Objectives

On successfully completing this topic, you will be able to:

• acknowledge the prevalence of mental health problems in the pregnant population

• recognise the importance of identifying the at-risk woman

• be aware of the need for team working with mental health teams

• be prepared for the onset of acute mental health problems after delivery

• understand the effects on the infant of maternal mental health medications and the need to collaborate with other specialties, both in pregnancy and after birth.

Introduction

Mental health problems are common in the community at large, with an incidence of at least 20%. The most common mental health problems are mixed anxiety and depression. Women are at least twice as likely to suffer from these conditions as men and they are most prevalent among younger women with children under the age of 5 years. Serious mental illnesses, such as schizophrenia and bipolar disorder (manic depressive illness), are less common, with a prevalence of approximately 1% for each condition and are no more common in women than in men.

Mental health problems in pregnancy

Conception rates in women with mental disorder (with the exception of severe learning disability and anorexia nervosa) are the same as the general population. Antenatal depression and anxiety are therefore common and as common as after delivery, affecting 10–20% of all women. In addition, women with personality disorders, panic disorder, obsessive compulsive disorder, psychoses, substance misuse and eating disorders will become pregnant.

The incidence (new onset) of serious mental illness (schizophrenia, psychoses and bipolar disorder) during pregnancy is markedly reduced compared with other times. However, serious mental illness does sometimes occur for the first time during pregnancy and poses particular management problems.