Electroconvulsive therapy during pregnancy

The stigma and anxiety associated with electroconvulsive therapy (ECT) can be amplified during pregnancy; this can be a barrier to ECT for clinicians and patients. However, ECT is an important component of therapy for several psychiatric disorders. Failing to use ECT when indicated can increase the risk of harm to the patient and fetus, due to suicidality, impulsivity and self-neglect.

Although inadequate treatment of psychiatric disorders is associated with adverse outcomes for the patient and fetus, ECT can also cause adverse effects. In addition to its usual adverse effects, ECT during pregnancy can cause mild vaginal bleeding, abdominal pain, transient benign fetal arrhythmias, uterine contractions (mostly transient) and preterm delivery. Some case reports and series describe relatively high rates of fetal adverse events (up to 29%); however, safety data are limited and there are insufficient high-quality data to determine a causal link with ECT.

ECT is an option if a pregnant patient usually takes a teratogenic psychotropic (eg sodium valproate) and alternative treatments cannot be used.

To prepare a pregnant patient for ECT, follow the same process as for nonpregnant patients, but also consult with the patient’s obstetrician—ECT should be used with caution if the patient has a condition that could lead to placental compromise (eg hypertension, diabetes). The anaesthetic care for pregnant patients undergoing ECT should be undertaken by an anaesthetist with expertise in ECT in pregnancy. Fetal cardiotocographic monitoring is required before, during and after ECT.