Maternal Mental Health Flashcards
What are the two main periods when maternal mental health issues can occur?
Antenatal (during pregnancy) and postpartum (from birth until up to a year)
What are the possible presentations of maternal mental health issues?
- Continuation of existing Mental Disorder
- Relapse in pre-existing condition
- New onset Mental Disorder
- Baby Blues
Why are doctors particularly concerned about mental health during pregnancy?
- Risk of relapse for women with pre-existing conditions
- Pregnancy can be stressful (physical complications, anxiety, social difficulties)
- Effect of substance abuse on developing fetus
What is Baby Blues?
- Occurs 3rd to 5th day postpartum
- Lasts a few hours to days
- Symptoms include overwhelmed feelings, tearfulness, exhaustion, irritability
- Resolves naturally with support, rest, and good nutrition
What defines Postpartum Depression (PPD)?
- Occurs within 4 weeks of birth
- Affects 10-16% of women
- Diagnosis can be missed, often dismissed as hormonal imbalance or Baby Blues
- Suicide is a leading cause of maternal death in New Zealand
What are some risk factors for Postpartum Depression (PPD)?
- Previous History of Depression or PPD
- Discontinuation of medication
- Childhood abuse
- Negative attitude towards pregnancy
- Lack of social support
- Having twins or triplets
- Losing a baby
- Pregnancy and birth complications
What biological factors can contribute to PPD?
- Sudden change in hormone levels
- Lack of sleep
- Pain and feeding issues
What are some societal stressors contributing to PPD?
- Sudden change in lifestyle
- Societal expectation of the ‘Happy Mother’
What feelings of loss are associated with PPD?
- Loss of autonomy
- Loss of opportunity
- Loss of relationships
- Loss of finances
- Loss of sexuality and femininity
- Loss of occupational identity
How should PPD be detected?
- Screen all women who have had a baby
- Consult with patient and/or family
- Use Edinburgh Postnatal Depression Scale and PHQ-9
What are the effects of untreated PPD on mother-infant interactions?
- Decrease in affectionate behavior
- Decreased responsiveness to infant cues
What are the long-term effects of untreated PPD on childhood development?
- Increased behavior problems
- Poorer educational outcomes
- Diminished social competence
- Increased rates of mental disorder and risky behavior
What is Postpartum Psychosis (PPP)?
- Occurs in 1-2 episodes per 1000 births
- Rapid onset in the first 2 weeks postpartum
- Associated with suicide and infanticide
- Can be a recurrence of bipolar disorder or schizophrenia
What are common symptoms of Postpartum Psychosis (PPP)?
- Extreme agitation
- Paranoia, confusion, disorientation
- Inability to sleep/eat
- Losing touch with reality
- Delusions and hallucinations
- Disorganized behavior
What are clinical considerations for treating breastfeeding mothers with mental health issues?
- Careful risk/benefit assessment of treatment
- Weigh risks of treatment against untreated illness
- Mood stabilizers and antipsychotics have teratogenic effects
What percentage of fathers experience depression from the 1st trimester to 1 year after delivery?
5-10%
How can paternal mental health affect children?
- Directly via quality of interactions
- Indirectly via support to the mother and family environment
What is the importance of screening for maternal mental health issues?
To identify and treat conditions that can impact the mother, child, and family
Fill in the blank: Suicide is the leading cause of maternal death in ________ and several other Western countries.
New Zealand
True or False: PPD is seen across all cultures and socio-economic statuses.
True
What is the incidence rate of Postpartum Psychosis (PPP)?
1-2 episodes per 1000 births
When does clinical onset of Postpartum Psychosis typically occur?
Mostly in the first 2 weeks post-partum
What are the potential tragic outcomes associated with Postpartum Psychosis?
Suicide and infanticide (rare: 1-3 of 50,000 births)
What can trigger Postpartum Psychosis?
Recurrence of pre-existing bipolar disorder or schizophrenia or may be new onset
Who is at higher risk for developing Postpartum Depression (PPD)?
Women with a history of bipolar disorder or schizophrenia
What type of treatment is usually required for Postpartum Psychosis?
Inpatient stay and medication (antipsychotic and mood stabilizer)
List some symptoms of Postpartum Psychosis.
- Extreme agitation
- Paranoia, confusion, disorientation
- Inability to sleep/eat
- Losing touch with reality
- Delusions
- Hallucinations
- Disorganized behavior
- Psychomotor agitation
- Incoherent speech, irrational thinking
What is a warning sign of Postpartum Psychosis?
Extreme sleep disruption
What must be considered when treating breastfeeding mothers with mental illness?
Careful risk/benefit assessment
What are some teratogenic effects of medications used to treat bipolar disorder?
- Mood stabilizers (e.g., Lithium)
- Antipsychotic medications
Are SSRIs considered safer for breastfeeding mothers?
Yes, but some concerns and ongoing research
How do antidepressants affect breastfeeding?
Excreted into human breast milk – no clear harms but research ongoing
What adverse effects can maternal depression have?
Adverse effects on infants
What factors should be considered in the treatment of pregnant and breastfeeding women?
- Severity of illness
- Psychiatric history
- History of response
- Available safety data in lactation
What is the incidence of paternal depression from the 1st trimester to 1 year after delivery?
5-10%
What is the biggest correlation with paternal depression?
Depression in the partner
List some factors associated with paternal depression.
- Marriage problems
- Lifestyle change
- Role with partner and child
- Stress at work
- Feeling physically separated
How can fathers’ mental health affect their children?
- Directly via quality of interactions or genetic effects
- Indirectly via support to the mother and family environment
What are the potential next generation effects of paternal postnatal mental disorders?
- Behavior
- Emotional development
- Educational outcomes
What range of issues can maternal mental health encompass?
- Baby blues
- Transient distress
- Post-natal depression
- Postpartum psychosis
When should maternal mental health be screened?
By health professionals seeing either mother or baby
What are the risks of untreated maternal mental health issues?
- Immediate risk of suicide or infanticide
- Long-term intergenerational effects
