. Regular monitoring of the infants’ renal clearance, thyroid function, and lithium levels is warranted when breastfeeding under lithium exposure. In this case series, we present three case reports of bipolar mothers who were treated with lithium during pregnancy and breastfeeding to add to the scarce literature on this important topic. In short, we strengthen the importance of therapeutic drug monitoring due to fluctuating plasma levels during pregnancy and after birth, and we can report the birth and development of three healthy infants despite lithium medication during pregnancy and breastfeeding.

Risk of Birth Defects From Vitamin A “Acne Supplements” Sold Online

Background: Dietary supplements are popular among US consumers and claim to address a variety of conditions, including acne. Acne supplements containing vitamin A are of particular interest, due to the potentially teratogenic effects of vitamin A doses over 10,000 IU. Objective: This study examined dosage, pregnancy risks, and labeling of vitamin A-containing acne supplements available online. Methods: An Internet search of acne supplements sold online was conducted between March and May 2020. Supplement labels and websites were analyzed for vitamin A content and pregnancy warnings, and then divided into categories based on dosage and teratogenic risk. Results: A total of 49 acne supplements was found, and of these 26 (53%) contain vitamin A. Three supplements are likely teratogenic, 4 contain vitamin A doses exceeding the daily level of intake that meets the nutritional needs of most people, and 15 have an unknown teratogenic risk. Among the 6 supplements with over 10,000 IU vitamin A, 2 have no pregnancy warning at all, including the supplement with the highest vitamin A dose found in this study. Conclusions: Dietary supplements are not subject to the same stringent regulations as drugs, and as such, consumers may be unaware of pregnancy risks. Furthermore, FDA requirements on labeling of vitamin A supplements may lead to consumer confusion regarding dosage. As such, we encourage stricter labeling requirements for vitamin A-containing supplements, including pregnancy warnings for high-dose supplements and clearer dosage labeling.

KEHAMILAN DENGAN GANGGUAN JIWA

Pregnancy is a dramatic episode of the biological and psychological changes and adaptations of a woman who never experienced it. The incidence of mental disorders in pregnancy was lower than postpartum and outside of pregnancy with 10 - 15% on post partum 10-15% and 2-7% beyond pregnancy. However Ohara reported that 10% of pregnant women was eligible if diagnosed with major and minor depression. There are two phases of pharma- cological management is described in the guidelines panel: the acute phase, symptoms are treated, drug dosage adjusted to prevent the adverse effects and patient given counseling, severe phase, patients were monitored at an effective dose to prevent relapse . In the maintenance phase, patients at risk for relapse is often still treated with medicines. Reported here the case of a female patient aged 31 years diagnosed with G2P1A0H1 term gravid 37- 38 weeks + bipolar affective disorder, current episode manic with psychotic symptoms. Patients have been known to suffer from a mental disorder since 2000 and has been submitted to psychiatry ward for as much as 9 times. Trigger disorder is unknown at this time, the patient suddenly angry for no apparent reason. Patients treated with pharmacotherapy of haloperidol 2x2 mg, roboransia and psychotherapy. Treatments including consideration of the patient to provide pharmacological therapy in a minimun dosage and psychotherapy to effectively reduce teratogenic risk to the fetus. Patients have been known to suffer from a mental disorder since 2000 and has been submitted to psychiatry ward for as much as 9 times. Trigger disorder is unknown at this time, the patient suddenly angry for no apparent reason. Patients treated with pharmacotherapy of haloperidol 2x2 mg, roboransia and psychotherapy. Treatments including consideration of the patient to provide pharmacological therapy in a minimun dosage and psychotherapy to effectively reduce teratogenic risk to the fetus. Patients have been known to suffer from a mental disorder since 2000 and has been submitted to psychiatry ward for as much as 9 times. Trigger disorder is unknown at this time, the patient suddenly angry for no apparent reason. Patients treated with pharmacotherapy of haloperidol 2x2 mg, roboransia and psychotherapy. Treatments including consideration of the patient to provide pharmacological therapy in a minimun dosage and psychotherapy to effectively reduce teratogenic risk to the fetus.Keywords: Mental disorders, bipolar affective disorder, pregnancy, psychotherapy

Seizure Medications Effects on Fetus, Neonate, and Lactation

Medication use in pregnancy requires a careful balance between the risks of fetal teratogenicity and the maternal benefits of disease treatment. For women with epilepsy, there are many antiepileptic medications available for use in pregnancy. Each varies in their safety profile, risk for fetal anomalies, and effectiveness of seizure control. In most scenarios, the benefits of maternal treatment outweigh the risk of fetal effects, especially in cases of refractory epilepsy or severe disease. Many of the newer anti-epileptic drugs appear to have less teratogenic risk than the older medications. The ideal AED is one that is effective from the woman, is least teratogenic, and used at the lowest possible dose. Overall, a detailed understanding of antiepileptic efficacy, the pharmacologic differences in pregnancy, and the potential adverse fetal effects are required for optimal treatment of pregnant patients with epilepsy.