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The long-term psychiatric and medical prognosis of perinatal mental illness

https://doi.org/10.1016/j.bpobgyn.2013.08.009Get rights and content

The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions.

Introduction

The perinatal period is a critical time in a women's life that is influenced by multiple factors that have consequences on the outcome of the pregnancy, but also may have significant long-term implications. Misri et al. [1] cogently described a ‘women's life span approach model to perinatal health,’ which recognises the myriad of determinants in the perinatal period and integrates the social, psychological, behavioural, environmental and biological forces that shape pregnancy and provide a model that demonstrates the interrelationships that influence long-term health. In this model, the entire life span is considered, including the role of preconception health factors that may occur long before pregnancy begins (i.e. pre-pregnancy obesity), as well as the multiple determinants that require targeted intervention to allow for improvements in perinatal outcomes [1]. This is important, as growing evidence suggests that complications during the perinatal period may provide a window into a woman's long-term health [2]. The stressors of major hormonal fluctuations, sleep deprivation, and caring for a new infant may trigger perinatal mental illness and unmask a psychobiological vulnerability that may manifest as psychiatric disease in later life. In this chapter, we take a multiple determinants approach and discuss long-term psychiatric and medical consequences of perinatal mental illness. We first examine the long-term risk of developing a chronic mood disorder (both unipolar and bipolar depression) among women who experience perinatal mental health and also discuss perinatal obsessive–compulsive disorder and long-term prognosis. Second, we discuss the strength of the evidence linking perinatal mental illness with obstetrical and other medical outcomes, including weight retention, pregnancy complications, and lactation difficulties.

Section snippets

Long-term psychiatric complications of perinatal mental illness

Perinatal mental illness confers potential serious long-term psychiatric and medical consequences for the mother, her baby, and the family [3], [4], [5]. Some are the result of maladaptive behaviours by women who experience depression during pregnancy. Women with antenatal depression are less likely to participate in recommended prenatal care practices, and are at increased risk of engaging in risky health behaviours, such as smoking and substance use in pregnancy [4], thereby increasing risk

Biological underpinnings and long-term risk of perinatal mental illness

Childbirth acts as a powerful trigger for depressive episodes in some women, and women with histories of mood disorders are vulnerable to a psychobiological postpartum trigger [23], [24], [25]. Recent work by Di Florio et al. [23] documents that more than 70% of parous women with a history of a mood disorder will experience at least one perinatal mood episode in relationship to pregnancy and childbirth. Moreover, women with previous histories of a mood disorder (unipolar and bipolar disorder)

Long-term obstetrical and medical outcomes of perinatal mental illness

Research on maternal perinatal mental illness with non-psychiatric long-term outcomes is scant; however, evidence of a link between perinatal anxiety and depression has been found with both pregnancy complications and reduced lactation initiation and duration. Both pregnancy complications and impaired lactation are associated with long-term maternal disease risk, and so it is plausible that women who experience perinatal mental illness may be at increased risk of other chronic disease

Clinical implications and directions for future research

Existing data suggest that psychiatric, obstetrical, and medical complications during pregnancy and the puerperium provide a window into a woman's long-term health. Women with a prior history of perinatal mood disorder (unipolar and bipolar depression) are at significantly increased risk for a recurrent episode in both the context of childbearing and outside of the perinatal period. Furthermore, evidence suggests that women with perinatal mental illness may be more likely to develop pregnancy

Conclusion

Childbirth acts as a powerful trigger for mood episodes in some women, and women with histories of a mood disorder are particularly vulnerable. Risk of recurrence of perinatal mental illness is considerable, both in the context of childbearing and outside of the perinatal period. Thus, perinatal mental illness does have long-term psychiatric outcomes that must be appropriately managed and addressed by the woman in partnership with her providers. Important evidence also links perinatal mental

Conflict of interest

None declared.

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