Psychosis and pregnancy

Volume 6 Issue 12 December, 2016

Pregnancy is generally considered to be a positive phase of life with happiness and well-being. However, expected changes in the life style, social behavior and apprehension regarding motherhood would pose as a psychological stressor. Adaptations of maternal mind and body to the new role through hormonal fluctuations and increasing metabolic demand could act as a physiological stressor. These stressors during pregnancy increase the risk of psychiatric problems in vulnerable individuals.

Studies have shown that nearly 25% of the pregnant women suffer from a psychiatric condition and 0.4-0.6% have psychotic symptoms during pregnancy. Psychosis represents the serious forms of mental disorder characterized by hallucinations, delusions, gross disturbances in thought and psychomotor activity. Though it is rare to see first onset psychosis during the pregnancy, most women who were previously diagnosed with psychosis can have exacerbation/relapse of the problems. Young, unmarried women, substance use, complicated pregnancies, recent stressful life events, prior history of psychiatric disorder, discontinuation of antipsychotic medication(s), lifetime exposure to traumatic events and poor overall health increase the risk of mental disorders.

Despite awareness of mental health problems, many patients and physicians during pregnancy do not seek mental health care. Even for severe psychotic symptoms treatment is not sought due to the fear of potential harmful effects of medicines on the developing fetus. The fact that is always missed is the adverse impact of psychiatric conditions on the pregnancy and its outcomes.

Psychiatric conditions when present during pregnancy leads to poorer health of mother and consequent inadequate postnatal care to the child. Untreated psychiatric ailments by itself is found to be an independent risk factor for increased abortions, requiring caesarean section, perinatal mortality, low birth weight and low Apgar scores. Maladaptive fetal growth and development, poor cognitive development, poor nutrition and behavioral problems during childhood and adolescence are often noted in off-springs of mothers having had psychiatric conditions during pregnancy and postpartum period.

Undue concerns are raised regarding the safety of antipsychotics. Antipsychotic use over years has shown them not to be having significant teratogenicity. Typical antipsychotics like haloperidol can minimally increase the risk of small for gestation baby and preterm deliveries. Experience and literature suggests atypical antipsychotics like Risperidone, Quetiapine and olanzapine are safer. Some atypical antipsychotics can derange the metabolic profile and thus increase the risk of gestational diabetes and increased birth weight. This could be managed by close monitoring of blood glucose levels. Overall the risks of untreated mental illness on pregnancy and its outcomes seem higher than the antipsychotic therapy. When an antipsychotic has been found to be effective in an individual woman, it’s always prudent to continue the same.

A good clinical practice should provide access to all women vulnerable to psychosis to pre-pregnancy counselling including planning pregnancies; folate supplementation, discussion with patient and family regarding options, and an active liaised care by team of obstetricians, psychiatrists, Ultrasonologists and Pediatricians.