Fostering Careful Peripartum Care

November 1, 2005

Pregnancy and new motherhood are considered happy and hopeful times. Bad outcomes, such as miscarriages and stillbirths, occur, however, and even with good outcomes, psychiatric disorders can present or worsen at this time. The incidence of depression in women during pregnancy is about the same as that for matched controls, and because depression is common in all women, this is a significant public health issue. More than 10% of women with panic disorder describe first symptoms as occurring around pregnancy, and there is evidence that pregnancy exacerbates psychotic disorders. Within a few days of giving birth, 25% to 75% of new mothers experience emotional lability, or the "baby blues," and 10% to 20% of new mothers experience postpartum depression. The peripartum is thus a time of great joy potentially complicated by the entire range of psychiatric illness.

Pregnancy and new motherhood are considered happy and hopeful times. Bad outcomes, such as miscarriages and stillbirths, occur, however, and even with good outcomes, psychiatric disorders can present or worsen at this time. The incidence of depression in women during pregnancy is about the same as that for matched controls, and because depression is common in all women, this is a significant public health issue. More than 10% of women with panic disorder describe first symptoms as occurring around pregnancy, and there is evidence that pregnancy exacerbates psychotic disorders. Within a few days of giving birth, 25% to 75% of new mothers experience emotional lability, or the "baby blues," and 10% to 20% of new mothers experience postpartum depression. The peripartum is thus a time of great joy potentially complicated by the entire range of psychiatric illness.

This issue of Psychiatric Issues in Emergency Care Settings considers psychiatric issues around the time of pregnancy and postpartum. The well-referenced review by Dr Chaudron anchors this issue. Dr Chaudron has written a comprehensive summary of topics that begins with the prenatal time, when depression is common and pregnancy loss can lead to significant dysfunction, to the time after pregnancy, when both the mother's and the baby's health and well-being must be considered in treatment decisions. The 3 case reports that follow (one by Dr Freeman, one by Drs Chaudron and Robertson-Blackmore, and one by Drs Patel and Chaudron) further emphasize the treatment issues faced in emergency situations.

While Dr Chaudron's review and the case reports tell us the current state of the art, Dr Scott's commentary reminds us that this is an area with a scant evidence base. Nevertheless, the articles in this issue provide a groundwork for those of us who practice in emergency settings to use when we see pregnant or postpartum women with psychiatric problems.

Although our cultural myths about the happiness of women during pregnancy and around the time of birth may not really be true, anyone who works with women of childbearing age can learn from this volume. Our job is to help women be happier and healthier during pregnancy and after childbirth. We must recognize the psychiatric comorbidities and refer patients for treatment that balances the risks and benefits to both the mother and child.

Rachel Lipson Glick, MD

Clinical Associate Professor

Department of Psychiatry

University of Michigan

Ann Arbor

References:

SUGGESTED READING

•Cohen LS, Nonacs RM, eds.

Mood and Anxiety Disorders During Pregnancy and Postpartum.

Washington, DC: American Psychiatric Press, Inc; 2005.•Stodland NL, Stewart DE, Munce SE, Rolfe DE. Obstetrics and gynecology. In: Levenson JL, ed.

Textbook

of Psychosomatic Medicine.

Washington, DC: American Psychiatric Press, Inc; 2005.