LEC 9: Maternal Mental Health

Question 1

Signs and Symptoms of Maternal Mental Health Problems

Answer 1

• Depressed mood most of the day
• Anhedonia
• Weight changes
• INsomnia or hypersomnia
• Psychomotor: restless, agitated, slowed
• Dominished energy level
• Feelings of worthlessness or excessive guilt
• Decreased concentration
• Increased indicisiveness
• Recurrent thoughts of death or suicide

Question 2

Anhedonia

Answer 2

Severly diminished interest or pleasure in activities.

Question 3

The Pinks

Answer 3

• 11%, 44% high risk
• Elation hours/ days after birth
• Normal to be happy and excited
  
  • But extreemes in mood in either direction need to be monitored
• Early discharge
• Sleep
• Bipolar
• Expectations of pregnancy

Question 5

Postpartum Blues

Answer 5

• “Normal” transient, emotional response
• Up to 85% of women spontaneously recover by 2 weeks
  
  • Depressed 2 to 3 days
  • PPD 4 to 8 weeks
  • Social support
• 60% of woman experience their first major depression in PP
• Idealization of birth and motherhood
• Hormones, thyroid, cholesterol, folate, anemia, stress
• Confirms need for increased wareness, early identification, and timely intervention

Question 6

Anxiety

Answer 6

• 4% to 15% of women
  
  • Up to 24% in pregnancy
• Inability to relax, persistent arousal
• Fearfulness, phobic
• Preoccupied/ Over-concern with baby
• High parenting expectations
• Panic attacks
  
  • Tension, sweats, palpitation
• Temporal relationship with depression

Question 7

Obsessive Compulsive Disease (OCD)

Answer 7

• Cleaning
• Checking
  
  • Baby, house
• Counting
• Ordering
• Obsession with germs, cleanliness
• Intrusive, repetitive thoughts
  
  • Harm coming to baby
• Guilt, worry, shame
• Hypervigilent
• Behaviours to avoid harm or minimize triggers
• Assure
  
  • Though does not equal action

Question 8

Post Traumatic Stress Disorder (PTSD)

Answer 8

• Around 3% of births
• Anxiety Disorder
  
  • Post terrifying event where grave harm occured or was threatened
• Birth
  
  • Powerless
  • Uncared for
  • No trust
  • Poor communiation
• Risk
• Birth Complications with Mother or Baby
  
  • Hemorrhage
  • Emergency C-section
  • Preterm birth
  • NICU baby
• Previous PTSD
• Previous sexual abuse

Question 9

Postpartum Psychosis

Answer 9

• 0.1 to 0.2% of women
• Insomnia, agitation, hallucinations, bizzarre perceptions
• Self-harm, infanticide, homicide
• Bipolarity, mood swings
• Usually in 1st few weeks and later up
• Associated with sleep disturbances

Question 12

Risk Factors

Answer 12

• Sociodemogeaphic
  
  • Gender
  • Ager
  • Income
  • Single
  • New immigrant
  • Ethnicity
• History of Depression
  
  • Psychiatric problems
  • Own and family
  • Mood reactions to hormonal cahnges
• Social
  
  • Unplanned
  • Lack of social support
  • Relationship issues
  • Partner and substance abuse
• Medical
  
  • Fertility problems
  • Obstetrical difficulties
  • Previous losses
  • Thyroid
  • Anemia
  • Pain
• Lack of sleep
• Mother issies
• 20% of all women are vulnerable

Question 13

Stress- Anxiety

Answer 13

• Unavoidable
• Short term = Adaptive
• :ong term = Harmful
• “Normal-ize” anxiety in pregnancy
  
  • “Good” mothers ‘worry’ about doing right thing
• But worry and effects of it are distressing in non-pregnant
  
  • Real or perceived stress

Question 14

Cortisol

Answer 14

• The stress hormone
• Normalize worry in childbearing women
• Hypothalamic-pituitary-adrenal HPA axis-placental neuroendocrine axis
• Maternal stress can affecct fetal development
  
  • Sustained pattern of stress reaction throughout life
  • Neuronal death and abnormal development of fetal brain structures

Question 15

Effects of Mental Health Problems on the Mother

Answer 15

• Relationship
  
  • Partners 10% of men overall
  • 75% if wife secerly depressed
• Gestational hypertension
• Abruption placenta
• Increased for epidural, operative, and preterm deliveries
• Less prenatal care, prenatal vitamins
• Increas in alcohol and smoking

Question 16

Effects of Mental Health Problems on the Baby

Answer 16

• Preterm
• Decreased apgar
• Decreased birth weight and weight gain
• Less and shoeter duration of breastfeeding
• Behaviour
  
  • More withdrawn, irritable, less consolable, depressed
• Patterns of stress reaction
• 3.3 times the risk of Sudden Infant Death Syndrom
• Effects of lifestyle

Question 17

Effects of Mental Health Problems on the Child

Answer 17

• Behaviour
  
  • Anxiety in pregnancy = inceased 3 times ADHD in boys and depression in girls
• Emergency room visits, somatic complaints
• Social and school difficulties
• Autism
• Criminality
• Mothers less attentive to safety and stimulation
  
  • Injuries and hospitalizations

Question 18

What can we do when women are experiencing postpartum depression?

Answer 18

• Pregnancy and postpartum are times of increased contact with health services
• Chance for the early identification of maternal mental illnesses

Question 19

Maternal Mental health Strategy

Answer 19

• 2 Initiatives to improve maternal mental health
  
  1. Increase awareness in SK
  2. Building capacity in SK

Question 20

Promote Positive Mental Health

Answer 20

• Exercise
  
  • Walking, swimming
• Sleep 6 hours in 24 hours
• Nutrition
• Simplify life
• Yoga or other relaxation
• Support quitting self-medication
  
  • Smoking, drinking, drugs

Question 21

Recommendations for Maternal Health

Answer 21

1. Education and Increase awareness
2. Universal screening
   
   • Normalize- we care about all aspects of your health- aphysical and mental
3. Prioritize pregnant and postpartum women in MHS
   
   • Accessible in each region
   • Increase treatment options
4. Sustainability and accountability
   5.

Question 22

Medications during Pregnancy

Answer 22

• First though is to come off
  
  • Up to 50-75% will relapse
  • 35% of pregnant women who are taking medications, are taking psychotropic medications
  • Up to 50% pregnancies are unplanned
• 1st month most critical
  
  • Teratogenesis
  • Most women don’t knowo pregnant
• If start medication during pregnancy
  
  • Not likely to beging until after 1st few weeks
• Neonatal adaptation syndrome
  
  • Transitory

Question 23

Medications

Answer 23

• SSRIs
  
  • Keep on one that they are stablized
  • Sertraline: Low transfer to fetus and through breastmilk
  • Wellbutrin, Zyban: Helps with depression and quitting smoking
• Atypical Antipsychotics
  
  • Anxiety
• Bipolar
  
  • Treatment can be problematic
  • Valporic Acid/ Epival and other anticonvulsants can increase risk for NTD
  • Lamotragine better tolerated
  • Increase in preconceptual and pregnancy Folic Acid

Question 24

Medication and Dosing

Answer 24

• Always aim for the lowest, most effective dose
  
  • Undertreatment
• Tapering
  
  • Lithium
• Depressive symptoms tend to increase as delivery appraoches- Hemodilution
  
  • If woman has decreased or discontinued medication closely monitor symptoms
• Medications may be needed ot help stabilize mood so that other approaches can work

Question 25

Other Forms of Therpay for Maternal Mental Health

Answer 25

• Electroconvulsice therapy (ECT)
• Bright light therapy
• Alternate treatment
  
  • Food and supplements
    
    • Folic acid
    • Omega 3 fatty acids
    • Vitamin D
    • St. John’s worth contraindicated in pregnancy
• Acupuncture, massage, meditation
• Group support, listening visitis, psychoeducational/interpersonal therapy

Question 26

Symptoms of Depression

Answer 26

• Less interest in things you usually like
• Crying for no reason
• Irritable, angry, or more sensitive
• More tired or feeling hyper
• Not sleeping or sleeping to much
• Problems concentrating
• Not able to cope
• Anxious or panicked
• Thoughts of harming yourself, your baby, or others