Few studies have investigated the level of planning of pregnancy among women with mental disorder and associated risk factors.

The purpose of this study was to determine the associated factors to UP and psychopathological consequences.

A cross sectional study was conducted at the Perinatal Mental Health Unit of the Hospital Clínic in Barcelona. The total sample comprised 675 consecutive pregnant women with diagnosis of mental disorder (DSM-IV criteria), seen between January 2006 and December 2018. Clinical, psychometric and socio-demographic variables were collected at the first visit. Pregnancy planning was assessed by a question “Was this pregnancy planned?” with three possible answers: 1) Yes, it was planned and has been well received; 2) No, it was not planned but it has been well received; and 3) No, it was an accident. Response 1 was coded as “planned pregnancy” and responses 2 and 3 as “Unplanned Pregnancy”.

38.4% of the sample had an UP. Younger age, lower levels of education, Latin-American population, multiparity, financials problems and poor relationship with the partner were associated with UP in women with mental disorder. The mean EPDS and STAI scores and the presence of self-harming thoughts were significantly higher in women with UP.

UP was associated with more depressive and anxious symptoms and more self-harming thoughts. It is necessary to promote reproductive health care for women with mental disorders and to take into account their reproductive life plan, especially in those with risk factors described.

No significant relationships.

Determination of lithium levels in serum has become a standard of care due to its narrow therapeutic rang, thus an immediate test for determination of blood lithium may contribute to minimize toxicit, to avoid relapse and to ensure treatment adherence. This is particularly relevant during pregnancy and early postpartum because pharmaokinetic changes in renal physiology.

The aim of this study is verify Medimate point-of-care method performance and systematically compare it with the routine laboratory measurement of lithium.

This cross-sectional method comparison study was conductec in the Unit of Perinatal Mental Health in the Hospital Clinic of Barcelona. Pearson and Bland-Altman analyses were performed to assess the accuracy, precision and correlation between the capillary electrophoresis technology (Medimate MiniLab) and the ion selective electrode (ISE) potentiometry method (AVL 9180).

Twenty-five women with bipolar disorder in treatment with lithium during perinatal period were enrolled, corresponding to 75 blood specimens for analyses. Correlation (r), mean difference (bias), and 95% limit of agreement (LOA) of the point-of-care method [r=0.917; bias 0.0021 (95% LOA; 0.440, 0.619) mEq/L], showed that difference between ISE method and capillary electrophoresis technology was not statistically significant.

Considering the practicality, the microchip capillary electrophoresis technology provides a simple and highly affordable way of measuring lithium levels in a single drop of blood outside the clinical laboratory. The Medimate point-of-care system (POC) appears well adapted for the rapid and specific detection of lithium as an alternative to the current ISE procedure.

No significant relationships.

Lithium is used as a first-line treatment for bipolar disorder during perinatal period. Dosing of lithium can be challenging as a result of pharmacokinetic changes in renal physiology. Frequent monitoring of lithium blood levels during pregnancy is recommended in order remain within the therapeutic window (0.5 to 1.2 mEq/L). Lower neonatal lithium blood level (<0.64 mEq/L) at time of delivery reduces the risk of lithium side effects in the neonate.

The aim of the present study was to quantify the rate of lithium placental passage in real word.

We included a total of 68 mother-infant pairs for which a lithium measurement was performed intrapartum. Lithium serum concentrations were determined by means of an AVL 9180 electrolyte analyzer. The limit of quantification (LoQ) was 0.20 mEq/L and detection limit was 0.10 mEq/L. Pearson analyse was performer to assess the correlation between mother and umbilical cord lithium serum concentrations.

The mean of umbilical cord serum concentration at delivery was 0.57 mEq/L (SD=0.26, range 0,20-1,42). The mean infant-mother lithium ratio at delivery for the 68 pairs was 1.12 (SD=0.24) across a wide range of maternal concentrations (range 0.14-1,40 mEq/L). There was a strong positive correlation between maternal and umbilical cord lithium blood levels (Peearson correlation coefficient 0.948, p<0.001).

Lithium demostrates complete placental passage. This finding is consistent with the results of others studies (Newport 2005; Molenaar 2021).

No significant relationships.

Clozapine is an effective second-generation antipsychotic that is approved for treatment-resistant schizophrenia and risk reduction of recurrent suicidal behavior in schizophrenia or schizoaffective disorder. Its available pregnancy pharmacikinetics data remain limited, which presents a challenge for clinicians managing women taking clozapine during perinatal period .

The aim of this study was to provide new data of clozapine and norclozapine placental passage and neonatal outcomes.

We retrospectively studied a consecutive case series of six pregnancies where there was clozapine exposure (5 in politherapy and 1 in monotherapy). Clozapine and norclozapine serum concentrations were determined in the mother-infant pairs on the day of delivery (intrapartum maternal blood and umbilical cord blood respectively) and measured using a validated high-performance liquid chromatography method. The within- and between-day precision expressed as the coefficient of variation (CV)% were both <10%. The limit of quantification (LoQ) was 5 ng/mL. Neonatal outcomes were reviewed from pediatric records.

The mean infant-mother clozapine and norclozapine ratio at delivery were 0.44 (SD=0.13) and 0.28 (SD=0.05) respectively. There was a weak positive correlation between maternal and umbilical cord clozapine and norclozapine serum concentratios (Pearson correlation coefficient 0.183, p=0.769 and 0.827, p=0.084 respectively). The rate of neonatal complications was 16%. One neonate (16%) , whose mother had drug abuse history during pregnancy, presented with a generalized neurodevelopment delay and the consequent need for continuous intensive care.

In our study, placental passage of clozapine and norclozapine was partial during delivery. Statistical power was limited for examining te association between neonatal clozapine levels and neonatal outcomes.

No significant relationships.

Women experiencing postpartum mental illness have unique needs. Psychiatric Mother Baby Units (MBUs) can provide specialist in-patient care for mothers without separation from their baby. Since 2018, an innovative Mother-Baby Day Hospital (MBDH) have been developed and implemented in a public hospital in Spain, directed at the intensive, integral, and multidisciplinary treatment.

The aim of the present study was to obtain preliminary data regarding its effectiveness in postpartum women with affective and anxiety disorders.

Thirty-three mothers and their babies with affective or anxiety disorders attended to MBDH CLINIC-BCN participated in the study. All women were assessed at admission, discharge, and 3 months follow-up. Primary outcomes were depression (EPDS) and anxiety symptoms (STAI-S), mother-infant bonding (PBQ) and functional impairment (HoNOs).

At discharge, 100% of women no longer met the full criteria for the main diagnosis (PSR≥5). Significant improvements from admission to discharge were achieved in depression and anxiety symptoms, mother infant bonding and functional impairment. Clinical significance was also calculated. After treatment, mothers had greater autonomy for care their babies. Similar results were observed at 3 months follow-up. The MBDH was rated by mothers as an excellent quality program and they would recommend it.

This study found that multidisciplinary intervention at MBDH for postpartum women with affective or anxiety disorders is effective, not only for maternal psychopathology but also for maternal care and bonding. It is imperative to develop specialized devices that integrate the care of the dyad by professionals specialized in perinatal mental health.

No significant relationships.

Lithium is an effective mood stabilizer and is widely used as a first-line treatment for bipolar disorder in the perinatal period. Several guidelines have provided clinical advice on dosing strategy (dose reduction versus stop lithium) in the peripartum period to minimize the risk of neonatal complications. An association has been observed between high neonatal lithium concentrations (> 0.64 mEq/L) and lower 1-min Apgar scores, longer hospital stays, and central nervous system and neuromuscular complications.

To quantify the rate of lithium placental passage at delivery. To assess any association between plasma concentration of lithium at delivery and neonatal outcome.

In this retrospective observational cohort study, we included women treated with llithium at least in late pregnancy. Maternal (MB) and umbilical cord (UC) lithium blood level measurement were collected at delivery. Lithium serum concentrations were determined by means of an AVL 9180 electrolyte analyzer. The limit of quantification (LoQ) was 0.20 mEq/L and detection limit was 0.10 mEq/L. From the medical records, we extracted information on neonatal outcomes (preterm birth, birth weight, Apgar scores, pH-values, and admision to NICU) and complications categoriced by organ system: respiratory, circulatory, hematological, gastro-intestinal, metabolic, neurological, and immune system (infections).

Umbilical cord and maternal lithium blood levels were strongly correlated: mean (SD) range UC/MR ratio 1.15 (0.24). Umbilical cord lithium levels ranged between 0.20 to 1.42 mEq/L. We observed no associations between umbilical cord lithium blood levels at delivery and neonatal outcomes.

In our study, newborns tolerated well a wide range of lithemias, between 0.20 and 1.42 mEq/L.

Women who take lithium during pregnancy and continue after delivery may opt to breastfeed, formula feed, or mix these options.

To evaluate the neonatal lithium plasma concentrations and nursing infant outcomes based on these three feeding trajectories.

We followed 24 women with bipolar disorder on lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ).

The mean ratio of lithium concentration in the umbilical cord to maternal serum being 1.12 (0.17). We used the Turnbull estimator for interval-censored data to estimate the probability that the LoQ was reached as a function of time. The median times to LoQ was 6–8, 7–8, and 53–60 days for formula, mixed, and breastfeeding, respectively. Generalised log-rank testing indicated that the median times to LoQ differed by feeding trajectory (p = 0.037). Multivariate analysis confirmed that the differences remained after adjusting for serum lithium concentrations at birth (formula, p = 0.015; mixed, p = 0.012). We did not found any acute observable growth or developmental delays in any of the neonates/infants.

Lithium did not accumulate in the infant under either exclusive or mixed-breastfeeding. Lithium concentrations declined in all trayectories. The time needed to reach the LoQ was much longer for those breastfeeding exclusively. Lithium transfer via breastmilk is much less than via the placenta. We did not found any acute observable growth or developmental delays in any infant during follow-up.

No significant relationships.

Preeclampsia is a new-onset hypertension with new-onset proteinuria after 20 weeks gestation. Scarce evidence regarding psychiatric effects of preeclampsia is available.

To describe a case of a pregnant 24 year-old patient with a premature cesarean section in context of severe preeclampsia and dissociative symptoms.

Patient referred to a third-level hospital for cesarean section due to a severe preeclampsia at week 32, in whom magnesium sulfate, labetalol perfusion and betamethasone are started. In the puerperium period only labetalol up to 300 mg/6h is maintained.

Due to the appearance of pulsating headache and photophobia, a computerized tomography is conducted, showing bilateral insular and occipital hypodensity related to vasogenic edema. High blood pressure is maintained (177/121 mmHg) despite antihypertensive treatment. A magnetic resonance imaging and an ophthalmologic exam do not show significant abnormalities and blood pressure is stabilized with treatment. However, the patient refers new-onset auditory imperative hallucinations and suicide thoughts, being referred to our Acute Psychiatric Ward for clinical assessment and intervention. Treatment with risperidone 2 mg is started. The day after her admission, she does not refer psychotic symptoms, explaining depersonalization symptoms in the previous 5 days, seeing herself having to choose a knife to commit suicide. After discharge, she maintains reiterative dreams in which she falls down from a building, not presenting dissociative symptoms during the day.

Further evidence regarding psychiatric effects of preeclampsia is needed in order to study the consequences of edema and pharmacological treatment. Blood pressure and psychiatric symptoms monitoring after preeclampsia should also be considered.

No significant relationships.

Clozapine is a second-generation antipsychotic agent approved for treatment-resistant schizophrenia and risk reduction of recurrent suicidal behavior in schizophrenia and schizoaffective disorder. Given the known negative consequences of relapse of severe mental disorders for both mother and infant, the maintenance of clozapine during pregnancy is recommended.1 Studies of pregnancy regarding to clozapine have demonstrated a heterogenous range of neonatal and infant complications.2

To evaluate neonatal and infants outcomes of clozapine exposure in pregnancy.

We report three cases of infants exposed to clozapine politherapy throughout pregnancy. The dose range for all women on clozapine was 200-600 mg/day. Infants were evaluated between 4-6 months of chronological age with the Bayley-III infant development scale (BSID-III)3 and with the Alarme Détresse Bébé Scale (ADBB)4 for the detection of early-signs of withdrawal.

Women remained stable during pregnancy but presented obesity and gestational diabetes. Clozapine Newborn were born to term by caesarean section due to breech presentation (N=2) or instrumental delivery due to loss of fetal well-being (N=1). They presented normal weight (3500-3800 gr). Two presented Apgarmin1-5 9/10 and one Apgarmin1-5 6/8 which showed lethargy and low alertness during the first weeks of life. All showed normal capacity for sociability, reciprocity and development of language and communication. However, one baby had scores in the low normal zone for cognition and another for motor skills.

The infant’s risks of clozapine exposure during pregnancy should be discussed with women and weighed against those associated with other treatments and/or with untreated severe mental illness.

To study whether there are personality characteristics that discriminate between IPV women and non-abused control women, taking into account the effect of emotional state (depressive symptoms).

A total of 176 women victim of IPV and 193 non-abused control women were assessed with the Dimensional Assessment of Personality Pathology (DAPP-BQ; Livesley, 1990), the Beck Depression Inventory -II (BDI-II; Beck, 1996), and the Index of Spouse Abuse (ISA; Hudson & McIntosh, 1981). Women victim of IPV were recruited from Domestic Violence Centers, and non-abused control women were recruited from Primary Care Centers and Mental Health Services. A two way analysis of variance (IPV * Depression) were used for detecting differences in personality traits taking into account the effect of depression (BDI ≥ 17).

After controlling for depression, IPV victims scored higher than control women in submissiveness (F=6.41; p=0.01), cognitive distortion (F=4.35; p=0.04), intimacy problems (F=27.02; p< 0.001), suspiciousness (F=5.02; p=0.03) and self-harm (F=4.93; p=0.03), and lower in rejection (F=14.66; p< 0.001).

IPV victims showed high submission, low hostility, intimacy problems, suspiciousness, tendency to depersonalization or derealization, and suicidal ideation and attempts, as a result of chronic abuse. Some of these aspects could be explained by the presence of PTSD, more than by pre-existing personality characteristics. Traumatic and chronic stress can alter functional aspects of the brain and lead to the development of dysfunctional cognitive and behavioral characteristics that may be considered in the psychotherapeutic approach.

Despite lithium has been used for the last 50 years as a maintenance treatment for bipolar disorder during pregnancy, there is limited information about perinatal clinical outcomes from fetal exposure to lithium.

1. 1. To quantify the rate of lithium placental passage

2. 2. To assess any association between plasma concentration of lithium at delivery and perinatal outcome.

Observational and prospective study. Subjects: Women in maintenance treatment with lithium, being attended during pregnancy at the Perinatal Psychiatry Programme of Hospital Clínic (Barcelona, Spain) between 2007 and 2009. Procedure: We assessed sociodemographical data; dose/day of lithium carbonate; other drugs doses; plasmatic concentration of lithium carbonate in maternal blood intrapartum and in the umbilical cord; obstetrical maternal complications; gestational age at delivery; weight at delivery; Apgar scores; congenital malformations; hospital stays, infant serum concetrations of thyroid-stimulating hormone.

Eight mother-child diads. Mean age of the mother (SD): 32.1 (4,7); 100% caucasian and married. Mean dose of maternal lithium (SD): 675mg (237,5mg). Premature rupture of membranes (%):25. Gestational mean age (in weeks) (SD): 39,9 (1). Birth weight (SD) : 3625gr (451,2gr); Mean Apgar1min (SD): 8,38 (1,1); Mean Apgar5min (SD): 9,75 (0,4). Loss of fetal intrapartum wellness (%): 12,5. Days of hospitalization (mean) (SD):9,5(16,6). Lithium plasmatic concentration (mEq/L), mean (SD): maternal 0,45(0,1), umbilical cord 0,33(0,1), lithium ratio uc/m 0,93 (0,3); infant TSH μU/mL mean (SD): 4,9(4,6).

Lithium placental passsage was 0,93 (0,63-1,07). ≤At umbilical cord lithium levels ≤ 0.60 mEq/L, we didn't have any preterm deliveries, low birth weight newborns, nor neonatal complications.

The prevalence of mood disorders (anxiety and depression) during pregnancy seems to be similar to the women of the same group without pregnancy. Women with recurrent depression and euthimic women who discontinued antidepressants medication during pregnancy are particularly at high risk for depressive illness. Data about perinatal effects of SSRI antidepressants are gradually accumulating and are controversial. Two meta-analyses and some controlled studies don't find increased risk for major malformations in SSRI-exposed newborn. However, other studies find an increased risk of congenital malformations, poor birth outcomes and neonatal complications.

Neonatal morbidity in infant newborn of women treated with antidepressant drugs.

We examine the relation between the pharmacological treatment of the maternal anxiety/depression during the pregnancy and acute morbidity in infant newborns.

Study group of 66 infant newborn of pregnant women with a diagnoses of major depressive episode or defined anxiety disorders according to DSM-IV, who were in treatment with antidepressant drugs during pregnancy. Control group: 120 newborn of healthy pregnant women, who did not receive any treatment, and were contemporary of the same gestational age and sex. Criteria of exclusion: demonstrated toxic consumption (alcohol, cocaine, cannabis, opiates, drug of synthesis). Studied variables: Type of childbirth and analgesia; weight and age of gestation; pH of umbilical artery and Apgar test; presence of malformations; morbidity; feeding; withdrawal syndrome.

Infant newborn of mothers exposed to the antidepressant treatment suffered from more pathology than those of the control group (16/66 vs. 14/114; 24.2% vs.12.3%; p=0.038). Two smaller malformations in the study group were observed, a preauricular appendix (group A) and one moderate pielocilicilar ectasy (group C), both in mothers who received paroxetine (2/60; 3.3% vs. 0/114; 0%, p=0.05, Fisher p=0.118, NS). Only one infant newborn displayed compatible clinical signs with moderate withdrawal syndrome (irritability, vomits) from a mother treated with venlafaxine. No case of convulsions was observed. Breast feeding was less frequent in the group of antidepressant treated mothers (38/66, 57.6% vs. 86/116, 74,1%, p=0.032).

The treatment with antidepressant drugs during pregnancy is necessary for some women. The clinician must weigh the relative risks of various treatment options and take into account individual patient wishes. Although the antidepressant drugs suppose an increased risk for the newborn, it could be assumable for the benefit that represents maintain the mother in an euthimic situation.

We propose to discuss the clinical management, as well as, the accuracy of the psychiatric and obstetric controls to minimize the neonatal complications.

Pregnancy and postpartum both imply high risk for developing psychiatric disorders in women.

To study the relationship between life events (LE) and social support degree (SS) during pregnancy and depressive symptoms in early postpartum period.

A cross-sectional study of 309 consecutive Spanish women, evaluated the second day postpartum. They were all over 18 years old and have signed the informed consent. We excluded: illiteracy, cognitive impairment or severe medical illness, psychiatric disorders during pregnancy and decease of the newborn. We collected socio-demographic and obstetrical data, as well as family and personal psychiatric history, the Edinburgh Postnatal Depression Scale (EPDS), LE (Saint Paul Ramsey) and SS (DUKE-UNK).

Mean age (SD) was 31.6 (4.7). Most of women were married, had intermediated or high level of education. Sixty-one percent were primiparous. Twenty-six percent had family history and 22% had personal psychiatric history. Mean (SD) of LE was 0.95 (0.89) and of SS was 53.1 (7.6). The prevalence of depressive symptoms according to EPDS scores was 18%. This subgroup of depressed women had more psychiatric family history (p=0.046), less LE (p< 0.001) and more SS during pregnancy (p=0.048). Logistic regression analysis showed that SS was the only significant variable (OR=1.085; 95%CI=0.997-0.994; p=0.001). LE did not achieve statistical significance (OR=1.085; 95%CI=0.997-1.180; p=0.059).

Low social support degree during pregnancy is associated with depressive symptoms during immediate postpartum.

This study has been done in part with grants Instituto Carlos III: G03/184, FIS: PI04178; 05/2565.

Although it is well know that the substance use during pregnancy has a negative impact on mother and child health, there are few data on pregnancy - related substance use as a risk factor for postpartum depression and child outcomes.

Aims: To determine maternal and child outcomes at 8 and 32 weeks postpartum of women who reported substance use during pregnancy.

This is a cohort study of 1804 Caucasian women in postpartum. Exclusion criteria: psychiatric disorders during pregnancy. Women were evaluated at 2-3 days, 8 and 32 weeks postpartum. Socio-demographic, obstetric, personal and family psychiatric history and substance use during pregnancy; the Edimburgh Postpartum Depression Scale (EPDS) were assessed. All women with EPDS>9 at 8 and 32 weeks were evaluated by a structured interview (DIGS) for DSM-III major depression.

The mean (SD) age was 31.7 (4.6). Forty-six percent of them were primiparous. Thirty-one percent has a family and 16% a psychiatry history. Fifty percent of women reported substance use during pregnancy: 42% caffeine, 21.6% nicotine, 8% alcohol and 0.6% cannabis. Incidence of major postpartum depression was: 12.7%. Incidence of: Apgar scores < 7 at 5 min after birth:0.4%, gestational age at delivery < 37 weeks:7.3%, birth weigt < 2.5 Kg:7.3%, and congenital malformations:1.4%.

In the presentation, the maternal and child perinatal outcomes of women exposed to licit and ilicit drugs will be summarize and will include a discussion of the future clinical and research implications. This work has been done in part with Grants: GO3/184;FIS:PI04178;PI041635,PI041783,PI041779,PI041758,PI041761,PI041791,PI041766,PI041782,RD06/0001/1009; CIBER-SAM.

The prevalence of mood disorders (anxiety and depression) during pregnancy seems to be similar to the women of the same group without pregnancy. Women with recurrent depression and euthimic women who discontinued antidepressants medication during pregnancy are particularly at high risk for depressive illness. Data about perinatal effects of SSRI antidepressants are gradually accumulating and are controversial. Two meta-analyses and some controlled studies don't find increased risk for major malformations in SSRI-exposed newborn. However, other studies find an increased risk of congenital malformations, poor birth outcomes and neonatal complications.

Neonatal morbidity in infant newborn of women treated with antidepressant drugs. We examine the relation between the pharmacological treatment of the maternal anxiety/depression during the pregnancy and acute morbidity in infant newborns.

Study group of 66 infant newborn of pregnant women with a diagnoses of major depressive episode or defined anxiety disorders according to DSM-IV, who were in treatment with antidepressant drugs during pregnancy. Control group: 120 newborn of healthy pregnant women, who did not receive any treatment, and were contemporary of the same gestational age and sex. Criteria of exclusion: demonstrated toxic consumption (alcohol, cocaine, cannabis, opiates, drug of synthesis). Studied variables: Type of childbirth and analgesia; Weight and age of gestation; pH of umbilical artery and Apgar test; Presence of malformations; Morbidity; Feeding; Withdrawal syndrome.

Infant newborn of mothers exposed to the antidepressant treatment suffered from more pathology than those of the control group (16/66 vs. 14/114; 24.2% vs.12.3%; p=0.038). Two smaller malformations in the study group were observed, a preauricular appendix (group A) and one moderate pielocilicilar ectasy (group C), both in mothers who received paroxetine (2/60; 3.3% vs. 0/114; 0%, p=0.05, Fisher p=0.118, NS). Only one infant newborn displayed compatible clinical signs with moderate withdrawal syndrome (irritability, vomits) from a mother treated with venlafaxine. No case of convulsions was observed. Breast feeding was less frequent in the group of antidepressant treated mothers (38/66, 57.6% vs. 86/116, 74,1%, p=0.032).

The treatment with antidepressant drugs during pregnancy is necessary for some women. The clinician must weigh the relative risks of various treatment options and take into account individual patient wishes. Although the antidepressant drugs suppose an increased risk for the newborn, it could be assumable for the benefit that represents maintain the mother in an euthimic situation. We propose to discuss the clinical management, as well as, the accuracy of the psychiatric and obstetric controls to minimize the neonatal complications.

Although perfectionism has generally been associated with depressive illness in general, there are no studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism and major postpartum depression.

In this case-control study, we compared the differences in perfectionism dimensions between 122 women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women. The Frost Multidimensional Perfectionism Scale (FMPS) was used to assess perfectionism. Other variables were also considered: Socio-demographic and obstetric data, psychiatric history, other personality traits, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms).

Multivariate models confirmed perfectionism as an independent factor associated with major postpartum depression. The FMPS dimension concern over mistakes was associated with a 4-fold increase in risk for major postpartum depression (OR = 4.14; 95%CI: 1.24–13.81). Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors.

Perfectionism, and particularly the concern over mistakes perfectionism dimension, is associated with major postpartum depression. These results highlight the importance of assessing personality traits together with other risk factors to identify women at risk of depression after childbirth.

Lithium has been used in the treatment of pregnant women with bipolar disorder for many decades but information on the effects of its exposure on perinatal variables is scarce.

To determine the effects of in-utero exposure to lithium on neonatal outcomes among infants born to women with treatment with lithium during pregnancy.

Prospective and observational study including all consecutive cases of pregnant women with bipolar disorder type I or II (N = 22) and maintenance treatment with lithium monotherapy (n=13) or polytherapy (n=9), attended at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA between 2005 and 2012. We evaluated sociodemographic data, lithium plasma concentrations in maternal blood and umbilical cord, obstetric and neonatal variables.

No statistically significant differences were found regarding sociodemographic data between both groups. Rates for umbilical cord:maternal plasma lithium levels were higher in women treated with polytherapy than in women who received lithium alone (1.08 vs. 1.05). Neonates exposed to polytherapy had a higher weight percentile at birth (p70 vs p50) and greater gestational age (39.72 vs. 38.28 weeks), than those exposed to lithium alone. Acute neonatal complications were more frequently observed in infants that were exposed to lithium monotherapy (33.3% vs. 38.50), being all complications transitory and not severe.

The infants exposed to lithium polytherapy presented a higher weight at birth compared to those who received lithium monotherapy. However, no statistically significant differences were found between treatment groups. Further research is needed to better clarify safety of lithium and its effect on neonatal outcomes.

Substance use in pregnancy is an increasingly common problem and has become an important public health issue. Postpartum depression has a high prevalence (10%) of women in Spanish population.

To study the impact of perinatal tobacco use in postpartum depression.

A cohort study of 1804 puerperal Spanish Caucasian women of general population. Variables collected: socio-demographic, obstetric, personal and family psychiatric history, substance use during pregnancy and 6 months postpartum, depressive symptoms (EPDS) and anxiety traits (STAI) at 2–3 days, 8 weeks and 32 weeks postpartum. Major postpartum depression (MPD) (EPDS>9) were confirmed through a structured interview (DIGS-DSM-IV). The sample was divided in four groups:

1. 1) No smoking,

2. 2) Smoking postpartum,

3. 3) Smoking pregnancy,

4. 4) Smoking pregnancy & postpartum.

The mean (SD) age was 31.8 (4.6), 46% were primiparous, 96.5% were married and 68% had at least secondary school. Thirty-one per cent had family and 17% personal psychiatric history. Twenty one percent reported tobacco use during pregnancy and 28.2% use tobacco in postpartum. Tobacco use in the four groups and MPD at 8 weeks (x2 = 17.872;df = 3;p < 0.001) and at 32 weeks postpartum (x2 = 15.582;df = 3;p = 0.001) were different. Only smoking postpartum group had a risk four times higher of having MPD at 8 weeks postpartum (OR=4.3; 95%CI = 1.91–9.66). Others independent variables: personal psychiatry history (OR = 2.53; 95%CI = 1.55–4.22), family psychiatry history (OR = 1.87; 95%CI = 1.15–3.06) and anxiety traits (OR = 1.12, 95%CI = 1.08–1.16). The results at 32 weeks showed the same risk factors.

The use of tobacco in postpartum had a considerable impact on mother's psychiatric health.

To our knowledge, only one study has assessed the risk of relapse of affective disorders after discontinuation of antidepressants in pregnancy (Cohen et al, 2006). The factors associated with antidepressant discontinuation are unknown.

To describe the factors associated to discontinuation of Selective Serotonin Reuptake Inhibitors (SSRI) in pregnant women and the rates of reintroduction of SSRIs throughout pregnancy.

A transversal study was conducted at the Perinatal Psychiatry Program. Total sample was composed by 201 pregnant women with depressive or anxiety disorder (DSM-IV criteria) who received SSRI at the time conception. Clinical and socio-demographic variables were collected at the first visit. Descriptive analysis was performed; categorical variables were compared by using Chi-square statistics or Fisher's exact test and continuous measures were compared by t tests.

Among the 134 women in the sample, 71 (53%) discontinued treatment with SSRI when they know they are pregnant. Socio-demographic and clinical characteristics did not differ significantly between women who maintain and women who discontinued treatment. Only unplanned pregnancy was associated with major risk of discontinuation treatment (OR 2.86, IC95 1.4–5.7). Also, women who discontinued medication had higher scores on EPDS and STAI (p < .05).

Nearly 58% (n = 41) of women who discontinued SSRI reintroduced antidepressant therapy during pregnancy, most of them between first and second trimester.

Unplanned pregnancy was a risk factor for abrupt discontinuation of SSRIs in pregnant women with depressive or anxiety disorder. More than half of pregnant women who discontinued SSRIs reintroduced antidepressant therapy during pregnancy.

Insulin-dependent diabetes, obesity and gestational diabetes are factors associated with macrosomia. Some psychiatric medications have well established side effects of weight changes in exposed pregnants. However, very few studies have investigated about the effects of lithium in fetal and neonatal anthropometry.

To investigate the effects of maternal use of lithium during pregnancy on fetal and neonatal growth.

A case-control study was conducted at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA. Case group consisted of 18 pregnant women on maintenance treatment with lithium monotherapy (n=13) or polytherapy (n=5) during pregnancy; control group involves 49 healthy women selected from an initial sample of 309. We evaluated sociodemographic data, lithium plasma concentrations in maternal blood and umbilical cord, fetal and neonatal anthropometry.

Women did not diabetes or obesity criteria pre-pregnancy and during pregnancy. Mean maternal age (SD) in lithium exposed cases was 33.5 (3.8) and 32.5 (4.1) in non-exposed pregnant. No statistically significant differences were found regarding sociodemographic variables and pre-pregnancy BMI. Caesarean section was required in 91.8% of lithium exposed mothers, whereas 8.2% of non-exposed women did not need it (p= 0.000). Fetuses exposed to lithium had greater abdominal circumference (p= 0.018) and femur length (p= 0.010) compared to non-exposed group. There were no differences in umbilical cord/maternal plasma lithium ratio between women treated with lithium monotherapy or polytherapy (1.11vs.1.03).

The fetuses exposed to lithium had a greater abdominal circumference, greater femur length and more caesarean section in comparison to non-exposed group. Fetal growth surveillance is recommended in pregnant treated with lithium.