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Mood disorders in mothers

 

Mood disorders may occur during pregnancy or in the first year after childbirth, as in any other phase of life. The underlying mechanisms are complex, and the general understanding includes the interconnectedness of biopsychosocial factors that may cause perinatal mood disorders.



In the perinatal period, the woman experiences physiological, physical, and psychological changes that are important for the development of the baby, and for preparing the woman to become a mother. However, these changes may also increase the woman’s risk of developing a mental illness or experiencing a relapse of previous illnesses. Women with a previous history of mood disorders are particularly vulnerable of experiencing worsening or relapse in the perinatal period (1,2). Psychiatric admissions are shown to increase significantly in the first three months after childbirth (3,4), and the risk of severe illness or admission is higher amongst mothers with a pre-existing mood disorder (2).


Perinatal depression is the most frequent mood disorder, affecting 10 to 15 percent of women during childbearing age (5,6). Perinatal mood disorders also include bipolar disorder and postpartum psychosis, and there is a frequent co-occurrence with anxiety disorders. Up to 20 percent of women meet the diagnostic criteria of at least one anxiety disorder in the perinatal period (7). The co-morbidity is usually referred to as perinatal mood and anxiety disorders (PMAD).


International guidelines recommend screening for mood and anxiety disorders, including traumatic experiences and domestic violence in the pregnancy, for all women in the antenatal care.  Image by Wix Media.
International guidelines recommend screening for mood and anxiety disorders, including traumatic experiences and domestic violence in the pregnancy, for all women in the antenatal care. Image by Wix Media.

Perinatal mood disorders generally show the same symptoms as mood disorders occurring outside this period (8,9), including somatic symptoms related to depression that can be mistaken as pregnancy-related (10). Perinatal mood disorders increase maternal morbidity and mortality, including obstetric consequences that affect the baby and the delivery. Furthermore, perinatal mood disorders are closely linked to the child’s health (11), and the woman’s mental health can also affect her partner (12). Additionally, problems in the immediate family may influence the level of risks that the children are exposed to (13). In the most severe cases mood disorders may lead to maternal suicide, one of the leading, direct cause of maternal death during pregnancy and in the first year after childbirth (14).


The consequences of inadequately or untreated perinatal mood disorders do not only affect the mother and her family, but they also have a negative impact on society. Bauer and colleagues found that “perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK” (15), estimating the costs related to short- and long-term consequences for the mothers and the children.


The morbidity and mortality that affect women who experience perinatal mood disorders, and the consequences for her close family and the society, warrants adequate interventions (16-18). Clinical recommendations include advice on contraceptive measures, pre-pregnancy planning and advice regarding psychopharmacological treatment during pregnancy and breastfeeding. There is also a need for planning and follow-up through an individualised care pathway that ensures integration of the involved services, e.g., the general practitioner, maternity services, and mental health services. Providing appropriate psychoeducation and information may facilitate empowerment through developing an evidence-based understanding of the benefits and risks of perinatal use of psychopharmaca and non-pharmacological treatment. Subsequently, it may encourage women to be assertive regarding their own treatment (19). Women with a previous history of mood disorders should be engaged in writing a treatment and prevention plan. Munk-Olsen and colleagues (2016) have suggested important factors to include, such as adequate medication, birth plans, prodromal and early signs of relapse and appropriate interventions, evaluation of the child postpartum, the woman’s preferences regarding breastfeeding, strategies to ensure adequate sleep, stress reduction, and interventions to support mother-baby bonding (4). International guidelines recommend screening for mood and anxiety disorders, including traumatic experiences and domestic violence in the pregnancy, for all women in the antenatal care (18).


On a political and service administrative level, it is important to note that the health sector cannot resolve these issues alone. Comprehensive care and collaboration with other services are important, emphasizing the necessity to develop strategies to meet the multifaceted needs of women experiencing mood disorders in the perinatal period, and their families. □


Uncategorized references by request

  1. Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. The Lancet. 2014;384(9956):1775-88.

  2. Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V. Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis. Am J Psychiatry. 2016;173(2):117-27.

  3. Kendell RE, Chalmers JC, Platz C. Epidemiology of Puerperal Psychoses. British Journal of Psychiatry. 1987;150(5):662-73.

  4. Munk-Olsen T, Maegbaek ML, Johannsen BM, Liu X, Howard LM, di Florio A, et al. Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence. Transl Psychiatry. 2016;6(10):e919.

  5. Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders. 2017;219:86-92.

  6. O'Hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. International Review of Psychiatry. 1996;8(1):37-54.

  7. Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis. J Clin Psychiatry. 2019;80(4).

  8. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (fifth edition). Arlington, VA: American Psychiatric Publishing; 2013.

  9. World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision. Geneva: World Health Organization; 2015.

  10. Nylen KJ, Williamson JA, O'Hara MW, Watson D, Engeldinger J. Validity of somatic symptoms as indicators of depression in pregnancy. Arch Womens Ment Health. 2013;16(3):203-10.

  11. World Health Organization. Maternal Health 2020 [

  12. Seedat S. Paternal perinatal mental disorders are inextricably linked to maternal and child morbidity. World Psychiatry. 2020;19(3):337-8.

  13. Reupert AE, J Maybery D, Kowalenko NM. Children whose parents have a mental illness: prevalence, need and treatment. Medical Journal of Australia. 2013;199(S3):S7-S9.

  14. Chin K, Wendt A, Bennett IM, Bhat A. Suicide and Maternal Mortality. Curr Psychiatry Rep. 2022;24(4):239-75.

  15. Bauer A, Parsonage M, Knapp M, Iemmi V, Adelaja B. The costs of perinatal mental health problems. London, UK: Center for mental health and London school of economics, health M; 2014 October 2014.

  16. Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020;19(3):313-27.

  17. National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance - clinical guideline (CG192). 2014.

  18. ACOG Committee Opinion No. 757: Screening for Perinatal Depression. Obstet Gynecol. 2018;132(5):e208-e12.

  19. Blount AJ, Adams CR, Anderson-Berry AL, Hanson C, Schneider K, Pendyala G. Biopsychosocial Factors during the Perinatal Period: Risks, Preventative Factors, and Implications for Healthcare Professionals. Int J Environ Res Public Health. 2021;18(15).

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