https://orcid.org/0000-0001-6823-7635
Abstract
Objective
The use of electroconvulsive therapy in pregnancy has been limited by concerns about its effects on fetal well-being, despite limited evidence that suggests it is safe and effective. No studies have utilized continuous fetal heart rate monitoring during electroconvulsive therapy sessions. We aimed to describe the fetal heart rate patterns of patients undergoing electroconvulsive therapy.
Design
This study is a prospective case series of pregnant patients undergoing electroconvulsive therapy with continuous fetal heart rate monitoring.
Setting
University-based hospital.
Population
Pregnant patients with a psychiatric indication for electroconvulsive therapy.
Methods
Patients underwent fetal heart rate monitoring immediately prior, during and immediately after ECT therapy.
Main Outcome Measures
Characterization of the fetal heart rate tracing.
Results
Five subjects underwent 44 electroconvulsive therapy sessions. Continuous fetal monitoring was performed on 34 of the sessions. Transient fetal heart rate decelerations occurred in 4 sessions, all self-resolved and none required intervention.
Conclusion
This case series is the first to report the results of continuous FHR monitoring during electroconvulsive therapy. The most common finding was a transient, self-resolving bradycardia that was not associated with adverse perinatal outcomes. This supports the opinion that electroconvulsive therapy is a safe treatment option in pregnancy in women with severe mental disease.
Details of Ethics Approval
This study was approved by the Institutional Review Board of the University of Arkansas for Medical Sciences (UAMS) (IRB 203244), and was conducted in accordance with the Declaration of Helsinki.
Acknowledgments
The authors would like to acknowledge Donna Eastham for her assistance in proofreading and technical editing.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
Shona Ray-Griffith reports grants from NIH, during the conduct of the study and receives support from the Translational Research Institute (TRI), grants UL1TR000039 and KL2TR000063 through the NIH National Center for Research Resources and the National Center for Advancing Translational Sciences; she currently receives clinical trial support from Sage Therapeutics and Neuronetics; she reports no directing funding source for this study and declares no conflict of interest. Jessica Coker reports grants from Brain and Behavior Research Foundation, National Institute on Drug Abuse, National Center for Advancing Translational Sciences, and Arkansas Children’s Research Institute, outside the submitted work; reports no direct funding source for this study and declares no conflict of interest. Zachary Stowe reports grants from NIH and CDC, personal fees from Sage Therapeutics, and external promotion review committee for Harvard/Brigham, outside the submitted work; receives research support from, consults for and receives speakers’ honoraria for GlaxoSmithKline, Pfizer and Wyeth Corporations; reports no direct funding for this project and declares no conflict of interest for this project. The authors report no other potential conflicts of interest for this work.