1. CHAPTER 16: Psychiatric Symptoms and Pregnancy

2. Introduction
Many women experience a spectrum of psychiatric symptoms around the time of childbearing.
Antenatal = during pregnancy
Postnatal = following pregnancy
Some women will experience psychiatric disorders, which are burdensome, costly, and require safe, efficacious treatment.

3. The Burden of Antenatal and Postnatal Psychiatric Symptoms
Reproductive events are not protective against psychiatric symptoms.
True prevalence is unclear due to methodological limitations.
E.g., timing and method of assessment
In DSM-IV-TR, there is no distinct prenatal or postpartum psychiatric disorder classification.

4. Mood Symptoms Antenatal Depressive Symptoms Prevalence: 8.5% to 11%
Pregnancy is a time of increased risk for women with a history of depression.
There is a potential for adverse consequences to pregnancy health, fetal development, birth outcomes, and postnatal health.

5. Mood Symptoms Antenatal Hypomanic and Manic Symptoms
Antenatal manic symptoms seem to be the least common affective experience.
Bipolarity is the most robust predictor of severe postnatal mental health complications, including psychosis .

6. Mood Symptoms Postnatal Depressive Symptoms “Baby blues”
Mood lability, depressed or irritable mood, interpersonal hypersensitivity, tearfulness, and preoccupation with infant well-being

7. Mood Symptoms Major Depressive Episodes (MDEs) With Postpartum Onset
Similar to MDE that occurs at nonreproductive times
More anxiety, somatic complaints, sleep disturbances
Distressing, intrusive thoughts about infant safety or parenting competency and guilt

8. Mood Symptoms Postnatal Hypomanic Symptoms
Similar to hypomania that occurs at nonreproductive times
May be more difficult to detect
An incorrect diagnosis may lead to:
Subsequent use of antidepressant pharmacotherapy for later postnatal depressive symptoms
An underestimation of risk for postpartum psychosis
Both of which are associated with increased risk for suicide and infanticide.

9. Intervention Recommendations
Evaluate pregnant women for risk factors at least once every trimester.
Provide early and frequent psychoeducation, assessment, and treatment.
Screen for personal or family history of bipolarity, especially before initiating pharmacotherapy.
Discourage abrupt changes in treatment regimen.

10. Psychotic Symptoms
In postpartum psychosis, symptom onset is often rapid, and there is a dramatic change in the woman’s functioning.
Symptoms may consist of:
Severe mood lability
Marked cognitive disturbance and impairment
Delusional beliefs about her infant
Bizarre behavior
Hallucinations
Unusual psychotic symptoms, such as tactile or olfactory hallucinations, and command hallucinations to kill her infant

11. Anxiety Symptoms Obsessive-Compulsive Disorder
Intrusive thoughts often center on causing harm to fetus or infant.
Differs from postpartum psychosis in that the woman recognizes that the thoughts are unreasonable and avoids action.
Inhibits bonding or attachment.
Associated with depressive symptoms.

12. Sociodemographic and Environmental Risk Factors
Factors that contribute to risk during and following pregnancy:
Poverty
Unintended pregnancy
Single relationship status
Good to poor overall health
Marital or partner-related conflict
Limited social support
Childhood adversity
Negative life events
Intimate partner violence before or during pregnancy
Childcare stress

13. Effects on Women and Their Families
Consequences of Antenatal Mood and Anxiety Symptoms
Adverse pregnancy, childbirth, and neonatal outcomes
Consequences of Postnatal Mood and Anxiety Symptoms
Impairments in mothering, poor mother–infant interactions, disrupted infant behavior and development, and inadequate infant health management

14. Engaging Women in Treatment
Identification Women in Need
Motivation and Practical Barriers to Care
Stigma
Treatment Acceptability

15. Conclusion
Puerperal psychiatric disorders are of great clinical and public health importance
Further study should address:
Strategies for understanding for whom to intervene, how to intervene, and how to engage
Whether there is a risk threshold for illness duration and severity, and whether there are sensitive periods when susceptibility and impact peak