8.27.24 MOMs Webinar: Co-Occurring Disorders in Pregnancy-8.27.24 Webinar Slides

8.27.24 Webinar Slides

Pdf Summary

Pregnancy in women with psychiatric disorders presents unique challenges and risks, including higher rates of adverse outcomes and pregnancy-related deaths due to mental health conditions like suicide and overdose. Untreated antepartum depression is a significant predictor of postpartum depression, which can negatively impact infant development, maternal-infant bonding, and child safety. Underrepresented populations are often excluded from relevant studies, which primarily focus on white, heterosexual, cisgender females from middle- or upper-income backgrounds.<br /><br />Common psychiatric disorders among pregnant women include depression, bipolar disorder, anxiety, PTSD, and more. Untreated peripartum depression is associated with irregular fetal heart rates, intrauterine growth retardation, and higher risks of neonatal intensive care unit admissions and premature death.<br /><br />Self-harm and infant harm risks are considerable, with maternal suicide rates between 5-6% of pregnancy-related deaths. Screening for psychiatric disorders is recommended by various health organizations using tools like the Edinburgh Postnatal Depression Scale and the PHQ-9. Stopping psychiatric medications during pregnancy can lead to high relapse rates, with major depression and bipolar disorder showing particularly high rates of relapse.<br /><br />Psychiatric medications, including antidepressants, antipsychotics, and mood stabilizers, present varying risks. For instance, SSRIs are linked to issues like persistent pulmonary hypertension and Poor Neonatal Adaptation Syndrome, but newer studies suggest lower risks of major malformations. Treatments such as Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (rTMS) are considered safe for severe cases.<br /><br />Non-pharmacologic treatments include psychotherapy, cognitive-behavioral therapy, and relaxation techniques like yoga and acupuncture. The goal during pregnancy is to minimize exposure to both medications and psychiatric illness. However, the literature faces limitations due to a lack of controlled studies and challenges in controlling for confounding conditions.<br /><br />Overall, managing psychiatric disorders in pregnancy requires a delicate balance to ensure both maternal and fetal health, with a focus on careful monitoring, appropriate treatment, and addressing the specific needs of each patient.

Keywords

Pregnancy

Psychiatric disorders

Antepartum depression

Postpartum depression

Maternal-infant bonding

Psychiatric medications

Self-harm risks

Non-pharmacologic treatments

Screening tools

Fetal health