Psychopharmacology and pregnancy
Galbally M, Snellen M, Lewis A Heidelberg: Springer-Verlag Berlin Heidelberg; 2014.
Book review of Psychopharmacology and pregnancy by Rebecca Hill
The editors of this book undertook to provide an overview of the current state of knowledge concerning the use of psychotropic medication in pregnancy, with a second stated aim of producing clinical guidelines for practitioners. The historical reluctance to include pregnant women in research, and the need to consider the interests of both mother and baby, makes this a Herculean task. Here, the task is well-accomplished, with noted researchers from the field presenting us with an excellent and concise summary.
The initial chapters set out the unique challenges in perinatal mental health, an understanding of which is essential when counselling a pregnant woman about the options available to her. These include the ethics of informed consent and the difficulties of interpreting a flawed evidence base. They also include explanations of how the interaction of maternal, fetal, genetic and environmental factors may mediate the effects on babies of perinatal exposure to maternal mental illness and associated medicines.
Later chapters consider in turn the major categories of perinatal mental illness, in most cases providing itemised guidelines for clinicians at their conclusion. A minor criticism is that the presentation of these guidelines varies between chapters. This tends to reduce the ease of use of the book as a ‘quick reference guide’.
More difficult topics such as borderline personality disorder, eating disorders and substance abuse have been included. There is a chapter on the impact of popularly used complementary and alternative treatments. Another deals with the use of ECT, a treatment with high efficacy from which pregnant women may find themselves unfairly excluded.
Clinicians unfamiliar with the topic will be able to find some quick, wise pointers by turning immediately to the guideline sections. Those seeking a deeper understanding of the literature will also be rewarded.