PSYCHIATRIC ILLNESS DURING PREGNANCY AND THE POSTPARTUM PERIOD

Depression and anxiety during pregnancy and postnatally are common and can affect many as 1 in 3 South African women. Psychiatric illness during pregnancy can be associated with adverse outcomes for both mother and baby, such as increased risk of preterm labour, low birth weight and small for gestational age babies. The optimum treatment of such illness is, therefore, vital.

Pregnancy is often considered to be a time of happiness and emotional well-being for women. However, for many women, pregnancy and motherhood can increase their vulnerability to psychiatric conditions such as depression, anxiety, eating disorders and psychoses. These conditions are often thought of as pregnancy-related changes. Therefore, it may go undiagnosed. It may often go untreated because of concerns about the potentially harmful effects of medication.

Women who suffer from psychiatric illnesses during pregnancy are less likely to receive proper prenatal care and more likely to use alcohol, tobacco and other substances known to have adverse effects on the outcomes of the pregnancy. Several studies have indicated that children born to depressed mothers suffer from low birth weight and fetal growth retardation. Pregnancy complications related to maternal depression and anxiety in late pregnancy can also increase the risk of having pre-eclampsia, operative delivery, and infant admission to a special care nursery for a variety of conditions including respiratory distress, hypoglycemia, and prematurity.

In a detailed session, often involving both partners, the risks of pregnancy, mental illness and treatment in your specific case will be discussed. The risks of pregnancy on the course of your illness, the risk benefit ratio to both and child of either stopping or continuing medication will be discussed, taking into account factors such as previous response to treatment, illness severity and past history of relapse. This will allow you and your health care provider to make informed choices around treatment in pregnancy.

Together with your obstretric and paediatric care provider, I will work with you in a collaborative manner, looking at issues ranging from medication safety in pregnancy and breastfeeding to the importance of sleep in depression and practical ways for the new mother to achieve this.