Active Ingredients: Gabapentin
Further, it is suggested that breastfeeding is associated with slightly enhanced performance on tests of cognitive development.
Breast feeding is also very important for development of emotional bond and attachment between the mother and the infant. The decision regarding continuing or not continuing breast feeding while continuing mood stabilizers is a difficult one.
Ideally, a risk benefit analysis should be carried out taking into consideration the physiological and psychological benefits of breastfeeding; the potential adverse effect of untreated maternal mental illness on the infant and maternal child bonding; impact of psychotropic medication on the cognitive and behavioral development of the infant, and the consequences of untreated mental illness on the mother.
The exposure of infant to various medications is dependent on the rate of absorption into maternal circulation, diffusion from maternal circulation to breast milk, and absorption of the agent in the infant. The concentration of medications in breast milk is influenced by lactose, serum albumin, lysozyme and approximately 30 other enzymes, prolactin, and minerals like calcium and phosphates.
It is known that, compared with the fore milk the milk ejected during the first half of a feeding, hind milk the milk ejected during the second half of a feeding has higher lipid content; hence, the milk secreted in the second half will have a higher concentration of lipid soluble maternal psychotropic medications than the first half.
Ability to conjugate various compounds develops from minimal levels to almost adult levels within 2 weeks of birth in most cases. In addition, compared to older infants, neonate have relatively lower fat storage sites, accordingly central nervous system CNS concentrations of lipid soluble substances are greater in newborns.
It is important to understand that the absolute risk is small 0. In was observed that withholding lithium therapy for 24—48 h before delivery resulted in reduction in maternal lithium concentration by 0.
A few reports have described adverse effects in the form of lethargy, hypothermia, hypotonia, and T-wave modifications on electrocardiogram ECG in newborns of mothers who continued to take lithium during the postpartum period.
Follow-up studies of children for 3. One of the recent studies evaluated 15 children, exposed to lithium prenatally, at the age of 3—15 years of age and reported lower scores on the performance intelligence quotient IQ, although overall intelligence was within normal limits.
However, no abnormality was observed in growth, behavior and general development. The risk for major birth defects in infants born to women receiving anticonvulsants has been reported to be twice that seen in general population.
It is effective in management of acute manic and depressive episodes and is also useful in prevention of relapse of both manic and depressive episodes.
Valproic acid and its various derivatives have been known to have an increased risk of causing neural tube defects in the range of 1. The neural tube defect with valproate more often involves the lumbosacral rather than the anencephalic region, suggesting the effect of valproate on the closure of neural crest.
Of the 149 valproate monotherapy exposed pregnancies, major malformations were seen in 16 cases. When these data were compared with the major malformations with other anticonvulsants, it was concluded that valproate was associated with more frequent adverse effects.
Another recent case—control study, which was based on European Surveillance of Congenital Anomalies antiepileptic-study database, evaluated the outcome of exposure to valproic acid monotherapy in 180 registrations.
Compared to no use of antiepileptic medications, use of valproic acid during the first trimester was associated with increased risk of spina bifida, atrial septal defect, cleft palate, hypospadias, polydactyl and craniosynostosis.
Long-term behavioral and cognitive outcome with exposure to valproate in pregnancy has been evaluated. Meador et al.