We searched PubMed, Embase, PsycINFO, and the Cochrane Library without language restrictions. Searches were done using the key search terms “pregnancy”, “prenatal”, “antenatal”, “postnatal”, “postpartum”, “perinatal”, “puerperal”, “breastfeeding”, “birth”, “weaning”, “childbirth”, “trimester”, “peripartum”, “lactation”, “ante-natal”, “post-natal”, “postpartum”, and “mood disorder” (exploded MeSH term), “anxiety disorder” (exploded MeSH term), “eating disorder” (exploded MeSH term),
SeriesNon-psychotic mental disorders in the perinatal period
Introduction
Non-psychotic mental disorders are among the commonest morbidities of pregnancy and the post-partum period (the perinatal period). Research about perinatal mental disorders so far has largely focused on depression, particularly postnatal depression. However, increasing evidence shows substantial morbidity from other disorders. In this Series paper, we also review the available evidence base for the epidemiology and treatment of anxiety disorders, post-traumatic stress disorder (PTSD), eating disorders, and personality disorders.
Section snippets
Depressive disorders
Depressive disorders are common during pregnancy and in the post-partum period and generally have the same phenomenology as non-childbearing depressive disorders (panel 1).1, 2, 3 Somatic symptoms can result from normal physiological changes in pregnancy and the early post-partum period, so therefore need to be assessed with care. However, these symptoms are more common in women with depression than in women who do not have depression in the perinatal period (with the exception of appetite
Risk factors
Despite substantial research into risk factors for perinatal disorders, particularly depressive disorders, there are few systematic reviews and a paucity of research using diagnostic measures, longitudinal approaches, and comparison groups. Studies often exclude women with a history of mental illness or particular groups of women, such as those who are infected with HIV or are chronically ill, which restricts our understanding of overlapping risks and comorbidities. However, a history of any
Depressive disorders
Because perinatal mental disorders can have serious consequences in terms of maternal morbidity and mortality and adverse infant outcomes,50 there is much interest in improvement of identification of disorders to increase treatment rates. Most research and debate has focused on the identification of postnatal depression, whether or not to use screening instruments routinely in the post-partum period, and which methods to use. The most frequently used screening method is the Edinburgh postnatal
Depressive disorders
Not much research has investigated the prevention of antenatal depression, whereas a Cochrane systematic review71 identified 28 RCTs (n>16 000) about psychosocial or psychological preventative interventions for postnatal depression (all but three were undertaken in HICs). Women who received an intervention were significantly less likely to develop postnatal depression than were those who received standard care (relative risk [RR] 0·78, 95% CI 0·66–0·93). Protective interventions included
Depressive disorders
Because of maternal treatment preferences and potential concerns about fetal and infant health outcomes, non-pharmacological treatment options are particularly important in the perinatal period. Evidence on the treatment of antenatal depression is limited to small trials (with 36–53 women) of interpersonal therapy, culturally relevant brief interpersonal psychotherapy, and CBT,87, 88, 89 and a Cochrane review (six trials, n=406) of other types of non-pharmacological interventions such as
Pharmacological treatment
The mainstay of pharmacological treatment for non-psychotic mental disorders in the perinatal period is antidepressants. Data suggests that in Europe around 3% of pregnant women take an antidepressant at some point in their pregnancy, mostly selective serotonin reuptake inhibitors (SSRIs), with rates of around 10% reported in the USA.95 Antidepressants are effective treatments for depression, particularly for severe cases, and meta-analyses have shown that efficacy compared with placebo
Future research directions
Data for the epidemiology and prognosis of perinatal mental disorders excluding postnatal depression, in both high-income and low-income settings are scarce. Similarly, there are few data for emerging risk factors (such as migration and substance misuse), prevention, and how and whether treatments (both psychological and pharmacological) need to be modified in the perinatal period. The effect of antidepressants on the infant exposed in utero and breastfeeding, particularly with respect to
Search strategy and selection criteria
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