Electroconvulsive therapy during pregnancy: a systematic review of case studies

Abstract

This study aims to explore practice, use, and risk of electroconvulsive therapy (ECT) in pregnancy. A systematic search was undertaken in the databases Medline, Embase, PsycINFO, SveMed and CINAHL (EBSCO). Only primary data-based studies reporting ECT undertaken during pregnancy were included. Two reviewers independently checked study titles and abstracts according to inclusion criteria and extracted detailed use, practice, and adverse effects data from full text retrieved articles. Studies and extracted data were sorted according to before and after year 1970, due to changes in ECT administration over time. A total of 67 case reports were included and studies from all continents represented. Altogether, 169 pregnant women were identified, treated during pregnancy with a mean number of 9.4 ECTs, at mean age of 29 years. Most women received ECT during the 2nd trimester and many were Para I. Main diagnostic indication in years 1970 to 2013 was Depression/Bipolar disorder (including psychotic depression). Missing data on fetus/child was 12 %. ECT parameter report was often sparse. Both bilateral and unilateral electrode placement was used and thiopental was the main anesthetic agent. Adverse events such as fetal heart rate reduction, uterine contractions, and premature labor (born between 29 and 37 gestation weeks) were reported for nearly one third (29 %). The overall child mortality rate was 7.1 %. Lethal outcomes for the fetus and/or baby had diverse associations. ECT during pregnancy is advised considered only as last resort treatment under very stringent diagnostic and clinical indications. Updated international guidelines are urgently needed.

British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017

“…A more recent systematic review examined 67 published case reports and case series including 169 women treated with 1,187 sessions of ECT (Leiknes et al, 2015).…”

Urinary concentrations of PAH and VOC metabolites in marijuana users

“…Use of marijuana can also cause many adverse health consequences, including anxiety and panic in naive users (Hall and Degenhardt, 2009), impaired respiratory function (Taylor et al, 2002), chronic bronchitis (Tetrault et al, 2007), elevated risks of increased heart rate (Jones, 2002) and myocardial infarction (Mittleman et al, 2001), and possibly lung cancer (Aldington et al, 2008; Berthiller et al, 2008). Long-term marijuana use is also associated with impaired cognitive abilities (Solowij et al, 2002), changes in brain function (Block et al, 2000), and use during pregnancy has been associated with reduced birth weight in the offspring, but not all studies (English et al, 1997; Fergusson et al, 2002; Gray et al, 2010; Brown and Graves, 2013; Huizink, 2014; Mark et al, 2015). …”

Treatment of nonpsychotic major depression during pregnancy: patient safety and challenges

“…Extensive case-series data provide much of the rationale for the effectiveness and safety of ECT during pregnancy 76,77. Although ECT has been used safely during all three trimesters of pregnancy and no consistent patterns of fetal or birth complications have been reported,76,78 the anesthetic agents and neuromuscular blockers that are commonly employed as part of modern ECT techniques undergo transplacental passage, and case literature suggests that reduced fetal heart rate, uterine contractions, and premature labor may be adverse effects of ECT given in late pregnancy 79. Randomized trials are lacking.…”