Mental Health in Pregnancy
Baby bluesAffects approx 50% of women post delivery
Brief episode of misery and tearfulnessUsually after first baby
PNDMild –severe non psychotic depressive illness
During first post natal year
Puerperal psychosis (PP)Acute onset of a manic/psychotic episode
Patients usually have past hx of BPAD/vulnerability to childbirth related trigger
Presents shortly after childbirth
Perinatal Mental Health
Type of disorder Incidence (%)• Mild/depressive/anxiety disorders 15.0-20.0• Severe depressive illness 3.0-5.0• Referral to psychiatric services 2.0• Admission to psychiatric unit 0.4• Puerperal psychosis 0.2
Maternal Mortality
Deaths from psychiatric cause2006-8=13 2009-11=13 2010-2012=16
Suicide
• Majority of women died violently, 87%
• Over half from hanging or jumping
Puerperal Psychosis
• Psychotic illness arising in previously well woman after childbirth.
• First onset psychotic illness
• Previous psychotic illness but well in years preceding the pregnancy
• Incidence 2 per 1000 births
• Onset –Acute within days of delivery
• Recurrence after subsequent childbirth
Puerperal Psychosis
• Anger and agitation/Insomnia• Confusion and perplexity (fluctuates with periods of
orientation)• Auditory hallucinations• Paranoia/grandiose delusions• Misrecognition of partner or mistaking others (such as male
staff) for partner/father of the child.• Mood disorder (manic and depressive in nature)• Strange thoughts/statements• Depersonalisation-loss of contact with reality with difficulty
relating emotionally to child• Thoughts of harming self or baby
Risk Factors Puerperal Psychosis
• Past Hx of puerperal psychosis (1 in 2)
• Family Hx of Bipolar illness or Puerperal psychosis (1 in3)
• History of serious affective disorder (bipolar illness and severe unipolar depression)
• Not strongly associated with psychosocial risk factors as non psychotic conditions
Marker Questions
• Have you ever been in hospital with you nerves?
• Has anyone in your direct family been in hospital with their nerves?
• Did your mother have postpartum psychosis/ “severe postnatal depression”?
SSRI in pregnancyare they “safe”?-yes
• Possible increase in congenital heart disease
• Possible Neonatal withdrawal
• Possible increase in PPHN
• (Best to avoid paroxitene and fluoxetine)
PPHN• Persistence after birth
of high pulmonary artery pressure
• R to L shunting across FO & DA
• Secondary to perinatal asphyxia, meconium aspiration, sepsis, diaphragmatic hernia
• Neonate cyanotic• Needs O2, may need
ventilation, NO, sildinafil, ECMO
PPHN primary studies• Chambers, 2006 (used in safety update) • After 20 weeks risk PPHN 1%
– Case control study. 377 with confirmed PPHN.– 14 on SSRI after 20/40, only 6 controls. OR 6.1– Retrospective, 99% SSRIs no PPHN
• Wichman 2007 – 808/25,000 on SSRI– 16 had PPHN –none on SSRIs
• Kallen 2008• 831,324 506 cases PPHN• OR 2 • Risk of PPHN SSRI 1.5/1000
• Andrade, 2009– 1104 on SSRIs in 3rd trimester– Confounders –diabetes & asthma more in exposed group– 5 PPHN (2 were on SSRI)– Risk not on SSRI 2.72/1000 – Risk on SSRI 2.14/1000
UK Tetrology Information Service
BUMPS
Signposting Non Drug RX
• Guided Self Help
• Psychological Therapies IAPT
• Support Groups
THANKS
• www.uktis.org• www.medicinesinpregnancy.org
• www.pandasfoundation.org.uk
• www.livinglifetothefulll.com• www.mind.org.uk• www.mindfulness4mothers.com• www.mindfulmotherhood.org
