ELECTROCONVULSIVE-THERAPY DURING HIGH-RISK PREGNANCY

Pregnancy increases the risk of injury associated with mental illness. The varieties of malnutrition, substance abuse, and aggression that m ay accompany mental illness can injure the unborn child in more severe ways than the patient herself. Dangers associated with illness-relate d behavior can outweight the risks of pharmacotherapy, but no psychotr opic drug is approved for use during pregnancy. Failure to produce a p rompt or lasting remission of psychiatric symptoms also is a significa nt possibility with medication. The morbidity from continued illness a nd the incompletely described adverse effects of psychotropic drugs in creases the attractiveness of ECT for severely depressed pregnant pati ents, especially with associated high-risk conditions. This paper disc usses physiologic changes occurring during pregnancy and ECT and revie ws contemporary monitors of maternal and fetal well-being. Guidelines are suggested for ECT during regular and high-risk pregnancies. The au thors conclude that using additional precautions with high-risk pregna nt patients permits ECT to be given with relative safety; medical and obstetric risk factors need not prevent its use.