It is increasingly recognised that many women with psychotic disorders have children 1,2 and that pregnancies of these women are high-risk. Psychotic disorders increase the risk of stillbir th and infant mortality 3 and can affect a woman's ability to care for herself and her infant. 4 Although women with psychoses are less fertile than the general population, 5 partly as a result of hyperprolactinaemia secondary to antipsychotic drugs, the increasing use of newer atypical drugs such as clozapine and olanzapine, which do not have this effect, is likely to lead to a rise in fertility, particularly in women with affective psychosis. 5 Women come into contact with many healthcare professionals during pregnancy and there are therefore many potential opportunities for prevention or attenuation of these risks. The challenge for health workers caring for women who are pregnant is how to ensure mental health problems are recognised and adequately treated. The NICE guideline on antenatal and postnatal mental health (2007) 6 recommends that at a women's first contact with services in the antenatal period, healthcare professionals should ask about past or present severe mental illness, previous treatment by a psychiatrist/specialist mental health team, including inpatient care, and a family history of perinatal mental illness.There is evidence from North America that women with psychotic disorders may start antenatal care later than controls and that women with mental health disorders receive poorer prenatal care. 7,8 Good liaison between services is therefore essential; healthcare professionals need to ensure that adequate systems are in place to ensure continuity of care and effective transfer of information. If a patient in contact with psychiatric services becomes pregnant, psychiatric services need to support the patient in engaging with primary care (including health visitors and community midwives) and obstetric services as early as possible in the pregnancy and liaise closely about the multidisciplinary care plan for the pregnancy and postnatal period. Risk of complications of pregnancyAll pregnancies carry risk, particularly to the fetus, with a base rate of obstetric risk and risk of congenital malformation of between 2 and 4 per cent. Patients with schizophrenia are at increased risk of impaired glucose tolerance and incident diabetes, 9 particularly if they are taking cer tain atypical antipsychotic drugs. 10 They are therefore at high risk of gestational diabetes. Women with psychotic disorders are also more likely to abuse substances, smoke and consume alcohol during pregnancy. 11,12 It is clear from a number of systematic reviews that women with psychotic disorders are at increased risk of obstetric complications 12,13 and stillbirths, 3 though these findings may be explained by confounding factors such as smoking, substance misuse, socioeconomic status, genetic susceptibility, poorer antenatal care, or possible effects of psychotropic medication. Risk of relapse during pregnancy and postpartumWhen counsell...
Unplanned pregnancies are a unique, yet significant risk factor in perinatal mental health. Our aim was to create an assessment tool to assess mother's views on contraception as part of the discharge planning process. We used a quantitative-qualitative approach. A clinician-guided questionnaire was completed by patients prior to their discharge from hospital and analysed using Microsoft Excel. Semi-structured interviews were used to explore views regarding family planning in greater depth. Interviews were recorded and transcribed verbatim onto Microsoft Word. Emerging themes were identified using a grounded theory thematic analysis approach. Eighteen inpatients were assessed at the Bethlem Mother and Baby Unit over a 4-month period (May-August 2015). Half of the women stated that the pregnancy was unplanned. The most common contraception methods used were condoms, followed by no method/natural cycle technique. Forty-four percent felt unsure of contraception options available and were keen for further advice and referral to family planning services. Interestingly, almost all the women interviewed stated that their experience of perinatal mental illness had changed their views on having more children. The contraception assessment tool is a short, simple questionnaire that can be adopted across inpatient and community settings. In cooperating family, planning into the discharge care plan could be protective in preventing future unplanned pregnancies in women at high risk of perinatal mental illness relapse. Performing the assessment also provided an added opportunity for psycho-education regarding reproductive health and medication use during the perinatal period. The tool also encouraged liaison with GPs and local family planning services.
Data on the disadvantaged urban child is meagre. A prospective survey of 60 households in Borella North, each with at least one child under 2 years of age, was carried out over 8 months. The socioeconomic status, the physical environment and the health of the population were investigated.One hundred and ten families lived in the 60 households and 29% of the population were under the age of 5 years. Only a minority of families had regular employment. The source of water was the roadside tap for 70% of households. Solid waste and blocked drains were present in the environment. 80% of homes were over-crowded. Family planning was practised only by 17% of parents. 25% of under fives were in grade 2 protein calorie malnutrition and 20% of this age group needed at least one hospital admission during the study period.We conclude that the disadvantaged urban child has health risks that need multidisciplinary interventions.
Background Offspring exposed to prenatal maternal depression (PMD) are vulnerable to depression across their lifespan. The underlying cause(s) for this elevated intergenerational risk is most likely complex. However, depression is underpinned by a dysfunctional frontal-limbic network, associated with core information processing biases (e.g. attending more to sad stimuli). Aberrations in this network might mediate transmission of this vulnerability in infants exposed to PMD. In this study, we aimed to explore the association between foetal exposure to PMD and frontal-limbic network function in infancy, hypothesising that, in response to emotional sounds, infants exposed to PMD would exhibit atypical activity in these regions, relative to those not exposed to PMD. Method We employed a novel functional magnetic resonance imaging sequence to compare brain function, whilst listening to emotional sounds, in 78 full-term infants (3–6 months of age) born to mothers with and without a diagnosis of PMD. Results After exclusion of 19 datasets due to infants waking up, or moving excessively, we report between-group brain activity differences, between 29 infants exposed to PMD and 29 infants not exposed to PMD, occurring in temporal, striatal, amygdala/parahippocampal and frontal regions (p < 0.005). The offspring exposed to PMD exhibited a relative increase in activation to sad sounds and reduced (or unchanged) activation to happy sounds in frontal-limbic clusters. Conclusions Findings of a differential response to positive and negative valanced sounds by 3–6 months of age may have significant implications for our understanding of neural mechanisms that underpin the increased risk for later-life depression in this population.
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