As more research is conducted within the field of women's mental health, there are times when recommendations may change depending on the available data.  We will discuss a case here to illustrate this point.
Our Perinatal and Reproductive Psychiatry team often discusses clinical cases in Rounds, a confidential forum in which we can get advice and consultation from peers who also work in the area of Women's Mental Health. We discussed a patient's situation recently that highlighted the controversial area about how to prevent mood episodes in a woman planning for pregnancy.
A study published in the Archives of General Psychiatry shows that children of women who experience the death of a close relative may have an increased risk of developing schizophrenia later in life. Â This study was conducted with records of children born in Denmark between 1973 and 1995, which were then linked to the central registry containing inpatient and outpatient treatment records. It consisted of 1.38 million individuals, including 21,978 children whose mothers experienced death of a close relative during the pregnancy, and 14,206 children of mothers who experienced illness of a close relative during the pregnancy.
Mood disorders and symptoms during pregnancy and the postpartum period are not uncommon and affect women across the world. Â In spite of relatively high rates of depression among childbearing women, there are often inadequate resources for treatment, particularly in poorer countries. In countries lacking resources, health care is often managed by community health workers or individuals with basic health care training who provide care to difficult-to-reach populations. There are often few mental health professionals, leaving many women without adequate treatment. In an attempt to provide treatment to a greater number of women, some investigators are attempting to train community health workers to provide some psychotherapy as part of their standard duties.
Earlier this year, Dr. Lee S. Cohen, Director of the MGH Center for Women's Mental Health, spoke with Dr. Mehmet Oz from Oprah.com and a woman with bipolar disorder about mood disorders during pregnancy and weighing the risks of treatment options.
Given recent discussions within our group and with our colleague, Lewis Holmes, MD, chief of the Genetics and Teratology Unit at Massachusetts General Hospital for Children and director of the North American AED (Antiepileptic Drug) Pregnancy Registry, I wanted to expand upon a previous blog post. In the initial post, I wrote that women who take certain medications, like mood stabilizers or antiepileptic drugs, are advised to take increased doses of folic acid before pregnancy and throughout pregnancy.
A new study reported in Human Reproduction supports what many other studies have found, that untreated depression during pregnancy increases the likelihood of delivering before 37 weeks gestation.
Infertility and its treatment have been shown to be a trigger for both depression and anxiety. Women with pre-existing histories of depression and anxiety who have been stable on medication may find themselves with worsening symptoms brought on by the stress involved in the process of infertility treatment. Many women find the process an emotional roller coaster of hopefulness and disappointment.
A recent population-based case-control study published in the American Journal of Obstetrics & Gynecology used Washington State birth certificates linked to hospital discharge data to evaluate the association between hospitalization for a psychiatric illness before delivery and risk of postpartum suicide attempt. The study compared women hospitalized for a postpartum suicide attempt (n = 355) with a group of controls who had not been hospitalized (n = 1420).
The link between maternal depression and anxiety during pregnancy and adverse neonatal outcome has been well-documented in the medical literature and reviewed on our website. A recent study published in the journal Early Human Development suggests that a mother's stress during pregnancy may also negatively affect her baby's sleep patterns.
