Introduction: Our consensus statement aims to clarify the use of antidepressants and anxiolytics during breastfeeding amidst clinical uncertainty. Despite recent studies, potential harm to breastfed newborns from these medications remains a concern, leading to abrupt discontinuation of necessary treatments or exclusive formula feeding, depriving newborns of benefits from mother’s milk. Methods: A panel of 16 experts, representing eight scientific societies with a keen interest in postpartum depression, was convened. Utilizing the Nominal Group Technique and following a comprehensive literature review, a consensus statement on the pharmacological treatment of breastfeeding women with depressive disorders was achieved. Results: Four key research areas were delineated: (1) The imperative to address depressive and anxiety disorders during lactation, pinpointing the risks linked to untreated maternal depression during this period. (2) The evaluation of the cumulative risk of unfavorable infant outcomes associated with exposure to antidepressants or anxiolytics. (3) The long-term impact on infants’ cognitive development or behavior due to exposure to these medications during breastfeeding. (4) The assessment of pharmacological interventions for opioid abuse in lactating women diagnosed with depressive disorders. Conclusions: The ensuing recommendations were as follows: Recommendation 1: Depressive and anxiety disorders, as well as their pharmacological treatment, are not contraindications for breastfeeding. Recommendation 2: The Panel advocates for the continuation of medication that has demonstrated efficacy during pregnancy. If initiating an antidepressant during breastfeeding is necessary, drugs with a superior safety profile and substantial epidemiological data, such as SSRIs, should be favored and prescribed at the lowest effective dose. Recommendation 3: For the short-term alleviation of anxiety symptoms and sleep disturbances, the Panel determined that benzodiazepines can be administered during breastfeeding. Recommendation 4: The Panel advises against discontinuing opioid abuse treatment during breastfeeding. Recommendation 5: The Panel endorses collaboration among specialists (e.g., psychiatrists, pediatricians, toxicologists), promoting multidisciplinary care whenever feasible. Coordination with the general practitioner is also recommended.

Introduction: The initiative of a consensus on the topic of antidepressant and anxiolytic drug use in pregnancy is developing in an area of clinical uncertainty. Although many studies have been published in recent years, there is still a paucity of authoritative evidence-based indications useful for guiding the prescription of these drugs during pregnancy, and the data from the literature are complex and require expert judgment to draw clear conclusions. Methods: For the elaboration of the consensus, we have involved the scientific societies of the sector, namely, the Italian Society of Toxicology, the Italian Society of Neuropsychopharmacology, the Italian Society of Psychiatry, the Italian Society of Obstetrics and Gynecology, the Italian Society of Drug Addiction and the Italian Society of Addiction Pathology. An interdisciplinary team of experts from different medical specialties (toxicologists, pharmacologists, psychiatrists, gynecologists, neonatologists) was first established to identify the needs underlying the consensus. The team, in its definitive structure, includes all the representatives of the aforementioned scientific societies; the task of the team was the evaluation of the most accredited international literature as well as using the methodology of the “Nominal Group Technique” with the help of a systematic review of the literature and with various discussion meetings, to arrive at the drafting and final approval of the document. Results: The following five areas of investigation were identified: (1) The importance of management of anxiety and depressive disorders in pregnancy, identifying the risks associated with untreated maternal depression in pregnancy. (2) The assessment of the overall risk of malformations with the antidepressant and anxiolytic drugs used in pregnancy. (3) The evaluation of neonatal adaptation disorders in the offspring of pregnant antidepressant/anxiolytic-treated women. (4) The long-term outcome of infants’ cognitive development or behavior after in utero exposure to antidepressant/anxiolytic medicines. (5) The evaluation of pharmacological treatment of opioid-abusing pregnant women with depressive disorders. Conclusions: Considering the state of the art, it is therefore necessary in the first instance to frame the issue of pharmacological choices in pregnant women who need treatment with antidepressant and anxiolytic drugs on the basis of data currently available in the literature. Particular attention must be paid to the evaluation of the risk/benefit ratio, understood both in terms of therapeutic benefit with respect to the potential risks of the treatment on the pregnancy and on the fetal outcome, and of the comparative risk between the treatment and the absence of treatment; in the choice prescription, the specialist needs to be aware of both the potential risks of pharmacological treatment and the equally important risks of an untreated or undertreated disorder.

Background/Objectives: Female sexual dysfunction (FSD) involves persistent issues with desire, arousal, orgasm, or pain during intercourse. The Female Sexual Function Index (FSFI), a validated 19-item questionnaire, is widely used to assess FSD. Childbirth, particularly vaginal delivery with perineal trauma, can increase FSD risk, with 41–83% of women affected at six months postpartum. However, early postpartum FSD remains underexplored. This study examines FSD risk factors in first-time mothers delivering vaginally, using longitudinal FSFI assessments before and after the delivery. Methods: A prospective observational study was conducted involving 80 primiparous women who delivered vaginally. The FSFI questionnaire was provided before childbirth and three months postpartum. We compared the group of women who developed early FSD after delivery (N = 45) with those with a normal FSFI score (>26.6). Results: Three months after vaginal delivery, participants exhibited a significant decrease in overall FSFI scores (−9.61 [95%CI: −11.6; −7.6]; p = 0.008). A total of 45 patients (56.2%) developed early FSD. Marital status emerged as a significant factor, with marriage acting as a protective factor (OR 0.27 [95%CI 0.05–1.24]; p = 0.044). Clitoral and periclitoral tears were associated with a higher risk of FSD than high-degree perineal lacerations (OR 3.02 [95%CI 1.56–6.24]; p = 0.021). Conclusions: At three months post vaginal delivery, primiparous women face a relevant risk of developing transient sexual dysfunction. Marital status and type of perineal tears are identified as key factors influencing postpartum sexual function. Further research is warranted to explore these factors comprehensively and provide timely clinical and psychological support to couples navigating the challenges of early family life.

E18558 Background: Solitary Plasmocytoma (SP) and Multiple Myeloma (MM) develop osteolityc bone lesions that can cause severe bone pain and pathologic fractures. This study investigated the impact of radiotherapy (RT) on pain relief and on recalcification. Methods: Patients with diagnosis of symptomatic MM and SP of bone were asked to rate their pain intensity according to a 0-10 verbal numerical rating scale (NRS) before starting radiotherapy and 2 months after irradiation. Response rate was defined according to International consensus on palliative radiotherapy criteria. Recalcification was estimated using radiological imaging at 6 months after radiotherapy and local control was defined as absence of relapse of lytic lesion on irradiated sites based on radiographic imaging. Results: From 1996 to 2007, 52 patients were treated: 42/52 (80.8%) were symptomatic MM and 10/52 ( 19.2%) were SP. Median age was 66 years (range 22-85) with a male:female ratio of 1.7:1. Irradiated sites were: spinal cord (68%), pelvic bone (12%), upper and lower extremities (9%), skull (7%) and ribs (4%). Median total dose of radiation was 38 Gy (range 16-60) delivered in a median daily fraction of 200 cGy/day (range 180-400). Forthy-five/52 (86,5%) patients presented pain before radiotherapy: severe (8≤NRS≤10) in 5/45 (11%), moderate (5≤NRS≤7) in 27/45 (60%), mild in 13/45 (29%) patients. Pain relief was obtained in 41/45 patients (91%): complete in 21 (51.2%) and partial in 20 patients (48.8%). All patients with severe pain obtained a resolution and none referred an increase of pain. Among patients with complete response, 7 (33.3%) achieved a drug reduction/suspension. Of 42 patients evaluable for recalcification, 21 (50%) obtained a radiological response, complete in 16 (38%) patients. Local control was achieved in 46/52 (88.4%) patients and, with a median follow-up of 57 months (range 21-210), 5-years local control was 80%. Conclusions: Our data confirm the effectiveness of radiotherapy on pain relief, with a reduction of drugs intake, on recalcification and support the early use of radiotherapy as part of multidiscinary approach to plasma cell neoplasms. No significant financial relationships to disclose.