Effect of Maternal Mental Illness on Pregnancy Outcomes

Katherine J Gold; Sheila M Marcus

Expert Rev of Obstet Gynecol. 2008;3(3):391-401.

Abstract and Introduction

Abstract

Many pregnant women experience psychiatric disorders in their childbearing years. Emerging research shows mental illness not only affects the mother's well-being but may also have significant effects on fetal outcomes. This review details what is known about the prevalence of mental illness during pregnancy as well as how such disorders may influence pregnancy outcomes. Maternal depression during pregnancy is an independent risk factor for low fetal birthweight and premature delivery, but other illnesses, such as anxiety disorders, eating disorders and psychotic illness, may also predict adverse birth outcomes. Possible behavioral, genetic and neuroendocrine mechanisms for these relationships are presented. Principles of treatment for psychiatric disorders during pregnancy are also discussed, with an emphasis on the role of the obstetrical provider.

Introduction

Nearly half of Americans will have a mental illness in their lifetime, and one out of four experiences a psychiatric disorder in any given year.^[1,2] Since the majority of these illnesses start before or during the child-bearing years, many pregnant women have significant psychiatric comorbidity ( Table 1 ). Most research has focused on the impact of stress, anxiety and depression on the developing fetus, but newer studies indicate that a wide variety of mental disorders can pose a risk for adverse pregnancy outcomes. In order to make appropriate decisions regarding whether, and how, to treat psychiatric symptoms during pregnancy, providers must understand what is known about the impact of untreated illness on the pregnancy and weigh these risks against potential risks from psychiatric medications used for treatment.

Preterm delivery (PTD) and low birthweight (LBW) continue to be significant risk factors for fetal and infant death and complications. If mental health affects timing of delivery or fetal growth there might be new approaches to improving perinatal outcomes. Despite widespread recognition that postpartum depression and postpartum psychosis present substantial risks for infant and child outcomes, the impact of antenatal mental illness on the fetus is less well understood. This review summarizes how psychiatric illness during pregnancy affects fetal outcomes and how obstetrical practitioners might use this information to provide optimal patient care. The review also highlights the current research and gaps in understanding relationships between mental health and pregnancy outcomes and proposes key areas where additional research is needed.

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Cite this: Effect of Maternal Mental Illness on Pregnancy Outcomes - Medscape - May 01, 2008.

Abstract and Introduction
Maternal Stress
Depressive Disorders
Anxiety Disorders
Other Psychiatric Disorders
Treatment Considerations
Explaining Mental Health Effects on Birth Outcomes
Limitations in Existing Research
Expert Commentary
Five-year View
Sidebar: Key Issues
References

Table 1. Estimated Prevalence of Selected Psychiatric Illness During Pregnancy
Disorder	Illness	Estimated prevalence (%)	Ref.
Depressive disorders	Major depression	13-20	^[10,87]
Depressive disorders	Bipolar disorder	Unknown
Anxiety disorders	General anxiety disorder	8.5	^[25,28]
	Panic disorder	1-2
	Post-traumatic stress disorder	3.5
	Obsessive-compulsive disorder	0.2-1.2
Eating disorders	Anorexia only	1.4	^[43]
	Bulimia only	1.6
	Both anorexia and bulimia	0.7
Personality disorders		6.4
Psychotic disorders		Unknown	^[35]

Box 1. Treatment Recommendations for Obstetric Providers Caring for Pregnant Women with Psychiatric Illness
Screen all pregnant women for depression using a standard tool, such as the Edinburgh Postnatal Depression Scale (which can be used both during and after pregnancy) Coordinate care with providers who are knowledgeable about psychiatric illness during pregnancy, particularly for women with recurrent, severe or complex disease When possible, incorporate nonpharmacologic treatment options such as cognitive-behavioral therapy, interpersonal therapy, support groups and stress education Balance risks of psychotropic medications with the risks of untreated psychiatric disease, which can have significant adverse effects on a pregnancy Recognize that for some women with moderate or severe disease, pharmacotherapy may be the most appropriate treatment to treat the disorder and prevent relapse

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