2 IntroductionMany women experience a spectrum of psychiatric symptoms around the time of childbearing.Antenatal = during pregnancyPostnatal = following pregnancySome 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 assessmentIn 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 timesMore anxiety, somatic complaints, sleep disturbancesDistressing, intrusive thoughts about infant safety or parenting competency and guilt
8 Mood Symptoms Postnatal Hypomanic Symptoms Similar to hypomania that occurs at nonreproductive timesMay be more difficult to detectAn incorrect diagnosis may lead to:Subsequent use of antidepressant pharmacotherapy for later postnatal depressive symptomsAn underestimation of risk for postpartum psychosisBoth 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 SymptomsIn postpartum psychosis, symptom onset is often rapid, and there is a dramatic change in the woman’s functioning.Symptoms may consist of:Severe mood labilityMarked cognitive disturbance and impairmentDelusional beliefs about her infantBizarre behaviorHallucinationsUnusual 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:PovertyUnintended pregnancySingle relationship statusGood to poor overall healthMarital or partner-related conflictLimited social supportChildhood adversityNegative life eventsIntimate partner violence before or during pregnancyChildcare stress
13 Effects on Women and Their Families Consequences of Antenatal Mood and Anxiety SymptomsAdverse pregnancy, childbirth, and neonatal outcomesConsequences of Postnatal Mood and Anxiety SymptomsImpairments in mothering, poor mother–infant interactions, disrupted infant behavior and development, and inadequate infant health management
14 Engaging Women in Treatment Identification Women in NeedMotivation and Practical Barriers to CareStigmaTreatment Acceptability
15 ConclusionPuerperal psychiatric disorders are of great clinical and public health importanceFurther study should address:Strategies for understanding for whom to intervene, how to intervene, and how to engageWhether there is a risk threshold for illness duration and severity, and whether there are sensitive periods when susceptibility and impact peak