2.2.1 Disorders Related to Pregnancy

Assessment and Management of Disorders Related to Pregnancy

Anxiety/mood symptoms in normal pregnancy:

During pregnancy, symptoms of anxiety and depression are common, particularly during the first and third trimesters. However, unless there is a past history of psychiatric illness, there is no reported increase in the incidence of psychiatric disorders.

Risk factors for developing anxiety and depression during pregnancy include:

• a family or personal history of depression,
• ambivalence about the pregnancy,
• high levels of neuroticism,
• and lack of social support.

Treatment typically involves psychosocial interventions, and specific psychiatric disorders should be identified and treated accordingly.

Miscarriage and abortion:

Following a miscarriage or abortion more than 50% of women experience an adjustment disorder, which includes significant depressive symptoms. Chronic symptoms are uncommon, but women who have experienced previous miscarriages or abortions or who have conflicts related to cultural or religious beliefs are at higher risk.

Pseudocyesis:

Pseudocyesis, also known as false pregnancy or phantom pregnancy, is a rare condition where a person experiences symptoms of pregnancy, such as missed periods, morning sickness, and abdominal enlargement, despite not being pregnant. The exact cause of pseudocyesis is unknown, but it is thought to be related to psychological factors, such as an intense desire for pregnancy or fear of infertility. It is regarded as a somatoform disorder or a variant of depression, it may present as a complication of post-partum depression or psychosis with amenorrhoea. Treatment for pseudocyesis usually involves psychological counselling and support. Although pseudocyesis does not involve a real pregnancy, the physical and emotional symptoms can be distressing for those affected.

Childbearing in patients with pre-existing mental disorders:

Childbearing in patients with pre-existing mental disorders presents unique challenges and risks. The post-partum period is often associated with increased vulnerability for relapse in many mental health conditions. Factors such as family history, illness severity, medication discontinuation, and lifestyle contribute to the risk of relapse and complications during and after pregnancy. Adequate assessment and multidisciplinary support are crucial for ensuring the well-being of both the parent and child in these cases.

Mental Disorder	Pregnancy and Post-partum Impact	Risk Factors and Outcomes
Schizophrenia	Less likely to relapse if on treatment	Relapse in 20% admitted to inpatient setting; lifestyle factors impact parent/child outcomes
Bipolar Disorder	Two-thirds relapse post-partum	Family history, illness episodes, medication discontinuation; 50-90% recurrence in later pregnancies
Anxiety and Panic Disorders	Unclear impact on symptoms	Conflicting evidence on panic disorder relapse
PTSD	No clear data on relapse	Possible risks for pregnancy complications
OCD	~30% worsening during pregnancy	–
Eating Disorders	Symptoms may improve during pregnancy	Postnatal depression, poorer health outcomes for the baby
Intellectual Disability (ID)	Higher pregnancy rates in borderline and mild ID	Main issue is not the parent’s IQ, but various factors causing social difficulties
Personality Disorders	Parenting ability varies	Assessment of child’s needs and exposure to social factors; multidisciplinary input needed

References:

1. Jones, I., Chandra, P. S., Dazzan, P., & Howard, L. M. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. The Lancet, 384(9956), 1789-1799. doi: 10.1016/S0140-6736(14)61278-2
2. Kendell, R. E., Chalm ers, J. C., & Platz, C. (1987). Epidemiology of puerperal psychoses. British Journal of Psychiatry, 150(6), 662-673. doi: 10.1192/bjp.150.6.662
3. Munk-Olsen, T., Laursen, T. M., Mendelson, T., Pedersen, C. B., Mors, O., & Mortensen, P. B. (2016). Risks and predictors of readmission for a mental disorder during the postpartum period. Archives of General Psychiatry, 73(9), 928-935. doi: 10.1001/archgenpsychiatry.2016.1133
4. National Institute for Health and Care Excellence. (2014). Postnatal care up to 8 weeks after birth: Clinical guideline. Retrieved from https://www.nice.org.uk/guidance/cg37
5. Suto, M., Murray, L., Mehta, R., Cooper, P. J., & Fearon, P. (2019). Hormonal regulation in mothers with postpartum psychosis. The British Journal of Psychiatry, 214(3), 149-157. doi: 10.1192/bjp.2018.289
6. National Institute for Health and Care Excellence (NICE). (2014). Antenatal and postnatal mental health: Clinical management and service guidance. Retrieved from https://www.nice.org.uk/guidance/cg192
7. Molyneaux, E., Howard, L. M., McGeown, H. R., Karia, A. M., Trevillion, K., & Brockington, I. F. (2014). Antidepressant treatment for postnatal depression. Cochrane Database of Systematic Reviews, (9), CD002018. doi: 10.1002/14651858.CD002018.pub2
8. Stewart, D. E., Robertson, E., Dennis, C.-L., Grace, S. L., & Wallington, T. (2014). Postpartum depression: Literature review of risk factors and interventions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147943/