An Overview of Reviews on the Safety of Electroconvulsive Therapy Administered During Pregnancy

Abstract

Objective: To inform obstetricians and psychiatrists about the safety of electroconvulsive therapy (ECT) administration during pregnancy and to reconcile conflicting recommendations concerning this treatment. Methods: A systematically conducted overview was undertaken on the safety of ECT during pregnancy. The Cochrane Library, MEDLINE/ PubMed, PsycINFO, and Ovid were independently searched by 2 of the authors from January 2015 to March 2017 using the following search terms: electroconvulsive therapy, ECT, and electroshock combined with pregnancy and reviews. Articles were reviewed and critically appraised using components of the PRISMA and AMSTAR systematic review assessment tools. Results: Of the 9 articles that were identified, 5 publications of varying methodological quality met inclusion criteria and involved a range of 32 to 339 patients. The most common problems that occurred in association with ECT were fetal arrhythmia, fetal bradycardia, premature birth, developmental delay, abdominal pain, uterine contraction, vaginal bleeding, placental abruption, and threatened abortion. The number of fetal deaths in each of the reviews ranged from 2 to 12. The authors of 1 of the 5 reviews recommended that ECT only be used as a last resort, whereas the authors of the other reviews took the stance that the administration of ECT during pregnancy was relatively safe. Differences in recommendations among reviews were in part due to inclusion criteria and how adverse events were attributed to ECT. Conclusions: Our overview supports the conclusion, which has also been endorsed by the American College of Obstetricians and Gynecologists and the American Psychiatric Association, that administration of ECT during pregnancy is relatively safe. Conclusions about safety, however, will become better established with the availability of more data.

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

“…There have been five systematic reviews of the safety of ECT in pregnancy since 2015 (Calaway et al, 2016; Coshal et al, 2019; Leiknes et al, 2015; Sinha et al, 2017; Spodniakova et al, 2015), with Calaway et al, focusing on the safety of ECT in the first trimester. These overlapping reviews examined several hundred case reports and concluded that ECT in pregnancy was relatively safe.…”

When to consider electroconvulsive therapy (ECT)

“…Other clinical indications for ECT as a first-line treatment for an episode of MDD include treatment resistance or repeated medication intolerance in a prior episode, a prior favorable response to ECT, and patient preference (58). (54,55,58,(61)(62)(63). In stark contrast with these guidelines, the National Institute for Health and Care Excellence (NICE) states that ECT should only be used 'to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with severe depressive illness, catatonia, or a prolonged or severe manic episode' (56).…”

<p>Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives</p>

“…Guidelines around this have been published. 131,134 ECT has been shown to be relatively safe in pregnancy, [135][136][137] in the elderly, 138 and in children and adolescents, 92,139 though some have challenged that safety data on ECT in children with autism were not systematically collected. 116 It has been demonstrated definitively that ECT does not cause structural brain damage, 140 even in patients who have received hundreds of lifetime treatments.…”