What Psychiatric Disorders may develop During Pregnancy?
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.
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.
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.
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 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.
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.
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.