What Psychiatric Disorders may develop During Pregnancy?

 What Psychiatric Disorders may develop During Pregnancy?

What Psychiatric Disorders may develop During Pregnancy?_ichhori.com

Pregnancy is usually a time of happiness and emotional well-being for a woman. It is expected to be that way by people. They expect the mothers to be all happy and excited. However, for many women, pregnancy is not all joyous and happy. Their mental health might get affected and pregnancy might make them vulnerable to psychiatric conditions such as depression, anxiety disorders, eating disorders, and psychoses.

These conditions often go undiagnosed because they are attributed to mood swings and pregnancy-related changes in temperament or physiology. Even if they are diagnosed, they are often untreated because women may have concerns regarding the potential harmful effects of medication. But it is important to treat the mental health problems by going to practitioners and allied health professionals who care for pregnant or postpartum patients affected by these conditions.

Mental health disorders like depression, panic disorder, bipolar illness, and other psychiatric conditions can develop during pregnancy and should be considered when doing the complete health check-up of a pregnant patient.

Depression in pregnancy

The symptoms of depression such as changes in sleep, appetite, and energy are often difficult to distinguish from the normal experiences of pregnancy, during the gestational period. It has been noted that up to 70% of women report negative mood symptoms during pregnancy. And, the women who meet the depression diagnostic criteria have been noted to be between 13.6 per cent to 17 per cent at 35 to 36 weeks of pregnancy period. Every pregnant woman’s depression varies throughout pregnancy, they may report a symptom during the first and third trimesters and then they may notice improvement during the second trimester.

Depression is the most common psychiatric disorder women may develop during pregnancy. Other disorders they may suffer from are anxiety disorders, such as panic disorder, obsessive-compulsive disorder, and eating disorders. It is rare for women to develop these mental health problems for the first time but there are higher chances of relapse for women previously diagnosed with some form of psychosis

Many social factors coupled with pregnancy tiredness have been correlated as contributing to depression during pregnancy. But the clearest and major factors include:

·       A previous history of depression

·       Discontinuation of medication who has a history of depression

·       A previous history of postpartum depression

·       And a family history of depression.

Several social factors may also contribute to depression during pregnancy:

·       A negative attitude toward the pregnancy

·       Lack of social support

·       Pregnancy stress associated with negative life events

·       And a partner or family member who is unhappy about the pregnancy.

Depression in some cases is left untreated during pregnancy. It happens either because symptoms go unrecognized or because of concerns regarding the effects of medications. It can lead to a lot of negative consequences such as:

·       Lack of compliance with prenatal care recommendations like poor nutrition, self-care, and self-medication.

·       Use of alcohol and drug.

·       Suicidal thoughts and thoughts of harming the foetus.

·       The postpartum depression after the baby is born.

·       An additional and important implication of untreated maternal depression is the psychological effect on the foetus.

This explains the relationship between maternal depression and early childhood problems. It may be part of events that starts with depressive symptoms during pregnancy.

Treatment of Depression

Treatment of depression during pregnancy can be done by going for therapy whenever you have depression, with the added need to ensure the safety of the foetus. Other treatment options are:

·       Psychotherapies have been recognized as an effective treatment for depression

·       Cognitive-behavioural therapy is also used for treating depression

·       Another method is interpersonal psychotherapy. 

·       Education and support are also important factors in pregnancy as it is a unique experience for women, some women may not know what to expect.

·       Pharmacological therapies have also been recognized as an effective treatment for depression. However, doctors should fully disclose both the risk and benefits of various antidepressant medications to the patient and, if possible, to her partner before starting any pharmacological treatment.

Anxiety disorders in pregnancy

Anxiety can be another common disorder that women may develop during pregnancy. During pregnancy, women are largely in unknown territory and this may lead to them worrying as to how the pregnancy period may go and have panic attacks as well. Some of the anxiety disorders are panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, and social phobia.

1.    Panic disorder

The panic disorder during pregnancy mainly varies and remains unclear. While in many cases it has been noticed that the symptoms of pre-existing panic disorder in pregnant women decrease during pregnancy, but many large-scale studies have suggested that there is no decrease in symptoms for pregnant women with pre-existing panic disorder.

Many women may experience the first symptoms of panic disorder during pregnancy. Women experiencing panic attacks for the first time should also be screened for thyroid disorder. There has been a correlation between anxiety and increased resistance in uterine artery blood flow. There has also been a correlation between plasma levels of cortisol in the mother and the foetus may affect the developing fetal brain. Treatments for panic disorder in pregnancy include pharmacological therapies which will give symptomatic relief, and includes antidepressants. Along with pharmacological, nonpharmacological therapies such as cognitive behavioral therapy, supportive psychotherapy, relaxation techniques, sleep hygiene, and dietary counseling should also be done.

2.    Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is the thoughts of a person that cannot be controlled known as obsessions and repetitive behaviours or rituals that cannot be controlled or compulsions. It has been noticed that many pregnant women are at an increased risk for the onset of OCD and the postpartum period. In one study it was noticed that among women who were diagnosed with OCD, 39% of the women reported that their OCD began during pregnancy. 

Treatments for OCD in pregnancy are the same as they are in nonpregnant adults. It mainly includes cognitive behavioural therapy and pharmacotherapy.

3.    Generalized anxiety disorder

There are fewer data available regarding the prevalence or course of generalized anxiety disorder (GAD) through pregnancy. Most women will naturally worry about the health of the baby and how they will go through with labour and physical changes that happen during pregnancy. Excessive worrying is considered to be a symptom of generalised anxiety disorder or depression.

4.    Social phobia

Many women do not experience any first-onset social phobia or pre-existing social phobia during pregnancy. A very small number of women may experience tocophobia, which is an unreasonable dread of childbirth. The study shows that these women are more likely to develop postpartum depression if denied the delivery method of their choice i.e., caesarean section.

Eating disorders in pregnancy

Women who may develop eating disorders while being pregnant are approximately 4.9%. While studies have reported that the symptoms of eating disorders may actually decrease during pregnancy. But there can be several negative consequences for both the mother and her child.

·       It has been reported that pregnant women with active eating disorders are at a greater risk for delivery by caesarean section

·       They are also prone to postpartum depression. 

·       In addition, eating disorders during pregnancy may lead to miscarriage and lower infant birth weights.

Psychoses in pregnancy

Psychoses is not that common among pregnant women. It has been noted that the development of psychosis for the first time during pregnancy is extremely rare. However, it is not true for women with a history of psychosis, particularly if they had psychosis in previous pregnancies. The relapse rates are high in women having prior psychoses. These can be bipolar illness, followed by psychotic depression and schizophrenia.

1)    Bipolar mood disorder

It appears that the symptoms of bipolar disorder may go down and they may experience relief from symptoms when they are pregnant, but the risk of relapsing in the postpartum period is high. In one recent study, it was reported that pregnancy had no impact on the course of bipolar disorder in women if they discontinued lithium before conceiving and the relapse rates for depression in the pregnant women were the same as in non-pregnant women.

 In another study, pregnant women appeared to be protected against an increase in symptoms in women who had discontinued their lithium during pregnancy. But there was a 14 per cent chance of relapsing in the last 5 weeks of pregnancy. What is common in both studies is the high risk of relapse in the postpartum period, ranging from 25% to 70%.

For women with a history of bipolar mood disorder, the decision to use mood stabilizers must be made by taking all the risks and benefits into consideration. The factors you should consider are the number and severity of previous episodes, family support, and a woman’s wishes. Careful monitoring of psychological symptoms throughout the pregnancy is of paramount importance.

2)    Schizophrenia

Schizophrenia in pregnancy suggests that this disease varies, with some women experiencing an improvement in symptoms, while others symptoms worsen. Regardless of the course of the illness, women with a history of schizophrenia should be closely monitored by health care professionals during pregnancy. This illness if developed or worsened during pregnancy can have devastating consequences for both the mother and her foetus which includes

·       Failure to obtain proper prenatal care

·       Negative pregnancy outcomes such as low birth weight and prematurity

·       And neonaticide or suicide.

Treatment of acute psychosis in pregnancy cannot be ignored and is mandatory. This includes a huge support system, pharmacotherapy, and hospitalization. And, electroconvulsive therapy may be used for psychotic depression.

Early identification and treatment of psychiatric disorders during pregnancy is important and it can prevent any major complications during pregnancy and also during the postpartum period. With the associated high risks to mother and baby, it is better that both psychotherapy and pharmacotherapy are considered.

References: https://bcmj.org/articles/psychiatric-disorders-pregnancy#:~:text=Depression%2C%20panic%20disorder%2C%20bipolar%20illness,health%20of%20a%20pregnant%20patient.&text=Depression%20is%20the%20most%20common%20psychiatric%20disorder%20associated%20with%20pregnancy.

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