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Pregnancy and the puerperium are at times sufficiently stressful to provoke mental illness. Such illness may represent recurrence or exacerbation of a preexisting psychiatric disorder, or it may signal the onset of a new condition. Especially prevalent in pregnancy and the puerperium are depressive and anxiety disorders (Kendig, 2017). Many of these disorders are associated with less prenatal care, substance use, preterm delivery, and other poor obstetrical and neonatal outcomes. In affected gravidas, the postpartum psychiatric illness rate also is higher (Baer, 2016). Last, perinatal mood disorders can adversely hinder the mother-child relationship.

Despite these known risks, obstetrical providers often are reluctant to confront or fail to identify mental health issues during pregnancy. Lyell and colleagues (2012) found that the diagnosis of depression was not documented in nearly half of the records of affected women.


Biochemical factors and life stressors can markedly influence mental health and mental illness during the perinatal period (Meltzer-Brody, 2018b). Intuitively, pregnancy exacerbates some coexisting psychological disorders. Namely, a higher risk for mood disorders is linked with pregnancy-related shifts in sex steroid and monoamine neurotransmitter levels, dysfunction of the hypothalamic-pituitary-adrenal axis, thyroid dysfunction, and immune response alterations (Yonkers, 2011). These changes, coupled with familial clustering of depression cases, suggest that a subgroup of women may be at greater risk for developing a unipolar major depressive disorder during pregnancy.

Women respond variably to the stresses of pregnancy. Some express persistent concerns regarding fetal health, child care, lifestyle changes, or fear of childbirth pain. Anxiety, sleep disorders, and functional impairment are common (Romero, 2014; Vythilingum, 2008). The level of perceived stress is significantly higher for women whose fetus is at high risk for a malformation, for those with preterm labor or delivery, and for those with other medical complications (Alder, 2007; Ross, 2006). For example, Hippman and associates (2009) screened for depression in 81 women who had an increased risk for a fetus with aneuploidy. Half of these women had a positive depression screening score, whereas only 2.4 percent of those with a normal pregnancy did so.

Several steps can diminish psychological stress in the event of a poor obstetrical outcome. For example, following a stillbirth, parental contact with the newborn and provision of photographs and other infant memorabilia is encouraged (Gold, 2007). Addressing associated sleep disorders also seems reasonable (Juulia Paavonen, 2017).

The Puerperium

This is a particularly stressful time for women, and risks for mental illness are increased. Up to 15 percent of women develop a nonpsychotic postpartum depressive disorder within 6 months of delivery (Tam, 2007; Yonkers, 2011). Depressive disorders are more likely in women with obstetrical complications such as severe preeclampsia or fetal-growth restriction, especially if associated with early delivery. Prior ...

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