Perinatal Mood and Anxiety Disorders Overview

Perinatal Mood and Anxiety Disorders (PMADs)

• Approximately 1 in 7 new mothers and 1 in 10 new fathers experience postpartum depression or other PMADs.
• Trauma-informed care prioritizes adaptation, resilience, and recovery.
• Prevalence rates for different PMADs:
  • Prenatal anxiety: 15%
  • Postpartum depression: 21%
  • Postpartum Panic Disorder: 11%
  • Postpartum OCD: 11%
  • Postpartum PTSD: 9%
  • Postpartum Psychosis: 1-2/1000
  • Psychosis in women with known bipolar disorder: 20-30%
• Postpartum panic disorder symptoms: extreme anxiety, shortness of breath, chest pain, dizziness, hot flashes, trembling, rapid heart rate, numbness, restlessness, agitation, irritability, excessive worry, fear; peaks at 2 minutes, improves after 10 minutes; best treated with education.
• Greatest fears in panic disorder: dying, going crazy, losing control.
• Impact of PMADs: increased medical costs, inappropriate care, child abuse/neglect, breastfeeding cessation, family dysfunction, adverse early brain development.
• Detection and treatment rates: 40% detected/diagnosed, 60% receive treatment.
• Risk factors for PMADs: gestational diabetes, past trauma, ambivalence about maternal role, unresolved losses, unwanted pregnancy, infertility issues, sick/colicky infant.

Specific PMADs - Prevalence and Risk Factors

• Postpartum depression in the first 3 months: 1 in 7; first year: 1 in 5 (Wisner 2012).
• Parents of multiples: 43% chance of PPD.
• Risk factor for PMADs: PCOS.
• Paternal PPD: associated with social/behavioral problems in boys, particularly at age 3.

Treatment and Support for PMADs

• Evidence-based screening tools: Edinburgh Postnatal Depression Scale (EPDS).
• Common cut-off score for positive EPDS: 10
• Non-traditional treatments: bright light therapy
• Cognitive restructuring (CBT): Identify automatic thoughts, observe thought-feeling connection, identify cognitive distortions
• Interpersonal Psychotherapy (IPT): Grief, role transitions, interpersonal disputes
• Trauma psychotherapy: Collaborative therapeutic relationship, client's story, client's strengths and resilience.
• Cognitive Behavioral Therapy for OCD (Jeffrey Schwartz): Re-label, Reattribute, Refocus, Revalue.
• Psychosocial adaptation to motherhood: Lederman's theory, themes of life growth, primary relatedness, supportive matrix, and identity reorganization.

Maternal Mental Health Considerations During Pregnancy & Postpartum

• Pregnancy denial: Affective denial (dismissive emotional significance of pregnancy), pervasive denial (misconstruing/absence of pregnancy symptoms).
• Neonaticide: Mother takes life of child within 24 hours of birth.
• Postpartum psychosis: May be conceptualized as an acute manic episode
• Interconception care: Planning and care between pregnancies

Resilience, Prevention, and Healthcare Approach

• Intergenerational transmission of resilience: Concept introduced in class to facilitate family resilience.
• 2020 MOM: Initiative to close gaps in maternal mental healthcare
• Maternal Mental Health Awareness week: Early May
• PSI help line: 1-800-944-4PPD (for licensed medical professionals).
• Community mobilization resources: Jane Honikman Postpartum Action Institute.
• Research report: National Center for Children in Poverty report on maternal depression.

Medication and Treatment Considerations during perinatal periods

• Antidepressants in pregnancy: If on an antidepressant and have a history of chronic or relapsing depression or new onset severe depression.
• SSRI and SNRI use in pregnancy: Studies have not shown birth defects in SSRI/SNRI usage.
• Starting SSRI during pregnancy: Start at a low dose.
• Breastfeeding and SSRIs: Not needed to change medication if successful during pregnancy.
• ECT (Electroconvulsive Therapy): Safe in pregnancy and postpartum.
• Medication after symptoms resolve: Continue medication for 1 year after a first episode of depression to prevent relapse.
• Bipolar disorder during pregnancy and postpartum: Women who stop mood stabilizers have 2x higher risk of recurrence and 4x faster recurrence, 70% of women with bipolar disorder who stop medication when pregnant become ill during pregnancy, 71% relapse during pregnancy, treatment with medication throughout pregnancy is recommended for women with a hx of postpartum psychosis who desire a second pregnancy.
• No significant increase in risk of autism/ADHD in fetuses exposed to SSRIs.
• Medication categories: A (safe), B (use with caution), C (not recommended), D (human fetal risk, last resort), X (contraindicated).
• MAOIs: Can cause hypertensive crisis.

Other Important Points

• Biological weathering: Chronic exposure to racism.

• Neonatal Adaptation Syndrome: Mild, self-resolves, seldom requires treatment.

• Perinatal loss: Conception through 28 days after birth

• Prenatal anxiety: 15.8%.

• PTSD in childbirth: 4%.

• Misdiagnosis of Bipolar Disorder: 69% of women with perinatal bipolar are initially misdiagnosed with unipolar depression.

• Bipolar disorder and PPD: 50% of first-time mothers with postpartum psychosis have no prior psychiatric hospitalization.

• Common Postpartum OCD fears: Fear of deliberate harm (41%).

• Prevalence of new-onset perinatal OCD: 30%.

• Neonatal mortality rate: 28/1000

• NICU parent mental health: 20-30% of NICU parents experience mental health disorders in the first postpartum year.

• Breastfeeding and Depression: Depression suppresses prolactin and oxytocin; PPD is more common in women with pre-pregnancy diabetes; Thyroid dysfunction and anemia can reduce milk supply and cause depression; women with PMADs were more likely to stop breastfeeding before 6 months postpartum.

• Postpartum Anxiety symptoms prevalence: 8-20%

• Hormones in PMAD: Women with PMADs have similar hormone levels compared to non-PMAD women.

• Perinatal bipolar disorders: 30% misdiagnosed for over 10 years; 45-52% relapse or exacerbate symptoms during pregnancy

• Postpartum psychological risk factors: Past trauma, ambivalence about the maternal role, and unresolved losses.

• Postpartum psychosocial stressors: Unwanted pregnancy; infertility issues; sick/colicky infant

• Prevalence of PMADS: 15-20%.

• Prevalence of PTSD: 12%, or up to 34% with traumatic birth.

• Alcohol abuse among postpartum women: 40-49%.

• Death ratios: White women: 12.7/100,000 live births ; other ethnic/racial groups; 14.4/100,000 live births

• Perinatal panic disorder: 11% of new mothers. Symptoms: nervousness, panic attacks, worries, and fears.

• Postpartum alcohol use: 40-49%

• New mothers with perinatal OCD: 11%

• Suicide/infanticide in perinatal psychosis: 5% suicide, 4.5% infanticide.

• Economic burden of untreated PMADs: $14.2 billion annually

• Pre and postnatal paternal anxiety: prevalence rates: 4.1% - 16%.

• Elevated anxiety in NICU mothers: 27%

• Difficulties with pregnancy: 10% of women between 15-44 reported difficulty getting/staying pregnant.

• Military women and parenting: 16.8% female military members, 42% with children, 55% married and enter parenthood earlier.

Medication/Treatment Details

• SSRIs: Sertraline (Zoloft) is a common treatment.
• Brexanolone: FDA-approved IV treatment for PPD.
• Zuranolol: FDA-approved oral neurosteroid treatment for postpartum depression (PPD).

Other Key Concepts and Statistics

• Neonatal abstinence syndrome: Increased nearly five-fold between 2000-2014, coinciding with rising rates of opioid prescribing to pregnant women.
• Cannabis use in pregnancy: Self-reported use: 2-5%.
• Misc. conditions: Subsyndromal depression, Tokophobia (fear of pregnancy).
• General population statistics: 12-month PTSD prevalence in American adults: 3.5%.
• Military maternal mental health: Anxiety is 3x higher in transgender persons
• General postpartum facts: 10-15% become depressed within 6 months.
• Deaths/live births: 1200 women in the US experience complications that are fatal annually.
• Illicit drug use in pregnancy: 5.4% of pregnant women (15-44) reported using illicit drugs in the past month.
• Postnatal paternal depression: Associated with social/behavioral problems in children (boys), especially at age 3.
• Postpartum anxiety: 8-20%
• Perinatal loss: Occurs from conception to 28 days postpartum
• Bipolar and initial symptoms: 60% of women with bipolar disorder present initially with depression.

Explore the prevalence and impact of Perinatal Mood and Anxiety Disorders (PMADs) among new parents. This quiz covers various disorders including postpartum depression, anxiety, and their symptoms. Learn about trauma-informed care and the significance of addressing these issues for better recovery outcomes.