What is the role of electroconvulsive therapy (ECT) in the treatment of pregnant women?

Updated: Sep 24, 2019
  • Author: Mehul V Mankad, MD; Chief Editor: Dennis M Popeo, MD  more...
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ECT is considered safe and effective for the mother and fetus in the treatment of major depressive disorder during pregnancy. [22, 63] ECT is a potential treatment for patients with bipolar disorder who are experiencing mixed episodes [27] , severe mania, or severe depression during pregnancy. [28]

ECT can be considered as an option to decrease extended exposure to psychotropic medication during pregnancy [85] or for those pregnant women whose symptoms fail to respond to standard therapy. [86] Obstetric consultation should be obtained and fetal monitoring should be used, when appropriate.

Patients in late pregnancy should lie on their left side during ECT to ensure adequate blood flow to the fetus. Hyperventilation is to be avoided. [87]

Transmission of anesthesia medications across the maternal-fetal barrier is considered to be minimal. [18] ECT is considered relatively safe in terms of teratogenicity and neonatal toxicity. [1] Because of an increased risk of gastric reflux and possible aspiration, pregnant women may be premedicated with a nonparticulate antacid, such as sodium citrate. [1]

Generally, breastfeeding does not need to be interrupted during ECT. Anesthetic agents pose little risk to the nursing infant. Exposure of nursing infants to medications may be decreased if the mother delays feeding for several hours after an ECT treatment. Alternatively, breast milk may be collected and stored before an ECT treatment and given via bottle after an ECT treatment. [1]

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