A case of pregnancy with severe polyhydramnios related to long-term use of lithium.

OBJECTIVES: Severe polyhydramnios during pregnancy may be associated with long-term lithium use and presents considerable challenges. This complication, which has been linked to induced nephrogenic diabetes insipidus (NDI), underscores the necessity for cautious management of pregnant women with bipolar disorder. This case report aims to elucidate the relationship between long-term lithium use, pregnancy, and the development of severe polyhydramnios, emphasizing the importance of diagnosing NDI in order to prevent obstetric and neonatal complications. METHODS: We present the case of a 42-year-old primigravida undergoing long-term lithium treatment for bipolar disorder type I, who developed severe polyhydramnios at 34 weeks of gestation. Clinical data including obstetric monitoring and neonatal outcomes were analyzed. RESULTS: This case emphasizes the need for heightened awareness and proactive measures to mitigate the risk associated with lithium treatment during pregnancy. Close monitoring and timely interventions are essential to ensure optimal outcomes for both mother and fetus. CONCLUSIONS: Our article puts forth the hypothesis that there is a link between lithium use during pregnancy and the occurrence of polyhydramnios and Nephrogenic Diabetes Insipidus (NDI), which may lead to severe obstetric and neonatal complications. This case report contributes to the limited literature on the subject and gives doctors practical advice that may help them make a better risk-benefit analysis. Further research is warranted in order to refine risk assessment protocols and management strategies in this complex clinical scenario.

Treating postpartum affective and/or anxiety disorders in a mother-baby day hospital: preliminary results.

INTRODUCTION: Women experiencing perinatal mental-health illness have unique needs. The present study analyzes preliminary data about the effectiveness of MBDH in treating postpartum women with affective and anxiety disorders. METHODS: We analysed 33 mothers with affective and/or anxiety disorders treated at the MBDH with their babies between March 2018 and December 2019. All women were assessed at admission, discharge and three months after discharge. Outcomes included symptoms of depression (EPDS) and anxiety (STAI-S), mother-infant bonding (PBQ) and functional impairment (HoNOs). We also assessed the clinical significance of changes in patients' scores on these scales and patient satisfaction. RESULTS: At discharge, no patients still met the full criteria for the main diagnosis. Between admission and discharge, symptoms of depression and anxiety, mother-infant bonding, functional impairment and autonomy in caring for babies improved significantly. These gains were maintained at three months follow-up. Patient satisfaction was high. CONCLUSIONS: These preliminary results suggest that multidisciplinary intervention for postpartum women with affective or anxiety disorders at the MBDH improves maternal psychopathology, mother-infant bonding and mothers' ability to care for their babies. MBDHs are a promising approach for delivering specialised perinatal mental-health care for mother-baby dyads.

Mother-baby day hospital (MBDH) could be an adequate device for women with perinatal mental disordersMultidisciplinary intervention is effective for treating postpartum anxiety and depressive disorders.Interventions at MBHD improve mother-infant bonding and mothers' ability to care for their babies.Further research is needed to assess the effectiveness at long term not only on maternal health also on child neurodevelopment.

Obstetric outcomes regarding the use of lithium in pregnant women with bipolar disorders: a prospective cohort study.

Lithium is the mood stabilizer of choice for the prevention of bipolar relapse over the perinatal period. A critical issue is its safety of the mother and the developing fetus. This study aims to compare obstetric outcomes in women with bipolar disorders (BD) regarding treatment with lithium during pregnancy. We enrolled a cohort of pregnant women with BD that received care at the Perinatal Mental Health Unit of a tertiary hospital between January 2005 and March 2017. The exposed group received lithium during pregnancy, whereas the unexposed group did not. The main outcomes were obstetric complications during pregnancy, during labor and delivery, neonatal complications, and congenital malformations. Demographic and clinical data were described using measures of frequency, central tendency, and dispersion. Between-group differences were calculated with chi-square, Fisher's test, t-tests, or Mann-Whitney U test. Our cohort included 100 pregnant women with BD: 53 (53%) used lithium during pregnancy, and 47 (47%) did not. There were no significant differences in obstetric complications, neonatal complications, or congenital anomalies. Nonetheless, newborns of lithium-treated women had lower Apgar scores at 1 min (mean 8.2 ± 1.6 vs. 8.9 ± 0.6, p = 0.026) and 5 min (9.6 ± 0.8 vs. 9.9 ± 0.5, p = 0.015). Our findings do not identify worse obstetric outcomes in women with BD that take lithium during pregnancy, except for an impact on newborn Apgar scores. Lithium might be an adequate treatment for pregnant women with BD, especially for those with a high recurrence risk, and always after an individualized risk-benefit assessment.

The CYP17†MspA1 Polymorphism and the Gender Dysphoria.

INTRODUCTION: The A2 allele of the CYP17 MspA1 polymorphism has been linked to higher levels of serum testosterone, progesterone, and estradiol. AIM: To determine whether the CYP17 MspA1 polymorphism is associated with transsexualism. METHODS: We analyzed 151 male-to-female (MtF), 142 female-to-male (FtM), 167 control male, and 168 control female individuals. Fragments that included the mutation were amplified by PCR and digested with MspA1. Our data were compared with the allele/genotype frequencies provided by the 1000 Genomes Data Base, and contrasted with a MEDLINE search of the CYP17 MspA1 polymorphism in the literature. MAIN OUTCOME MEASURES: We investigated the association between transsexualism and the CYP17 MspA1 polymorphism. RESULTS: A2 frequency was higher in the FtM (0.45) than the female control (0.38) and male control (0.39) groups, or the MtF group (0.36). This FtM > MtF pattern reached statistical significance (P = 0.041), although allele frequencies were not gender specific in the general population (P = 0.887). This observation concurred with the 1000 Genomes Data Base and the MEDLINE search. CONCLUSION: Our data confirm a sex-dependent allele distribution of the CYP17 MspA1 polymorphism in the transsexual population, FtM > MtF, suggestive of a hypothetical A2 involvement in transsexualism since the allele frequencies in the general population seem to be clearly related to geographic origin and ethnic background, but not sex.

The (CA)n polymorphism of ERß gene is associated with FtM transsexualism.

INTRODUCTION: Transsexualism is a gender identity disorder with a multifactorial etiology. Neurodevelopmental processes and genetic factors seem to be implicated. AIM: The aim of this study was to investigate the possible influence of the sex hormone-related genes ERß (estrogen receptor ß), AR (androgen receptor), and CYP19A1 (aromatase) in the etiology of female-to-male (FtM) transsexualism. METHODS: In 273 FtMs and 371 control females, we carried out a molecular analysis of three variable regions: the CA repeats in intron 5 of ERß; the CAG repeats in exon 1 of AR, and the TTTA repeats in intron 4 of CYP19A1. MAIN OUTCOME MEASURES: We investigated the possible influence of genotype on transsexualism by performing a molecular analysis of the variable regions of genes ERß, AR, and CYP19A1 in 644 individuals (FtMs and control females). RESULTS: FtMs differed significantly from control group with respect to the median repeat length polymorphism ERß (P = 0.002) but not with respect to the length of the other two studied polymorphisms. The repeat numbers in ERß were significantly higher in FtMs than in control group, and the likelihood of developing transsexualism was higher (odds ratio: 2.001 [1.15-3.46]) in the subjects with the genotype homozygous for long alleles. CONCLUSIONS: There is an association between the ERß gene and FtM transsexualism. Our data support the finding that ERß function is directly proportional to the size of the analyzed polymorphism, so a greater number of repeats implies greater transcription activation, possibly by increasing the function of the complex hormone ERß receptor and thereby encouraging less feminization or a defeminization of the female brain and behavior.

Association study of ERß, AR, and CYP19A1 genes and MtF transsexualism.

INTRODUCTION: The etiology of male-to-female (MtF) transsexualism is unknown. Both genetic and neurological factors may play an important role. AIM: To investigate the possible influence of the genetic factor on the etiology of MtF transsexualism. METHODS: We carried out a cytogenetic and molecular analysis in 442 MtFs and 473 healthy, age- and geographical origin-matched XY control males. The karyotype was investigated by G-banding and by high-density array in the transsexual group. The molecular analysis involved three tandem variable regions of genes estrogen receptor ß (ERß) (CA tandem repeats in intron 5), androgen receptor (AR) (CAG tandem repeats in exon 1), and CYP19A1 (TTTA tandem repeats in intron 4). The allele and genotype frequencies, after division into short and long alleles, were obtained. MAIN OUTCOME MEASURES: We investigated the association between genotype and transsexualism by performing a molecular analysis of three variable regions of genes ERß, AR, and CYP19A1 in 915 individuals (442 MtFs and 473 control males). RESULTS: Most MtFs showed an unremarkable 46,XY karyotype (97.96%). No specific chromosome aberration was associated with MtF transsexualism, and prevalence of aneuploidy (2.04%) was slightly higher than in the general population. Molecular analyses showed no significant difference in allelic or genotypic distribution of the genes examined between MtFs and controls. Moreover, molecular findings presented no evidence of an association between the sex hormone-related genes (ERß, AR, and CYP19A1) and MtF transsexualism. CONCLUSIONS: The study suggests that the analysis of karyotype provides limited information in these subjects. Variable regions analyzed from ERß, AR, and CYP19A1 are not associated with MtF transsexualism. Nevertheless, this does not exclude other polymorphic regions not analyzed.

Obstetric complications in bipolar disorder: The role of mental health disorders in the risk of caesarean section.

BACKGROUND: Women with Bipolar Disorder (BD) during pregnancy present a negative impact on them and their babies' health. Caesarean Section (C-Section) is an intervention to reduce complications associated with childbirth, but it also has risks, including maternal infections, anaesthetic and psychological complications. There are few studies that analyse the C-Section rates in women with BD compared to the general population. METHODS: A case-control study was conducted in a general university hospital. 100 pregnant women with BD matched with 100 controls without psychiatric illness who were attending the same hospital at delivery. We compared obstetrical outcomes during pregnancy, Pre/During Labour, onset of labour and mode of delivery specifying the type of C-Section. RESULTS: Rate of C-Section was significantly higher in BD group compared to the control group (OR=2, 95% CI 1,4-1,6). Case group had more somatic illness (SI) without treatment (P<, 001). BD (P=,021), primiparity (P=, 003), obstetric complications during pregnancy (P<, 001), obstetric complications during labour (P<,001), and SI with and without treatment (P<,001 and P=,007, respectively) were higher in women that required C- section. CONCLUSION: Women with Bipolar Disorder have near two-fold increased risk of C-section than women without Bipolar Disorder of similar age, gestational age and parity. Somatic illness was more prevalent in BD group that required C-section and this relation probably is related to high probability of having somatic comorbidities in patients with BD.