Psychiatric disorders in pregnancy & postpartum includes following
- 10% of pregnant women develop a depressive illness
- There is a significant increase in new psychiatric episodes in the first 3 months after delivery. At least 80% are mood disorders, primarily depression.
- Pregnancy doesn’t protect against depression; relapse rates are high in those with the history of depression who discontinue medication
- Pregnancy doesn’t protect against relapse
- The risk of perinatal psychosis is 0.1 – 0.25% in the general population, but is 50% in women with history of bipolar disorder.
- In the first month after child birth there is a 20 – fold increase in the relative risk of psychosis
- The risk of postpartum psychosis in patients with the history of postpartum psychosis is 50 – 90 %.
The mental health of the mother in the perinatal period influences foetal well-being, obstetric outcome and child development.
Treatment in Pregnancy & Postpartum
- Psychological intervention wherever possible
- Drugs must be used with extreme caution in pregnancy and in those mothers who are breast feeding
- The risk of prescribing to pregnant women must be weighed against the risk of not prescribing i.e. in some pregnant women it may be safer to prescribe
Besides 20 years of consultant psychiatrist experience in adult psychiatry, Dr. A H Naliyawala is the medical lead in perinatal psychiatry in his local NHS Trust in East Sussex for the last 4 years.