The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Department of Psychiatry & Behavioral Sciences, Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Hum Psychopharmacol. 2021 Jul;36(4):e2784. doi: 10.1002/hup.2784. Epub 2021 Mar 25.
The purpose of this study was to evaluate the degree to which reproductive health issues are discussed with women of child-bearing age on an inpatient psychiatric unit. We hypothesized that preconception care is limited, and that contraceptive status of patients is rarely elicited. For this sub-analysis, we focused on counseling related to potential impacts of psychotropic medications on pregnancy, and on contraceptive status, especially when prescribed teratogenic medications.
A retrospective search was conducted for women between the ages of 18 to 49 years at the time of admission, over a 6-month period. One hundred and forty-eight unique encounters were identified, and electronic charts were reviewed for information regarding: discharge medications, medication counseling, contraceptive use, pregnancy and relationship status, pregnancy history, nature of obstetrics and gynecology consults, substance use, and diagnoses.
Almost a fifth (n = 29) of encounters included discharge on at least one potentially teratogenic medication and more than 50% had recent substance use. However, less than 10% of all encounters had documentation of contraceptive status and only one case had documented discussion of reproductive effects of medication; this despite the fact that roughly one third (33.8%) had at least one documented prior pregnancy and two patients were pregnant at the time of admission.
Few women of reproductive age admitted to the inpatient psychiatric unit had chart-documented counseling on reproductive health, including known side effects of teratogenic medications. This indicates an urgent need for inclusion of reproductive health, including counseling on the risks and benefits of taking psychotropics during the peripartum period, into inpatient mental health care.
本研究旨在评估在住院精神科病房中与育龄妇女讨论生殖健康问题的程度。我们假设孕前保健有限，且患者的避孕状况很少被引出。为此子分析，我们重点关注与精神药物对妊娠的潜在影响以及避孕状况相关的咨询，尤其是在开致畸药物时。
在 6 个月的时间内，对年龄在 18 至 49 岁之间的女性进行了回顾性搜索。确定了 148 个独特的就诊，对电子病历进行了审查，以获取有关信息：出院药物、药物咨询、避孕措施、怀孕和关系状况、怀孕史、妇产科咨询的性质、物质使用和诊断。
近五分之一（n=29）的就诊包括至少一种潜在致畸药物的出院，超过 50%的人最近有物质使用。然而，不到 10%的就诊有避孕状况的记录，只有一个病例记录了药物对生殖的影响；尽管大约三分之一（33.8%）有至少一次记录的既往怀孕，并且两名患者在入院时怀孕。
很少有生育年龄的女性在住院精神科病房中有关于生殖健康的记录咨询，包括致畸药物的已知副作用。这表明迫切需要将生殖健康纳入住院精神卫生保健，包括在围产期服用精神药物的风险和益处的咨询。
