Perinatal mood and anxiety disorders arise during pregnancy or in the first year postpartum. They affect between 10 and 20 percent of pregnant women and new mothers, and the non-child-bearing parent can experience problems as well. Particularly for women who have had a mental illness, whether during their reproductive years or not, getting help is essential because relapse is common at this life stage.
Many women are reluctant to report psychiatric symptoms: some feel ashamed about being less than overjoyed about pregnancy or parenting; others fear that child protective services will be informed; and some worry about the safety and effectiveness of medications during pregnancy or breastfeeding. Women may also under-report symptoms because they are not certain whether the symptoms are related to normal changes in pregnancy or postpartum. However, effective and safe treatments exist, so primary care practitioners should offer treatment or referrals to women for the benefit of their mental health and the well-being of their families.
Impact of Untreated Perinatal Mental Health Problems
Untreated mental illness in pregnancy and postpartum carries various risks. The risks in pregnancy may include low infant birth weight, preterm delivery (less than 37 weeks gestation), increased risk of childhood emotional and behavioural problems, and poor infant learning and cognitive development.
Reassure your patient that getting help for psychiatric symptoms is not in itself grounds for calling child protective services; rather, it is a positive step, and treatment can lead to symptom remission. Explain that treating acute episodes of depression or anxiety is very unlikely to harm the baby, and that it is chronic, untreated mental illness and significant social adversity that can most seriously affect pregnancy health and infant well-being and development.