Megan Galbally

Publications (16)32.94 Total impact

• Article: Perinatal mental health services: what are they and why do we need them?

  Megan Galbally, Gaynor Blankley, Josephine Power, Martien Snellen
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  ABSTRACT: OBJECTIVE: To review the evidence for perinatal mental health as a sub-specialist area of mental health and describe the development of a service model. CONCLUSIONS: Perinatal mental health is emerging as a sub-specialist area of mental health with specific knowledge and expertise in assessment, diagnosis and treatment. It requires services to ensure that women and infants receive optimal care across pregnancy and the postpartum.
  Australasian Psychiatry 02/2013; · 0.86 Impact Factor
• Article: Breastfeeding and infant sleep patterns: an Australian population study.

  Megan Galbally, Andrew J Lewis, Kerri McEgan, Katherine Scalzo, Fm Amirul Islam
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  ABSTRACT: OBJECTIVE: Our purpose was to determine if babies breastfed at 6 months of age were more likely to wake at night and less likely to sleep alone than formula-fed babies. PATIENTS AND METHODS: Data were drawn from the first wave of The Longitudinal Study of Australian Children, an ongoing, nationally representative study of the growth and development of Australia's children. The 4507 participants met the criteria for this study. The measures examined infant sleep problems as the outcome and breastfeeding at 6 months of age as the exposure in addition to the demographic data, maternal mental health, infant birthweight and gestational age at delivery. RESULTS: After adjustment for covariates, reports by mothers of infants that breastfed at 6 months of age suggested infants were 66% more likely to wake during the night and 72% more likely to report difficulty sleeping alone. However, breastfeeding had a strongly protective effect on wheezing, coughing, snoring and breathing problems, and it was not associated with restless sleep or problems getting to sleep for the infant. CONCLUSIONS: Breastfeeding was found to be associated with increased night waking and this is consistent with other studies. There are biological reasons why this might be required to ensure breastfeeding continues to 6 months and beyond. The current low rates of sustained breastfeeding in many Western countries needs to be reconsidered in relation to parental and public health practices promoting prolonged nocturnal infant sleep patterns.
  Journal of Paediatrics and Child Health 01/2013; · 1.28 Impact Factor
• Source

  Available from: Andrew J Lewis

  Article: Perinatal mental health, antidepressants and neonatal outcomes: findings from the Longitudinal Study of Australian Children

  Andrew J Lewis, Megan Galbally, Catherine M Bailey
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  ABSTRACT: Background This study presents findings on the characteristics of women who used antidepressants in pregnancy and how such mothers compare to depressed and non-depressed mothers in terms of their demographics and health across pregnancy. We also present findings on the birth outcomes for these three groups of women.
  Neonatal, Paediatric and Child Health Nursing 11/2012; 15(3):22-28.
• Article: Further Findings Linking SSRIs During Pregnancy and Persistent Pulmonary Hypertension of the Newborn: Clinical Implications.

  Megan Galbally, Salvatore Gentile, Andrew J Lewis
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  ABSTRACT: Persistent pulmonary hypertension of the newborn (PPHN) is a rare but potentially life-threatening neonatal condition. Several authors have suggested that late pregnancy exposure to selective serotonin reuptake inhibitors (SSRIs) may increase the risk of PPHN. This association has been investigated in seven published studies that have shown mixed findings based on diverse methods. Several methodological limitations may account for the diversity of findings, which include, in some studies, a lack of control for well established risk factors for PPHN. The methodological improvement in the most recent study tentatively suggests that infants prenatally exposed to SSRIs are approximately twice as likely to suffer PPHN. Further research on the biological mechanisms involved is required. Clinicians should consider late pregnancy exposure to SSRIs as one of several possible risks for PPHN, which has implications for both prescribing SSRIs to pregnant women and for neonatal care of SSRI-exposed infants.
  CNS Drugs 10/2012; 26(10):813-22. · 4.80 Impact Factor
• Article: Anti-depressant use during pregnancy in Australia: findings from the Longitudinal Study of Australian Children.

  Andrew J Lewis, Catherine Bailey, Megan Galbally
  Australian and New Zealand Journal of Public Health 10/2012; 36(5):487-8. · 1.20 Impact Factor
• Source

  Available from: Andrew J Lewis

  Chapter: THE BIOLOGY OF FETAL EXPOSURE TO SEROTONIN REUPTAKE INHIBITORS: IMPLICATIONS FOR NEURODEVELOPMENT

  Megan Galbally, Andrew J Lewis, Salvatore Gentile, Susan Walker, Anne Buist
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  ABSTRACT: This chapter will discuss the biology of exposure to antidepressants during pregnancy as it interacts with fetal neurodevelopment. A systematic review of prevalence rates in pregnancy found 12% of women in third trimester meet criteria for depression and the Avon Longitudinal Study of Parents and Children (ALSPAC) found that more women were depressed at 32 weeks pregnant than 8 weeks postpartum. Untreated depression in pregnancy has been associated with increased pregnancy complications, poorer child development and increased risk of postnatal depression. While psychological treatments are indicated for many women with antenatal depression, pharmacological treatment may be indicated for those who either don"t respond, have moderate to severe depressive symptoms, or don"t have access to psychological treatments. Antidepressants may also be indicated for women with Anxiety Disorders. The most commonly prescribed antidepressants are the selective serotonin reuptake inhibitors (SSRIs). Rates of prescription in North America for antidepressants in pregnancy are rising yet the implications for exposure on the child"s longer term neurodevelopment are still relatively unknown. Until now, the limited number of studies has not revealed any effects on global cognitive function. Yet there have been 5 studies published recently which suggest an effect of exposure on psychomotor development and a single, unreplicated study which
  06/2012;
• Article: A review of the use of psychotropic medication in pregnancy.

  Megan Galbally, Martien Snellen, Andrew J Lewis
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  ABSTRACT: There is increasing awareness within obstetric services of the importance of treating maternal mental illness due to the association with increased maternal mortality, morbidity and poorer child outcomes. However, there is limited research on the risks and benefits of pharmacological treatment of women in pregnancy. This review is focused on studies published in the past 18 months. Antidepressants and antiepileptic mood stabilizers are the most frequently studied of the pharmacological treatments for mental illness. There are clear risks of neonatal serotonin discontinuation symptoms associated with antenatal antidepressant use. It remains unclear whether there is an elevated risk of malformations, persistent pulmonary hypertension of the newborn, prematurity, low birth weight and negative child developmental outcomes. Mood stabilizers have been associated with an increased malformation risk and some are associated with poorer neonatal and child developmental outcomes. There are available only limited studies on antipsychotics in pregnancy. Given the limited research on psychotropic medication in pregnancy, each woman, in collaboration with her clinician, needs to consider the risks in the context of her individual circumstances. However, any consideration of the risks of pharmacological treatment must be considered in relation to the risks associated with untreated mental illness.
  Current opinion in obstetrics & gynecology 09/2011; 23(6):408-14. · 2.49 Impact Factor
• Article: Review: adverse effects of antidepressants use during pregnancy.

  Andrew J Lewis, Megan Galbally
  Evidence-based mental health 05/2011; 14(2):40.
• Article: Developmental outcomes of children exposed to antidepressants in pregnancy.

  Megan Galbally, Andrew J Lewis, Anne Buist
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  ABSTRACT: To examine the developmental outcomes in children exposed to antidepressants in utero and compare those to children not exposed to these medications A prospective case-controlled study of children exposed to antidepressants in pregnancy assessed 22 exposed and 19 not exposed children using the Bayley Scales of Infant Development, third edition. The control group was measured at a mean age of 23.09 (SD 3.82) months and the medicated group at 28.53 months (SD 6.22). Maternal variables were assessed using a purpose-designed questionnaire and the Beck Depression Inventory (II) in pregnancy and at three assessments in the postpartum. Children exposed to antidepressant medication in pregnancy scored lower on motor subscales in particular on fine motor scores than non-exposed children with a moderate effect size of Cohen's d = 0.47 fine motor and Cohen's d = 0.43 for gross motor. Due to lack of power these findings did not reach conventional criteria for statistical significance. There was no association found between maternal depression and neurodevelopment. This finding of a possible effect from antidepressant exposure in pregnancy on children's motor development is similar to the findings from a previous study. Future research is needed which assesses children at an older age using specific assessments of motor development.
  Australian and New Zealand Journal of Psychiatry 02/2011; 45(5):393-9. · 2.93 Impact Factor
• Article: Mood stabilizers in pregnancy: a systematic review.

  Megan Galbally, Matthew Roberts, Anne Buist
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  ABSTRACT: To undertake a systematic review of the effects of exposure to mood stabilizer medication in pregnancy, evaluating teratogenicity and other outcomes for mother and child. This was one of three concurrent systematic reviews of psychotropic medication exposure in pregnancy. A systematic search was carried out of electronic databases, reference books and other sources for original research studies which examined the effects of commonly used mood stabilizers (sodium valproate, carbamazepine, lamotrigine and lithium carbonate) on pregnancy outcomes. These included malformations, pregnancy complications, neonatal complications and longer term developmental outcomes for children exposed. All mood stabilizers were found to be associated with a risk of malformation and perinatal complications. Studies which examined longer term neurodevelopmental outcomes found poorer outcomes for those children exposed to sodium valproate or polytherapy in pregnancy than for other individual AEDs. The data available for longer term child outcomes with lithium exposure is too limited to draw any conclusions. This review found that exposure in pregnancy to all four commonly used mood stabilizers may be teratogenic, and is associated with increased rates of pregnancy and neonatal complications. There was also more limited information that sodium valproate may be associated with poorer longer term child developmental outcomes. These findings must be balanced with the risk of relapse and poor pregnancy and child outcomes with untreated maternal bipolar disorder. The information obtained from these reviews of psychotropic medications will assist clinicians in managing women with mental illness in pregnancy.
  Australian and New Zealand Journal of Psychiatry 11/2010; 44(11):967-77. · 2.93 Impact Factor
• Article: Neonatal growth outcomes at birth and one month postpartum following in utero exposure to antidepressant medication.

  Andrew J Lewis, Megan Galbally, Gillian Opie, Anne Buist
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  ABSTRACT: There is evidence of increasing prescription of antidepressant medication in pregnant women. This has arisen from the recognition of the importance of treating maternal depression. This must be balanced, however, with information on outcomes for infants and children exposed to antidepressants in pregnancy. The aim of the present study was to examine whether neonatal outcomes including gestational age at birth, neonatal growth outcomes at birth and then at 1 month postpartum were altered by in utero exposure to antidepressant medication using a prospective and controlled design. A prospective case-control study recruited 27 pregnant women taking antidepressant medication and 27 matched controls who were not taking antidepressant medication in pregnancy at an obstetric hospital in Melbourne, Australia. Of the 27 women taking medication, 25 remained on medication in the third trimester. A purpose-designed self-report questionnaire and the Beck Depression Inventory-II were completed in pregnancy, after birth and at one month postpartum. In addition information was collected on exposed and non-exposed infants including Apgar scores, birthweight/length/head circumference and gestational age at birth. Weight/length/head circumference was again collected at 1 month of age. Infants exposed to antidepressants in utero were eightfold more likely to be born at a premature gestational age, had significantly lower birthweight and were smaller in length and head circumference than non-exposed infants. There was no association between birth outcomes and maternal depression. At 1 month, the difference in weight in the exposed group became significantly greater than the control group. Antidepressant exposure in utero may affect gestational age at birth and neonatal outcomes independently of antenatal maternal depression. Further studies are needed to examine whether these findings vary according to the type of antidepressant prescribed and follow up growth and development in exposed infants beyond 1 month.
  Australian and New Zealand Journal of Psychiatry 05/2010; 44(5):482-7. · 2.93 Impact Factor
• Article: Prenatal exposure to antidepressant medications and neurodevelopmental outcomes: a systematic review.

  Salvatore Gentile, Megan Galbally
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  ABSTRACT: In weighing the risk and benefits of pharmacological treatment of depression during pregnancy it is important to consider risks of long-term as well as short-term implications for children from exposure. Hence, this article examines the evidence to date of studies which have examined longer-term neurodevelopment teratogenic effects on child outcomes (including cognitive, motor and behavioral outcome measures) following in utero exposure to antidepressants. A systematic review of published literature between January, 1973 and February, 2010 was conducted using the following key-words: pregnancy, child/infant development/neurodevelopment, antidepressants. All studies (N = 12) that reported primary data on neurodevelopmental outcome of infants exposed prenatally to antidepressants were assessed and analyzed. The identified studies varied considerably in their own methodology, including the age of the children studied, the scales and assessments used, and the different aspects of neurodevelopment (such as cognitive, motor and behavioral outcomes) that were examined. Despite these limitations, the majority of studies found no difference between those exposed and controls on the various neurodevelopmental outcome measures, whereas only two studies identified statistically significant differences in motor function. These preliminary reassuring results must be confirmed by larger studies with longer period of follow-up and providing more robust measures of neurodevelopmental outcome, in order to definitively exclude any potential risk of neurodevelopmental teratogenicity associated with antidepressant exposure in utero.
  Journal of affective disorders 03/2010; 128(1-2):1-9. · 3.76 Impact Factor
• Article: Management of antipsychotic and mood stabilizer medication in pregnancy: recommendations for antenatal care.

  Megan Galbally, Martien Snellen, Susan Walker, Michael Permezel
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  ABSTRACT: The aim of the present study was to develop recommendations for antenatal care and monitoring for women with bipolar disorder and schizophrenia who are on lithium carbonate, antipsychotic or anti-epileptic medication during pregnancy. A literature search and review of original research, published reviews and guidelines was undertaken for mood stabilizers and antipsychotics in pregnancy and for the management of bipolar disorder and schizophrenia in pregnancy. This information was summarized, condensed and then reviewed by representatives of psychiatry, pharmacy, paediatrics and obstetrics to produce an information booklet and subsequently monitoring recommendations and tables. A model of antenatal monitoring and care for women with schizophrenia, bipolar disorder and related disorders who are maintained on psychotropic medication was developed. This included an online and published booklet for clinicians summarizing psychotropic medication in pregnancy, and lactation and monitoring tables that could be part of patient case files. These were to assist in reminding and educating staff on the need for additional monitoring and assessment above standard antenatal care for women on mood stabilizers and antipsychotic medication. Women with bipolar disorder and schizophrenia have an increased risk of complications in pregnancy from their illness and from the medications they are prescribed. A summary of the risks and a model of suggested additional monitoring during pregnancy have been developed in consultation across a number of clinical disciplines.
  Australian and New Zealand Journal of Psychiatry 02/2010; 44(2):99-108. · 2.93 Impact Factor
• Source

  Available from: Andrew J Lewis

  Article: Serotonin discontinuation syndrome following in utero exposure to antidepressant medication: prospective controlled study.

  Megan Galbally, Andrew J Lewis, Jarrad Lum, Anne Buist
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  ABSTRACT: The aim of the present study was to examine neonatal symptoms previously reported to be associated with exposure to antidepressant medication in late pregnancy in a group of infants exposed to antidepressants, using a prospective and controlled design. A prospective case-control study recruited 27 pregnant women taking antidepressant medication and 27 matched controls who were not taking antidepressant medication in pregnancy. Of the 27 women taking medication, 25 remained on medication in the third trimester and, of these, 23 women had complete data available. In pregnancy and after delivery women were assessed with the Beck Depression Inventory-II and a purpose-designed questionnaire. After delivery mothers were asked a set of nine questions pertaining to symptoms of discontinuation in their newborn and questions about pregnancy and delivery complications. There was an increased risk of discontinuation symptoms in neonates exposed to antidepressant medication in late pregnancy and an association with higher dose medication. The study group were found to be significantly more likely to display behaviour such as crying, jitteriness, tremor, feeding, reflux and sneezing and sleep for <3 h after a feed. They also had significantly higher rates of jaundice and admissions to the special care nursery. Exposure to antidepressants in late pregnancy is associated with a range of symptoms in the neonate that are consistent with the effects of exposure to antidepressants in late pregnancy. The clusters of symptoms most highly correlated are the gastrointestinal and central nervous system symptoms. These finding helps to identify the common symptoms associated with a neonatal serotonin discontinuation syndrome.
  Australian and New Zealand Journal of Psychiatry 10/2009; 43(9):846-54. · 2.93 Impact Factor
• Article: Mother-infant psychotherapy and perinatal psychiatry: current clinical practice and future directions.

  Megan Galbally, Andrew Lewis, Martien Snellen, Campbell Paul, Klara Szego, Tom Trauer
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  ABSTRACT: To explore trends in the practice of mother-infant psychotherapy among perinatal psychiatry clinicians based in Melbourne. A cross-sectional survey with a purpose designed self-report questionnaire was used to assess the attitudes and practices of 47 perinatal and infant psychiatry clinicians in their use and understanding of mother-infant psychotherapy. Seventy per cent of clinicians in this field of psychotherapy who responded to the questionnaire subscribe to a psychodynamic model, although cognitive behavioural models are also used. The interventions were mostly used in conjunction with other interventions, would be more accurately described as 'parent-infant psychotherapy', and non-psychiatrists in the area tended to be more likely to be formally trained in psychotherapy, but only 4% were formally trained in specific mother-infant psychotherapy. There was a unanimous request for further clinical training in this area. The emerging field of perinatal psychiatry needs to develop coherent therapeutic models and conduct outcome trials on specific interventions. Specific trainings in these models, in assessment and in diagnostic frameworks are required to enhance clinical efficacy, for research and service development purposes.
  Australasian Psychiatry 01/2007; 14(4):384-9. · 0.86 Impact Factor
• Article: The role of oxytocin in mother-infant relations: a systematic review of human studies.

  Megan Galbally, Andrew James Lewis, Marinus van Ijzendoorn, Michael Permezel
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  ABSTRACT: Oxytocin is associated with the establishment and quality of maternal behavior in animal models. Parallel investigations in humans are now under way. This article reviews the current research examining the role of oxytocin in mother-infant relations, attachment, and bonding in humans. A systematic search was made of three electronic databases and other bibliographic sources for published research studies that examined oxytocin and mother-infant relations in humans, including attachment, maternal behavior, parenting, and mother-infant relations. Eight studies were identified, all of which were unique in their methodologies, populations studied, and measures used. Seven studies found significant and strong associations between levels or patterns of oxytocin and aspects of mother-infant relations or attachment. Oxytocin appears to be of crucial importance for understanding mother-infant relationships. The findings of this review suggest that the pioneering, but preliminary, research undertaken to date is promising and that replication with larger samples is needed. Research that draws on more robust measures of attachment and bonding, as well as improved measures of oxytocin that include both central and peripheral levels, will elucidate the role of oxytocin in human mother-infant relationships. As the production of oxytocin is by no means restricted to mothers, the extension of the oxytocin studies to fathering, as well as to alloparental caregiving, would be an intriguing next step.
  Harvard Review of Psychiatry 19(1):1-14. · 3.05 Impact Factor