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Obstetrical & Gynecological Survey Apr 2021Psychological reactions to perinatal loss, although often self-limited, may lead to significant psychological morbidities. Obstetrician-gynecologists and other maternal... (Review)
Review
IMPORTANCE
Psychological reactions to perinatal loss, although often self-limited, may lead to significant psychological morbidities. Obstetrician-gynecologists and other maternal health providers play a key role in recognizing the range of psychological responses to perinatal loss and providing education, support, and treatment options to their patients.
OBJECTIVE
This review aims to define psychological reactions associated with perinatal loss, examine psychotherapy and psychopharmacologic treatments for psychiatric morbidities, discuss interpregnancy interval following perinatal loss, and highlight brief, psychological interventions that can be implemented by maternal health providers.
EVIDENCE ACQUISITION
Search terms "perinatal loss psychology," "reproductive loss grief," "perinatal psychopharmacology," "psychopharmacology grief," and "interpregnancy interval" were utilized to search PubMed, Google Scholar, and PsycINFO.
RESULTS
Grief is an expected, normal response to perinatal loss. Psychological morbidities, including major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder, are also associated with perinatal loss. Risk factors for these conditions include history of a psychiatric illness, childlessness, unknown cause of perinatal loss, limited social support, and marital/relationship discord. Careful interviewing and brief screening measures can help identify patients who may suffer from depressive or anxiety disorders following reproductive loss. Patients with perinatal loss can benefit from psychological and possibly pharmacologic treatments. Recommended interpregnancy interval after perinatal loss should be customized by gestational age and cause of loss.
CONCLUSIONS AND RELEVANCE
Patients with perinatal loss emotionally benefit from their reproductive health care providers acknowledging the psychological aspects of reproductive loss, inquiring about their emotional needs, and providing information regarding grief and mental health referrals.
Topics: Abortion, Spontaneous; Female; Humans; Maternal Health Services; Mental Disorders; Postnatal Care; Pregnancy; Psychotherapy; Puerperal Disorders
PubMed: 33908614
DOI: 10.1097/OGX.0000000000000874 -
JAMA Psychiatry Feb 2013CONTEXT Affective disorders are common in women, with many episodes having an onset in pregnancy or during the postpartum period. OBJECTIVE To investigate the occurrence...
CONTEXT Affective disorders are common in women, with many episodes having an onset in pregnancy or during the postpartum period. OBJECTIVE To investigate the occurrence and timing of perinatal mood episodes in women with bipolar I disorder, bipolar II disorder, and recurrent major depression (RMD). SETTING AND PATIENTS Women were recruited in our ongoing research on the genetic and nongenetic determinants of major affective disorders. Participants were interviewed and case notes were reviewed. Best-estimate diagnoses were made according to DSM-IV criteria. The 1785 parous women identified included 1212 women with bipolar disorder (980 with type I and 232 with type II) and 573 with RMD. Data were available on 3017 live births. MAIN OUTCOME MEASURES We report the lifetime occurrence of perinatal mood episodes, the rates of perinatal episodes per pregnancy/postpartum period, and the timing of the onset of episodes in relation to delivery. RESULTS More than two-thirds of all diagnostic groups reported at least 1 lifetime episode of illness during pregnancy or the postpartum period. Women with bipolar I disorder reported an approximately 50% risk of a perinatal major affective episode per pregnancy/postpartum period. Risks were lower in women with RMD or bipolar II disorder, at approximately 40% per pregnancy/postpartum period. Mood episodes were significantly more common in the postpartum period in bipolar I disorder and RMD. Most perinatal episodes occurred within the first postpartum month, with mania or psychosis having an earlier onset than depression. CONCLUSIONS Although episodes of postpartum mood disorder are more common in bipolar I disorder and manic and psychotic presentations occur earlier in the postpartum period, perinatal episodes are highly prevalent across the mood disorder spectrum.
Topics: Adult; Age of Onset; Bipolar Disorder; Data Interpretation, Statistical; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Female; Genetic Predisposition to Disease; Health Surveys; Humans; Middle Aged; Peripartum Period; Pregnancy; Pregnancy Complications; Prevalence; Puerperal Disorders; Recurrence; Risk Factors; Time Factors; United Kingdom
PubMed: 23247604
DOI: 10.1001/jamapsychiatry.2013.279 -
Diseases of the Nervous System Dec 1974The authors describe clinical features of thirteen patients with postpartum psychoses and present data from a follow-up study with an average duration of six years. In...
The authors describe clinical features of thirteen patients with postpartum psychoses and present data from a follow-up study with an average duration of six years. In particular, three patients are described who showed rapidly alternating manic and depressive symptoms. The theoretical and therapeutic implications of these findings are discussed.
Topics: Adult; Ambulatory Care; Bipolar Disorder; Conflict, Psychological; Depression; Female; Follow-Up Studies; Hospitalization; Humans; Interview, Psychological; Marriage; Medical Records; Psychotic Disorders; Puerperal Disorders; Schizophrenia
PubMed: 17896755
DOI: No ID Found -
Comprehensive Psychiatry 1989Postpartum emotional disorders generally fall into one of three categories: "blues," depressions, or psychoses. Such postpartum syndromes are described as to their... (Review)
Review
Postpartum emotional disorders generally fall into one of three categories: "blues," depressions, or psychoses. Such postpartum syndromes are described as to their presenting symptomatology, phenomenology, treatment, and prognosis. The role of the appropriate use of psychotropic medication in these conditions, after proper diagnosis, is also discussed. This overview is meant to be helpful to consultation-liaison psychiatrists and to other psychiatrists who work closely with obstetricians and primary care physicians.
Topics: Depressive Disorder; Female; Humans; Pregnancy; Psychotic Disorders; Puerperal Disorders; Risk Factors
PubMed: 2647399
DOI: 10.1016/0010-440x(89)90124-7 -
The Journal of Clinical Psychiatry Jul 1988The literature on postpartum psychiatric disorders is limited to descriptions of depressive and/or psychotic syndromes. The authors describe three cases of panic...
The literature on postpartum psychiatric disorders is limited to descriptions of depressive and/or psychotic syndromes. The authors describe three cases of panic disorder presenting for the first time in the early postpartum period. Clinicians should differentiate between postpartum panic disorder and the well-recognized presentation of postpartum depression.
Topics: Adult; Anxiety Disorders; Depressive Disorder; Diagnosis, Differential; Fear; Female; Humans; Life Change Events; Panic; Pregnancy; Puerperal Disorders; Thyroid Function Tests
PubMed: 3391980
DOI: No ID Found -
International Journal of Obstetric... Nov 2020This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder. (Observational Study)
Observational Study
BACKGROUND
This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder.
METHODS
In this prospective, longitudinal, observational study, women were assessed at different time points for depression and post-traumatic stress disorder. The risk of depression or post-traumatic stress disorder based on patient characteristics and specific birth events was assessed within three months postpartum.
RESULTS
We enrolled 600 women; 426 were eligible for postpartum assessment. At six weeks and three months postpartum, 15.9% and 12.7% screened positive for depression respectively. Positive post-traumatic stress disorder screenings at six weeks and three months postpartum were 6.2% and 5.1% respectively. Twenty-seven women (8.3%) with a negative screening at six weeks converted to a positive depression or post-traumatic stress disorder screening at three months. A pre-existing history of anxiety or depression was associated with an increased risk of developing depression (aOR 2.12, 95% CI 1.30 to 3.47) and post-traumatic stress (aOR 3.15, 95% CI 1.42 to 7.02) within three months postpartum. The risk of developing post-traumatic stress disorder within three months postpartum was also increased among patients experiencing their first delivery (aOR 2.55, 95% CI 1.10 to 5.88) or operative management of postpartum hemorrhage (aOR 4.44, 95% CI 1.16 to 17.02).
CONCLUSION
Depression and post-traumatic stress symptoms either persisted or had new onset at three months postpartum. Mental health screening and postpartum follow-up after six weeks should be considered in high-risk patients who have a history of psychopathology, nulliparity, or undergo operative management of postpartum hemorrhage.
Topics: Adolescent; Adult; Depression, Postpartum; Female; Humans; Longitudinal Studies; Parturition; Prospective Studies; Puerperal Disorders; Risk Factors; Stress Disorders, Post-Traumatic; Surveys and Questionnaires; Young Adult
PubMed: 32861082
DOI: 10.1016/j.ijoa.2020.07.008 -
Acta Psychiatrica Scandinavica Nov 2004To study adult mental health in offspring of mothers who experienced severe puerperal disorder.
OBJECTIVE
To study adult mental health in offspring of mothers who experienced severe puerperal disorder.
METHOD
Mothers, followed up a mean of 23 years after puerperal disorder requiring hospitalization, were interviewed regarding adult psychiatric illness, childhood neurotic symptoms and conduct problems of 48 offspring of the index episode and 62 additional siblings.
RESULTS
In these predominantly young adults the lifetime rate of ICD-10 adult psychiatric illness was 26%, and was higher in offspring of puerperal episodes (35% vs. 15%, P = 0.07). There were also high rates of childhood symptoms and problems.
CONCLUSION
There are high lifetime rates of adult psychiatric illness in young adult offspring of mothers with puerperal disorder, which are likely to increase further with time, and warrant special attention.
Topics: Adolescent; Adult; Child; Conduct Disorder; Female; Follow-Up Studies; Hospitalization; Humans; Mental Health; Mother-Child Relations; Neurotic Disorders; Psychotic Disorders; Puerperal Disorders; Risk Factors; Siblings
PubMed: 15458560
DOI: 10.1111/j.1600-0447.2004.00406.x -
Endocrinology and Metabolism Clinics of... Jun 2000Postpartum thyroiditis is the most common endocrinologic disorder, with an incidence that varies geographically from 5% to 10%. It has important clinical sequelae... (Review)
Review
Postpartum thyroiditis is the most common endocrinologic disorder, with an incidence that varies geographically from 5% to 10%. It has important clinical sequelae including symptoms of hyperthyroidism, hypothyroidism, and depression. Long-term follow-up of women who experience postpartum thyroiditis reveals a high recurrence rate in subsequent pregnancies. Postpartum thyroiditis is an autoimmune disorder, and thyroid antibody-positive women in the first trimester have a 33% to 50% chance of developing thyroiditis in the postpartum period. Whether or not to screen for postpartum thyroiditis remains controversial.
Topics: Autoimmune Diseases; Depression, Postpartum; Female; Humans; Hyperthyroidism; Hypothyroidism; Puerperal Disorders; Thyroiditis; Thyroiditis, Autoimmune; Ultrasonography
PubMed: 10874538
DOI: 10.1016/s0889-8529(05)70140-7 -
Cognition & Emotion 2015Perinatal psychological problems such as post-natal depression are associated with poor mother-baby interaction, but the reason for this is not clear. One explanation is... (Review)
Review
Perinatal psychological problems such as post-natal depression are associated with poor mother-baby interaction, but the reason for this is not clear. One explanation is that mothers with negative mood have biased processing of infant emotion. This review aimed to synthesise research on processing of infant emotion by pregnant or post-natal women with anxiety, depression or post-traumatic stress disorder (PTSD). Systematic searches were carried out on 11 electronic databases using terms related to negative affect, childbirth and perception of emotion. Fourteen studies were identified which looked at the effect of depression, anxiety and PTSD on interpretation of infant emotional expressions (k = 10), or reaction times when asked to ignore emotional expressions (k = 4). Results suggest mothers with depression and anxiety are more likely to identify negative emotions (i.e., sadness) and less accurate at identifying positive emotions (i.e., happiness) in infant faces. Additionally, women with depression may disengage faster from positive and negative infant emotional expressions. Very few studies examined PTSD (k = 2), but results suggest biases towards specific infant emotions may be influenced by characteristics of the traumatic event. The implications of this research for mother-infant interaction are explored.
Topics: Depression, Postpartum; Depressive Disorder, Major; Emotional Intelligence; Emotions; Female; Humans; Infant; Infant, Newborn; Judgment; Mother-Child Relations; Pregnancy; Pregnancy Complications; Psychology, Child; Puerperal Disorders; Reaction Time; Stress Disorders, Post-Traumatic
PubMed: 25472032
DOI: 10.1080/02699931.2014.977849 -
International Journal of Cardiology Jun 2007Peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular dysfunction and symptoms of heart failure occur in the peripartum period in previously... (Review)
Review
Peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular dysfunction and symptoms of heart failure occur in the peripartum period in previously healthy women. Incidence of PPCM ranges from 1 in 1300 to 1 in 15,000 pregnancies. The etiology of PPCM is unknown, but viral, autoimmune, and idiopathic causes may contribute. The diagnostic criteria are onset of heart failure in the last month of pregnancy or in first 5 months postpartum, absence of determinable cause for cardiac failure, and absence of a demonstrable heart disease before the last month of pregnancy. Risk factors for PPCM include advanced maternal age, multiparity, African race, twinning, gestational hypertension, and long-term tocolysis. The clinical presentation of patients with PPCM is similar to that of patients with dilated cardiomyopathy. Early diagnosis and initiation of treatment are essential to optimize pregnancy outcome. Treatment is similar to medical therapy for other forms of dilated cardiomyopathy. About half the patients of PPCM recover without complications. The prognosis is poor in patients with persistent cardiomyopathy. Persistence of disease after 6 months indicates irreversible cardiomyopathy and portends worse survival.
Topics: Adult; Cardiomyopathy, Dilated; Cardiotonic Agents; Drug Therapy, Combination; Female; Humans; Incidence; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Puerperal Disorders; Risk Factors; Severity of Illness Index; Treatment Outcome; Ventricular Dysfunction, Left
PubMed: 17208320
DOI: 10.1016/j.ijcard.2006.08.005