post partum Flashcards
prevalence or perinatal depression
Major depression during pregnancy
9.4 – 12.7%
- 1% in first 3 months
- 9% in first 12 months
prevalence of depression in MDD
25%-30% of women with history of MDD are at risk for postpartum depression
postpartum blues peaks
Features: tearfulness, lability, reactivity
different than postpartum depression
Peaks 3-5 days after delivery
Present in 50-80% of women
Common for women to feel this after their baby’s birth, but for 1 in 7 women this progresses to more serious mood disorder of PPD
blues correlate with the magnitude of the drop in
estrogen
these recptors are concentrated in the brain during pregnancy and the experience
how to progesterone play a role in blues
allopregnalone is the progesterone metabolite
this is a GABA agonists and CNS GABA levels & sensitivity may decrease during pregnancy as an adaptation
The reduced brain GABA may recover more slowly in women with “blues”
oxytocin
1 thing that helps uterus go back to normal post delivery
Peripheral effects include uterine contraction and milk ejection
disruption in oxytocin affects maternal behavior negatively
The normal heightened emotional responsiveness caused by oxytocin may predispose to depression in the context of high stress and low social support
criteria for MD
At least one of the following (by self-report or others’ observations) for 2 weeks
Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
four or more:
Changes in weight and appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feeling worthless or guilty Impaired concentration, indecisiveness Thoughts of death
Clinical Features of Postpartum Depression
Depressed, despondent and/or emotionally numb
Sleep disturbance, fatigue, irritability
Loss of appetite
Poor concentration
Feelings of inadequacy
Ego-dystonic thoughts of harming the baby
clinical presentation peaks
Clinical presentation peaks 3-6 months after delivery
by DSM -IV definition postpartum depression beings when
Begins within 4 weeks of birth
by DSM-IV definition
Postpartum period considered up to 1 year
Related to environmental stressors
Postpartum Psychoses
Bipolar disorder
Major depression with psychotic features
Schizophrenia spectrum disorders
Medical conditions (e.g. thyroid disease, low B12)
Drugs (e.g. amphetamines, hallucinogens, bromocriptine
1-2 per 1,000 women giving birth
About 35% of women with bipolar diathesis
onset of postpartum psychoses
Onset usually within 3 weeks postpartum
sxs of psychoses
Delusions (e.g. baby is possessed by a demon)
Hallucinations (e.g. seeing someone else’s face instead of baby’s face)
Insomnia
Confusion/disorientation (more than non-postpartum psychoses)
Rapid mood swings (more than non-postpartum psychoses)
Waxing and waning (can appear and feel normal for stretches of time between psychotic symptoms)
Factors That May Contribute To Risks Associated With Antenatal Depression
Indirect effects
Reduced prenatal care
Less optimal nutrition
Poor appetite and weight loss
Socioeconomic deprivation
Increased use of cigarettes and alcohol
Direct effects
Changes in cortisol & HPA
axis development
Effects of Untreated Depression on Obstetric Complications
Low birth weight
Premature birth
Pre-eclampsia
effects of antenatal depression
Newborns cry excessively and are more inconsolable
Babies (up to age 1) have poorer growth and increased risk of infection
Children (up to age 5) have more difficult temperaments, more distress, sadness, fear, shyness, frustration
Early Consequences of Untreated Postpartum Depression for Offspring
Sometimes none
Disturbed mother-infant relationship
Cortisol elevation (baby and mother)
Failure to thrive
Physical injury/death
Later Consequences of Prolonged Maternal Depression for Offspring
Depression
Behavioral disturbance, including conduct disorder
Reduced cognitive abilities
More school problems (truancy, dropping out)
Role reversal
Effects of Maternal Stress and Anxiety During Pregnancy (5)
Altered fetal hemodynamics and movement
Lower gestational age
Lower infant birth weight
Lower Apgar scores
Enduring changes in cortisol measures in offspring – so far observed up to age 10
Potential Effects of Postpartum Depression on Relationships
Altered roles within the couple
Altered roles within the extended family
Establishing alternate caregiver patterns that become difficult to change later
Impaired communication
Psychiatric symptoms in the partner
increase risk of suicide in post partum depression
Pregnancy is unwanted, especially when woman wanted an abortion but could not obtain one
Partner abandoned woman during pregnancy
Woman has had prior pregnancy loss and/or death of children
prevalence of thoughts of harm: low risk
Common in non-psychotic PPD – 41% of depressed mothers vs 7% of controls
ego-dystonic (obsessive in nature & odd/frightening to mother)
Mother has taken steps to protect baby (distance)
Thoughts of Harming Baby: High Risk
Mother has delusional beliefs about the baby
e.g. that the baby is a demon
Thoughts of harming baby are ego-syntonic
mother thinks they are reasonable and/or feels tempted to act on them
Mother has a history of violence
Mother has labile mood and/or impulsive behavior
attachment theroy impacts
Infants of depressed mothers are at high risk for developing an insecure attachment
Relational problems between infants and their caregivers are connected to early social, emotional, and behavioral problems for children
