Introduction

Motherhood is supposedly a wonderful and fulfilling experience for most women. Unfortunately some women will face emotional and psychological problems during pregnancy and after delivery. For women who are mentally ill, pregnancy can be quite detrimental to their mental health if it’s not planned or managed properly.

Pre-pregnancy:

Women with pre existing mental illness should consult their therapists doctors/specialists before conceiving. They should find out regarding impact of disorder and its treatment on their health and fetus such as:

• Risk of relapse
• Risks associated with stopping or changing medication
• Risk to the fetus

During pregnancy and after delivery:

For women with history of or currently having mild symptoms of illnesses listed below, early referral to mental health service is advisable even if current mental status is stable.

• Serious mental illness such as schizophrenia, bipolar disorder, schizoaffective disorder or severe depression
• Postpartum psychosis or severe postnatal depression
• Severe anxiety disorder such as obsessive compulsive disorder
• Eating disorder such as anorexia or bulimia

Women with above illnesses have a high risk of becoming unwell during and also after childbirth. Mental health professionals will discuss about care and treatment choices most suitable for them.

Treatment:

The best treatment will depends on the type and severity of illness. Treatment modalities include medication and psychological therapies.

Medication

It is important to discuss medication with mental health professionals to get information needed to decide what’s best for mother and baby. The best time is to discuss before conceiving, however many pregnancies are unplanned. Therefore, consult doctors as soon as the condition is known.

It is very important not to stop medication before discussing with mental health professionals. This may result in relapse of the mental illness. Doctors will help in giving information regarding advantages and disadvantages of stopping/ continuing with medication and choosing particular medication. Even though no psychotropic drug has been approved by Food and Drugs Administration (FDA) for use during pregnancy, there are medications that have been used and didn’t show any increase risk for the fetuses.

Some of the points to think of before making decisions include:

• Past history of relapse(s)
• How fast illness relapse upon stopping medication
• Type(s) of medication most suitable
• Latest information about drug safety during pregnancy and breastfeeding

Psychological therapies

This modality may be helpful for some women instead of medication. However, some may require both medication and psychological therapies.

References:

1. ‘Mental health in pregnancy’. Updated 2012. Leaflet by Royal College of Psychiatrists, UK.
2. ‘Pregnancy and mental health’. Website Stanford school of Medicine
3. ‘Antenatal and postnatal mental health. Quick reference guide.’ National Institute for Health and Clinical Excellence (NICE).