Electroconvulsive Therapy in Pregnancy: Safety, Best Practices, and Barriers to Care

Importance Approximately 10% to 16% of women meet diagnostic criteria for depression during pregnancy. Untreated maternal depression is associated with adverse pregnancy outcomes including premature birth, low birth weight, and fetal growth restriction. Objective The aim of this study is to review the current safety data on electroconvulsive therapy (ECT) in pregnancy and provide guidance to clinicians on the role of ECT in pregnancy and the special considerations for its use in our population. Evidence Acquisition We reviewed 4 meta-analyses on the use of ECT in pregnancy as well as the source material (case series, etc) for these meta-analyses. We reviewed the official position statements on ECT in pregnancy from obstetric and psychiatric governing bodies as well as clinical best practice information from practitioners of ECT in pregnancy. Results Electroconvulsive therapy may be underutilized due to stigma and lack of access for these women. Rates of ECT use in pregnancy are difficult to determine. There are physiologic differences in pregnancy that merit additional attention during ECT, including increased risk of aspiration, concern for aortocaval compression, and the possibility of fetal heart rate changes associated with prolonged seizure activity. Serious adverse outcomes associated with ECT use in pregnancy are rare. Conclusions and Relevance Electroconvulsive therapy is a highly effective and safe treatment modality for unipolar depression, bipolar disorder, schizophrenia, and other psychiatric illnesses. Electroconvulsive therapy treatment in pregnancy requires a multidisciplinary team approach with obstetrics, maternal-fetal medicine, psychiatry, and anesthesiology, but is overall felt to be safe and effective. Target Audience Obstetricians and gynecologist, family medicine physicians. Learning Objectives After completing this activity, the learner should be better able to assess the current evidence and best practices regarding ECT use in pregnant patients; describe risks, benefits, and contraindications to ECT use in pregnant patients; and explain the potential for practice gaps in the utilization of ECT in pregnancy.