Authors: Rachel Dhillon MD, Jessica Kriksciun MD, Ashley Clark MD, Alison Reminick MD, Michelle Singh DO
Background: Breastfeeding rates have increased worldwide following advocacy efforts that emphasize the benefits for mother, baby, and society. In the United States there are approximately 500,000 pregnancies in women who have or develop psychiatric illnesses (1). Many of these illnesses benefit from psychotropic medications, and oftentimes these medications are safe to continue during pregnancy and while breastfeeding. Misinformation about the safety profile of psychotropics during lactation can lead to premature discontinuation of medications and worsening of psychiatric symptoms. This can have detrimental consequences for the mother-child dyad and the broader family, as well as societal implications. The aim of this project was to assess the views among psychiatry residents towards psychotropics and lactation before and after a short education intervention.
Methods: We designed a 30 minute lecture for our educational intervention. The topics covered included the benefits of breastfeeding, a summary of key psychotropic medications and their risk/benefit profiles during lactation, key resources to find accurate and comprehensive medication safety data during lactation, and University of California San Diego (UCSD) hospital policies regarding lactation on the inpatient psychiatric unit. The presentation was given two consecutive years to psychiatry interns during protected didactic time; once in February 2023 to seven students and again in March 2024 to six students. Interns were asked to complete a 6 question survey before and after the presentation regarding their views on lactation and psychotropics. Responses were measured using a 5-point Likert Scale and pre and post intervention data was analyzed using paired sample t-tests.
Results: All 13 students completed the pre and post educational intervention questionnaire. There were statistically significant differences (p < 0.01) between pre and post survey ratings for 5 out of the 6 questions. The responses to these questions indicate significant improvement in interns’ comfort and knowledge about the benefits of breastfeeding and considerations for psychotropic medications in this population. There was no statistically significant difference (p = 0.05) in a question about the value of understanding breastfeeding for psychiatric practice.
Conclusions: Our findings suggest that a short educational intervention on psychotropics and lactation can have a profound positive impact on the comfort psychiatry trainees feel addressing and managing such complex considerations.
[1] Crawford-Faucher, A. M. Y. (2010). Safety of Psychotropic Medications in Breastfeeding. American Family Physician, 81(11), 1369-1370.
