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Mental Health Problems in Pregnancy and Postnatal Period
Transcript of Mental Health Problems in Pregnancy and Postnatal Period
Change in sleep
Change in appetite
Baby taken away
High Income Countries
Middle and Low Income Countries
Effects of Pregnancy on Maternal
Most Common form of mental disorder in pregnancy
More common prenatally compared to postnatal
Peaks in 1st and 3rd trimester, with reduction in 2nd
Post partum depression
Signs and Symptoms of
Inability to cope
Loss of Libido
Poor nutrition and self care
First time > re-emerging attacks
Investigate thyroid function before diagnosis
Generalised Anxiety Disorder
Tendency to worry
Health of foetus
Coping with labour
and bodily changes
Anorexia Nervosa and Bulimia
Not so common
Low birth weight infants
Higher chance of C-section
14% relapse in last 5 weeks of pregnancy
Careful monitoring in antenatal follow up
low birth weight
Prenatal follow up failure
Maternal Mental Health on Foetus
Mothers with mood disorder in early pregnancy - have 2 times higher risk of giving birth to baby with psychiatric disorder
Less frequent positive
Talk to the partner and family members
Postpartum Psychiatric Illnesses
50 - 85% of women
In first 2 weeks of postpartum
Increased emotional reactivity
Mild and spontaneously remits
Not considered psychiatric disorder
No specific treatment required
13 % of mothers
In first 2-3 postpartum months
Edinburgh Postnatal Depression Scale
1-2 in 1000 women
In first 3 months postpartum
Often necessitates hospitalization
Past history of mental illness
Current emotional distress
Family history of mental illness
Cognitive Behavioral Therapy (CBT)
Treat antenatal depression and anxiety.
Beating Blues Before Birth intervention.
Randomized control trial involving 54 pregnant women diagnosed with depression
Cognitive behavioural therapy
Treatment as usual
Interpersonal therapy (IPT)
Treats antenatal depression.
Focuses on identifying problems and how the individual interacts with or doesn't interact with others.
Necessary adjustments made.
Anxiety in pregnancy
is preferred over pharmacological approach.
Medication required when CBT or social support is inadequate.
Selective serotonin reuptake inhibitors
can be used.
- citalopram, fluoxetine, sertraline
- paroxetine is discouraged.
Depression in pregnancy
IPT to improve social interactions and coping with life transitions.
CBT to adjust patient's self-defeating thought patterns.
SSRI or SNRI are used.
Mood stabilizers --> antipsychotics
associated with congenital cardiac malformations.
Risk of relapse if drugs are stopped.
may be essential in rapid cycling bipolar.
SSRI can be used and not contraindicated in breastfeeding.