Perinatal psychiatry

Abstract 

Perinatal psychiatric disorders are common and can result in significant suffering for women and their families, indeed suicide is a leading cause of maternal death. The severest form of postpartum mood disorder, puerperal psychosis, follows approximately 1 in 1000 deliveries. Women with a history of bipolar disorder or who have suffered a previous severe postpartum episode are at a many hundredfold increased risk, and their identification in the antenatal period is a key aspect of management. Decisions regarding the use of psychotropic medication in pregnancy must be made following a full risk:benefit analysis. Risks of taking many medications remain unknown but include teratogenic effects, withdrawal or toxic symptoms in the newborn and long-term developmental effects. However, these must be balanced against the risks of untreated mental illness and the risk of recurrence from stopping or switching well-established and efficacious medications. More data is clearly needed to inform the difficult choices regarding medication that women with severe mental illness are forced to make in regard to pregnancy.

Keywords: perinatal, postnatal depression, postpartum, puerperal psychosis