PMH-C Anxiety Disorders in Pregnancy 3 — Questions and Answers
Question 1: A pregnant woman with panic disorder asks about the risk of neonatal adaptation syndrome if she takes an SSRI. Which symptom cluster is most associated with this syndrome?
- Macrosomia, polycythemia, and hypoglycemia
- Jitteriness, poor feeding, and transient respiratory distress (Correct answer)
- Hyperbilirubinemia, thrombocytopenia, and seizures
- Cleft palate, cardiac defects, and hypospadias
Correct answer: Jitteriness, poor feeding, and transient respiratory distress
Neonatal adaptation syndrome with SSRIs presents as jitteriness, poor feeding, and transient respiratory distress, which is self-limiting and distinct from withdrawal.
Question 2: Which anxiety disorder is most likely to have its onset triggered specifically by the physiological changes of early pregnancy?
- Specific phobia
- Social anxiety disorder
- Panic disorder (Correct answer)
- Agoraphobia
Correct answer: Panic disorder
The cardiovascular and respiratory changes of early pregnancy (e.g., increased heart rate, shortness of breath) can trigger panic attacks in susceptible individuals, precipitating panic disorder.
Question 3: What is the primary mechanism by which prenatal maternal anxiety is thought to affect fetal neurodevelopment?
- Direct placental transfer of anxiolytic medications
- Glucocorticoid exposure altering fetal HPA axis programming (Correct answer)
- Reduced maternal appetite leading to nutritional deficits
- Maternal hyperventilation causing fetal hypoxia
Correct answer: Glucocorticoid exposure altering fetal HPA axis programming
Maternal cortisol crosses the placenta and is thought to program the fetal HPA axis, increasing the child's later stress reactivity.
Question 4: A woman at 20 weeks gestation has a history of childhood sexual trauma and presents with hypervigilance, avoidance of prenatal exams, and flashbacks. The most appropriate trauma-informed approach is:
- Delay all pelvic exams until the postpartum period
- Coordinate care with a trauma-informed therapist and allow patient control during exams (Correct answer)
- Prescribe a benzodiazepine before every prenatal visit
- Refer exclusively to a psychiatrist and stop OB care temporarily
Correct answer: Coordinate care with a trauma-informed therapist and allow patient control during exams
Trauma-informed care emphasizes patient safety, choice, and collaboration; allowing control during exams and coordinating with therapy is the evidence-based approach.
Question 5: Which screening tool has been validated specifically to assess anxiety symptoms in the perinatal period and complements the Edinburgh Postnatal Depression Scale?
- State-Trait Anxiety Inventory (STAI)
- Penn State Worry Questionnaire
- Perinatal Anxiety Screening Scale (PASS) (Correct answer)
- Social Phobia Inventory (SPIN)
Correct answer: Perinatal Anxiety Screening Scale (PASS)
The PASS (Perinatal Anxiety Screening Scale) was developed and validated specifically for perinatal populations to detect a range of anxiety disorders.
Question 6: A clinician is considering buspirone for a pregnant patient with GAD who cannot tolerate SSRIs. What should the clinician know about buspirone in pregnancy?
- It is FDA Pregnancy Category A with extensive safety data
- Safety data in human pregnancy is limited and animal studies show some concern (Correct answer)
- It is absolutely contraindicated due to confirmed teratogenicity
- It is the preferred second-line agent per all major perinatal guidelines
Correct answer: Safety data in human pregnancy is limited and animal studies show some concern
Buspirone has limited human pregnancy safety data; animal studies have shown adverse effects at high doses, so it is used with caution and only when benefits outweigh risks.
Question 7: When educating a pregnant patient about the risks of untreated versus treated anxiety, which statement is most accurate?
- All pharmacological treatments pose greater risk than untreated anxiety
- Untreated severe anxiety carries its own fetal and maternal risks that must be weighed against treatment risks (Correct answer)
- Psychotherapy is risk-free and always sufficient to treat perinatal anxiety
- Anxiety is benign in pregnancy and does not require treatment
Correct answer: Untreated severe anxiety carries its own fetal and maternal risks that must be weighed against treatment risks
Shared decision-making requires acknowledging that untreated severe anxiety has documented fetal and maternal risks (e.g., preterm birth, poor self-care) that must be balanced against treatment risks.
PMH-C Anxiety Disorders in Pregnancy 3
A pregnant woman with panic disorder asks about the risk of neonatal adaptation syndrome if she takes an SSRI.
Which symptom cluster is most associated with this syndrome?