Title: Fetomaternal Outcome of Major Psychiatric Problems in Pregnancy
Authors: Dr Sujamol Jacob, Dr Shabnam A P
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.68
Abstract
Background: Women in childbearing age group are often vulnerable to mood and anxiety disorders. Approximately 30% of women experience some type of psychological disturbances during their life time. Women with these disturbances may experience profound changes during pregnancy. Evidence suggests that these disorders can adversely affect pregnancy outcome. So it is important that physicians understand the course of these disorders so that they can appropriately counsel women who are or intend to become pregnant. However systematic prospective data are limited on the outcome of mood and anxiety disorders in pregnancy. This study is designed to assess the feto maternal outcome of major psychiatric disorders in pregnancy.
Methods: This is a hospital based cohort study conducted in the Department of Obstetrics and Gynaecology, Sree Avittom Thirunal Hospital, Govt. Medical College, Trivandrum, Kerala. Known psychiatric patients registered for antenatal checkup are included in the study. This includes patients with or without treatment and also drug defaulters. Details of psychiatric illness are collected using a structured questionnaire and analysis done by SSPS software and analyzed by calculating chi square and P value (<.0.05 is considered significant)
Results: The study identified three major psychiatric problems in pregnancy they are depression, bipolar mood disorders and schizophrenia. Pregnancy outcome measures showed higher incidence of miscarriage rates, preterm labour and cesarean section rates in these patients. Neonatal outcome analysis showed a significant increase in low birth weight, poor 1 minute Apgar scores and poor breast feeding in this group .Study also identified the need for continued psychiatric counseling and drug therapy in the puerperium to prevent postpartum exacerbation.
Conclusion: Pregnancy is a major psychological as well as a major physiological event. Virtually all women can develop mental disorders during pregnancy as poverty, extreme stress, marital conflict and low social supports tend to increase the risk forspecific disorders. These can have adverse maternal and fetal outcome if left untreated. Hence a routine prenatal screening for mental illness and nonjudgmental and individualized care delivered by a multi-disciplinary team is critical for successful treatment and outcome.
References
1. Jablensky AV, Morgan V, Zubrick SR, Bower C, Yellachich L, Pregnancy, delivery, and neonatal complications in a population cohort of women with schizo-phrenia and major affective disorders. Am. J Psychiatry 162, 79-91 (2005).
2. Littleton H L, Breitjopf CR, Berenson A B, Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis. Am.J. Obstet Gynaecol. 196 (5), 424 – 432 (2007).
3. Ferry C P, Mitsuhiro SS, Barros MCM e al,. The impact of maternal experience of violence and common mental disorders on neonatal outcomes: a survey of adolescent mothers in Sao Paulo, Brazil, BMC Public Health 7, 209 (2007).
4. Kammerer M, Taylor A, Glover V, The HPA axis and perinatal depression: a hypothesis. Arch.WomensMent. Health 9, 187-196 (2006).
5. Davis E P, Glynn L M, Schetter CD, Hobel C, Chicz – DemetA, |Sandman CA. Prenatal exposure to maternal depression and cortisol influences infant temperament J. Am Acad. HildAdloesc. Psychiatry 46 (6) 737-746 (2007).
6. J Affect Disord. 102 (1 – 3), 137 – 143 (2007) mes with maternal depression. Includes literature supporting outcomes and mechanisms.
7. Field T, Diego M, Hernandez – Reif M. Prenatal depression effects on the fetus and newborn: a review Infant Behav. Dev: 29 (3), 445 – 455 (2006). Comprehensive review of fetal outcomes with maternal depression. Includes literature supporting outcomes and mechanisms.
8. Berle J, Mykletun A, Daltviet A K, Rasnyssen S, Holsten F, Hahl AA. Neonatal outcomes in offspring of women with anxiety and depression during pregnancy. Aarch. Women’s Ment. Health 8, 181 – 189 (2005).
9. Neggers Y, Goldenber R, Cliver S , Hauth J, The relationship between psychosocial profile, health practice’s, and pregnancy outcomes. Acta. Obstet. Gynaecol. Scand, 85 (3) 277 – 285 (2006)
10. Kammere M, Taylor A, Glover V. The HPA axis and perinatal depression: a hypothesi. Arch. Womensment, Health 9, 187 – 196 (2006).
11. Chung T K, Lau K T, Yip AS, Chiu F K, etal, Antepartum symptomatology is associated with adverse obstetric and neo natal outcome. Psychosomatic Medicine 2001; 63: 830 – 34. Frequency of psych-iatric disorders among women attending antenatal and general female outpatient department in a tertiary care hospital.
12. Gortmarker S L, Clark C J, Graven SN. Sobol A M, Geronimus A Reducing infant mortality in rural America. Evaluation of the rural infant care program. Health service Res. 1987; 22: 91 – 116.
13. Sharifa Mir, RozinaKarmaliani, Juanita Hatcher, NargisAsad, Siham Sikander Prevalence and risk factors contributing to depression among pregnant women in district chitral, Pakistan – 2012 : JPPS 2012; 9(1): 28-36.
14. Dube K C, A Study of prevalence and biosocial variables in mental illness in aRuralandairurban corn munity in litter Pradesli – India Acts. Psychiatrscand ., 1970:46:327 – 59.
15. Anya Topiwala, GurjivenHothi, and Klaus P. Ebmeier .Management of perinatal mood disorders Scottish intercollegiate |Guidelines Network (March 2012).2012, p. 15.
16. Gold K J, Lancaster C A, Fluynn H A, etal; Risk factors for depressive symptoms during pregnancy: a systematic review. Am J ObstetGynaeco, 2010 Jan; 202 (1 ): 5-14.
17. Anderson, L Sundstrom-Poromaa, I., Wulff, M Astrim, Bixo M, 2006. Depression and anxiety during pregnancy and six months postpartum: a fo0llow up study. Acta Obstet. Gynaecol. Scand. 85, 937 – 944.
18. Arch WomensMent Health. 2006 Mar; 9 (2);103 – 7 Epub 2005 Dec 29 antenatal psychiatric illness and adequacy of prenatal care in an ethnically diverse inner – city obstetric population.
19. Lindahl V, Pearson J L, Colpe L, Prevalence of suicides during pregnancy and postpartum. Arch WomensMent Health. 2005;8:77-87.