| Schedule Frequent Postpartum Visits |
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Schedule extra visits to: > Assess the woman and her substance use issues > Determine if the basic needs of the woman are being met, e.g., food, safe place to stay, support > Determine if the woman is being abused by her partner (pregnancy and postpartum are increased risk times for woman abuse) > Assess the care the infant is receiving: hygiene, nutrition, comfort, etc. > Assist the woman in contacting child protective services if she needs more support, or if child neglect or abuse suspected > Discuss contraception needs > Immunizations (see infectious disease section) |
| Postpartum Mood and Anxiety Disorders |
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| > Increased risk of postpartum depression (PPD) if the woman experienced depression during pregnancy, at another time in her life or after a previous pregnancy > Monitor the woman to determine if she is developing a postpartum mood and anxiety disorder: appetite and sleep changes, depressed mood, panic attacks, thoughts of harming self or infant, increased calls about infant concerns, decreased coping skills, etc. > Check throughout the first year; PPD can develop immediately or months after birth > SSRIs linked to increased risk (1%) of persistent pulmonary hypertension of the newborn; some SSRIs associated with congenital malformations (see literature for updates)* and self-limited neonatal adaptation syndrome e.g., jitteriness, respiratory distress, weak cry, seizures – benefit-risk decision should be made on individual case basis* > Use lowest dose of SSRI in pregnancy; consider starting an antidepressant immediately after birth if there is an increased risk of PPD > Consider referral to a psychiatrist or PPD support group |
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| *References | |
| > Wooltorton E. Presistent pulmonary hypertension of the newborn and maternal use of SSRIs. CMAJ 2006; 174(11): 1555-1556 > Einarson TR, Einarson A. Newer antidepressants in pregnancy and rates of major malformations: a meta-analysis of prospective comparative studies.Pharmacoepidemiology & Drug safety 2005; 14(12):823-7 > Louik C, Lin AE, et al. First-Trimester use of selective serotonin – reuptake inhibitors and the risk of birth defects. NEJM 2007; 356(26): 2675-2683 |
