Use of psychotropic drugs during pregnancy and breast-feeding

OBJECTIVE

To write clinical guidelines for the use of psychotropic drugs during pregnancy and breast-feeding for daily practice in psychiatry, obstetrics and paediatrics.

METHOD

As we wanted a guideline with a high degree of consensus among health professionals treating pregnant women with a psychiatric disease, we asked the Danish Psychiatric Society, the Danish Society of Obstetrics and Gynecology, the Danish Paediatric Society and the Danish Society of Clinical Pharmacology to appoint members for the working group. A comprehensive review of the literature was hereafter conducted.

RESULTS

Sertraline and citalopram are first-line treatment among selective serotonin reuptake inhibitor for depression. It is recommended to use lithium for bipolar disorders if an overall assessment finds an indication for mood-stabilizing treatment during pregnancy. Lamotrigine can be used. Valproate and carbamazepin are contraindicated. Olanzapine, risperidone, quetiapine and clozapine can be used for bipolar disorders and schizophrenia.

CONCLUSION

It is important that health professionals treating fertile women with a psychiatric disease discuss whether psychotropic drugs are needed during pregnancy and how it has to be administered.

Preterm dietary study: meal frequency, regurgitation and the surprisingly high use of laxatives among formula-fed infants following discharge

AIM

To describe eating habits and possible feeding intolerance among preterm infants based on type of nutrition.

METHODS

The parents of infants born below 32 weeks filled in questionnaires, before and after discharge, about type of nutrition, number of meals, regurgitation, number of stools and laxative use.

RESULTS

A total of 769 questionnaires based on 286 very preterm infants were completed, and 753 were included. At 40 weeks of corrected age, infants fed both fortified and unfortified human milk received more daily meals (mean 7.37 and 7.57) than preterm formula-fed infants (mean 6.79) (p < 0.05). Fortification of human milk did not seem to increase the incidence of regurgitation. Between 38.7 and 42.9% of the preterm infants were treated with laxatives from discharge to 6 months of corrected age. Infants fed preterm formula prior to discharge, at term, at 2 and 4 months of corrected age received laxatives more often than infants fed human milk, with odds ratios of 13.7, 137.5, 49.7 and 40.5, respectively (p ≤ 0.001).

CONCLUSION

Constipation seems to be frequent among very preterm infants. Laxative use averaged 40% across all the different feeding groups and was as high as 70-85% in formula-fed preterm infants over the course of the study.

Intestinal blood flow is controlled by both feed arteries and microcirculatory resistance vessels in freely moving rats

1. In freely moving rats, intestinal blood flow, aortic blood pressure and blood pressure at the base of mesenteric arcades were measured simultaneously so as to determine the role of feed arteries and of the microcirculation in the control of intestinal vascular resistance. Segmental resistances of feed arteries (Rfeed) and of microcirculatory vessels (Rmicro) were calculated. 2. At rest, Rfeed and Rmicro were 32 and 68%, respectively, of the total intestinal vascular resistance. 3. Injection of noradrenaline (2 micrograms i.v,) increased Rfeed by 151% and Rmicro by 243%. Angiotensin II (400 ng i.v.) did not increase Rfeed significantly, but increased Rmicro by 239%. Conversely, serotonin (15 micrograms i.v.) increased Rfeed by 414% but did not affect Rmicro significantly. 4. Spontaneous physical activity increased Rfeed by 29% and Rmicro by 39%, while sudden environmental stress increased Rfeed by 116% and Rmicro by 129%. Infused noradrenaline (1 microgram min-1 i.v.) or adrenaline (0.8 microgram min-1 i.v.) reduced intestinal flow by 21 and 16% respectively, while noradrenaline, but not adrenaline, increased intestinal resistances. 5. alpha 1-Blockade with prazosin (0.1 mg i.v.) reduced Rfeed and Rmicro by 43 and 16%, respectively. Thereafter, environmental stress decreased Rfeed by 24% while Rmicro was unaffected. Intravenous noradrenaline and adrenaline responses were attenuated. 6. We conclude that in freely moving rats, mesenteric feed arteries, as well as microcirculatory vessels, are true resistance vessels, and that both participate in the control of intestinal blood flow.

Mesenteric blood pressure profile of conscious, freely moving rats

1. Blood pressure has been measured in the aorta and at four points in the mesenteric circulation of conscious, freely moving rats under physiological, resting conditions. 2. Using small polythene catheters, blood pressure was measured simultaneously in the aorta and either distally in the superior mesenteric artery (group A), at the base of a mesenteric arterial arcade (vessel diameter ca 100 microns) (group B), at the base of a mesenteric venous arcade (group C) or distally in the superior mesenteric vein (group D). Local blood flow distribution proximal and distal to the measurement point was restored after the cannulations through appropriate ligations. 3. In conscious animals 5-17 h after surgery, systemic mean blood pressure was 121 +/- 2 mmHg. Local pressures at the four locations (as a percentage of systemic pressure) were: 95 +/- 1% in group A, 64 +/- 2% in group B, 13 +/- 1% in group C and 7 +/- 1% in group D. Thus, large arteries dissipated 5% of the total pressure drop, arcade small arteries 31%, the intramural circulation 51%, arcade veins 6% and the remaining veins plus the hepatic circulation 7%. 4. Immediately after surgery, the corresponding pressure drops were 4, 16, 66, 5 and 9%, respectively, thus emphasizing that the pressure profile can be profoundly affected by surgery and anaesthesia. 5. The data indicate that under resting conditions in conscious, freely moving rats, half the mesenteric vascular resistance resides outside the intramural circulation, primarily in the arcade small arteries.