Psychiatric disorders in pregnancy-

Pregnancy is generally thought to be a time of happiness and emotional well-being for a woman. However, for many women, pregnancy and motherhood increase their vulnerability to psychiatric conditions such as depression, anxiety disorders, eating disorders, and psychoses. These conditions are often underdiagnosed because they are attributed to pregnancy-related changes in maternal temperament or physiology. In addition, such conditions are often undertreated because of concerns about potential harmful effects of medication. Depression, panic disorder, bipolar illness, and other psychiatric conditions can occur during pregnancy and should be considered when assessing the health of a pregnant patient.

Psychiatric disorders in pregnancy

Psychiatric disorders in pregnancy

Treatment from mental health services. There are no data on the prevalence or course of generalized anxiety disorder GAD through pregnancy. Summary Early identification and treatment of psychiatric disorders in pregnancy Psychiatric disorders in pregnancy prevent morbidity in pregnancy and postpartum with the concomitant risks to mother and baby. On, there is a growing Psychiatric disorders in pregnancy of information the reproductive safety of lamotrigine Lamictaland this may be a useful alternative for some women. Data from disorrders Registry did not show an elevated risk of malformations associated with lamotrigine exposure. We'd love your feedback.

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Psychiatric disorders in pregnancy to lithium, prenatal exposure to some anticonvulsants is associated with a far greater risk for organ malformation. In women with a history of bipolar mood disorder, the decision whether to use mood stabilizers must be made following an assessment of risks and benefits. Anxiety disorders in pregnancy Data are available on some Brazillian girls sleeping nude the disorders that affect pregnant women panic disorder and obsessive-compulsive disorder but very little information exists regarding others generalized anxiety disorder and social phobia. Generalized anxiety disorder There are no data on the prevalence or course of generalized anxiety disorder GAD Psychiatric disorders in pregnancy pregnancy. In an effort to improve the accuracy and usefulness of information regarding the safety of medications used during pregnancy and breastfeeding, the FDA proposed a newly designed system on June 30th Protective effect of pregnancy in women with lithium-responsive Psychiatric disorders in pregnancy disorder. Generally, an eBook can be downloaded in five minutes or less Pharmacological therapies are also recognized as effective treatment for depression. Browse by Genre Available eBooks Depression in pregnancy During pregnancy, symptoms of depression such as changes in sleep, appetite, and energy are often difficult to distinguish from the normal experiences of pregnancy.

Particularly vulnerable are those women with histories of psychiatric illness who discontinue psychotropic medications during pregnancy.

  • Pregnancy is generally thought to be a time of happiness and emotional well-being for a woman.
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Particularly vulnerable are those women with histories of psychiatric illness who discontinue psychotropic medications during pregnancy. This study estimated that women who discontinued medication were 5 times as likely to relapse as compared to women who maintained treatment.

High rates of relapse have also been observed in women with bipolar disorder. One study indicated that during the course of pregnancy, The risk of recurrence was significantly higher in women who discontinued treatment with mood stabilizers Although data accumulated over the last 30 years suggest that some medications may be used safely during pregnancy, knowledge regarding the risks of prenatal exposure to psychotropic medications is incomplete.

Thus, it is relatively common for patients to discontinue or to avoid pharmacologic treatment during pregnancy. In , the U. Food and Drug Administration FDA provided guidelines to drug companies for labeling medications with regard to their safety during pregnancy. This system of classification used five risk categories A, B, C, D and X based on data derived from human and animal studies.

In an effort to improve the accuracy and usefulness of information regarding the safety of medications used during pregnancy and breastfeeding, the FDA proposed a newly designed system on June 30th Companies will be required to remove the pregnancy letter categories from the labeling for all prescription drugs and will have to revise the labeling with updated information. Women with histories of psychiatric illness frequently come in for consultations regarding the use of psychotropic medications during pregnancy.

Not infrequently, women present with the first onset of psychiatric illness while pregnant. Many pregnancies are unplanned and may occur unexpectedly while women are receiving treatment with medications for psychiatric disorders. Many women may consider stopping medication abruptly after learning they are pregnant, but for many women this may carry substantial risks.

Decisions regarding the initiation or maintenance of treatment during pregnancy must reflect an understanding of the risks associated with fetal exposure to a particular medication but must also take into consideration the risks associated with untreated psychiatric illness in the mother.

Psychiatric illness in the mother is not a benign event and may cause significant morbidity for both the mother and her child; thus, discontinuing or withholding medication during pregnancy is not always the safest option.

Depression and anxiety during pregnancy have been associated with a variety of adverse pregnancy outcomes. Several studies have described low birth weight and fetal growth retardation in children born to depressed mothers. Preterm delivery is another potential pregnancy complication among women experiencing distress during pregnancy.

Pregnancy complications related to maternal depression and anxiety in late pregnancy have also been described, including an increased risk for having pre-eclapsia, operative delivery, and infant admission to a special care nursery for a variety of conditions including respiratory distress, hypoglycemia, and prematurity.

All medications diffuse readily across the placenta, and no psychotropic drug has yet been approved by the Food and Drug Administration FDA for use during pregnancy. When prescribing medications during pregnancy, one must consider the following risks associated with prenatal exposure: risk of teratogenesis, risk of neonatal toxicity, and risk of long-term neurobehavioral sequelae.

Therefore, discussion around risks of exposures during pregnancy may be broken down by the timing of exposure or trimester, with particular vigilance around first trimester exposures. For each organ or organ system, there exists a critical period during which development takes place and is susceptible to the effects of a teratogen. For example, neural tube folding and closure, forming the brain and spinal cord, occur within the first four weeks of gestation.

Anecdotal reports that attribute these syndromes to drug exposure must be cautiously interpreted, and larger samples must be studied in order to establish a causal link between exposure to a particular medication and a perinatal syndrome. Although the data suggest that some medications may be used safely during pregnancy if clinically warranted, our knowledge regarding the long-term effects of prenatal exposure to psychotropic medications is incomplete. Because neuronal migration and differentiation occur throughout pregnancy and into the early years of life, the central nervous system CNS remains particularly vulnerable to toxic agents throughout pregnancy.

Behavioral teratogenesis refers to the potential of a psychotropic drug administered during pregnancy to have long-term neurobehavioral effects. Of all the antidepressants, fluoxetine Prozac is the best characterized antidepressant. Data collected from over cases indicate no increase in risk of major congenital malformation in fluoxetine-exposed infants. Several meta-analyses combining studies with exposures to SSRIs do not demonstrate an increase in risk of congenital malformation in children exposed to these antidepressants, with the exception of paroxetine Paxil.

Other published studies have not demonstrated increased teratogenicity of paroxetine. Importantly, independently conducted meta-analyses of available data sets have consistently found a lack of association between paroxetine exposure and cardiovascular malformations. When evaluated on an individual basis and when pooled, these studies do not indicate a significant association between fetal exposure to TCAs and risk for any major congenital anomaly.

Among the TCAs, desipramine and nortriptyline are often preferred since they are less anti-cholinergic and the least likely to exacerbate orthostatic hypotension that occurs during pregnancy.

In this sample, there were 20 infants with major malformations. This represents a 3. While this information regarding the overall risk of malformation is reassuring, earlier reports had revealed an unexpectedly high number of malformations of the heart and great vessels in bupropion-exposed infants.

A retrospective cohort study including over infants exposed to bupropion during the first trimester did not reveal an increased risk of malformations in the bupropion-exposed group of infants nor did it demonstrate an increased risk for cardiovascular malformations.

Scant information is available regarding the reproductive safety of monoamine oxidase inhibitors MAOIs , and these agents are generally not used in pregnancy as they may produce a hypertensive crisis when combined with tocolytic medications, such as terbutaline.

With regard to the newer antidepressants, prospective data on women exposed to venlafaxine Effexor during the first trimester of pregnancy suggest no increase in risk of major malformation as compared to non-exposed controls.

To date, the literature does not include prospective data on the use of duloxetine Cymbalta. There were no significant differences among exposed and non-exposed groups with regard to rates of congenital malformations. While these initial reports are reassuring, larger samples are required to establish the reproductive safety of these newer antidepressants.

It is estimated that at least to exposures must be collected to demonstrate a two-fold increase in risk for a particular malformation over what is observed in the general population. Several recent studies have suggested that exposure to SSRIs near the time of delivery may be associated with poor perinatal outcomes. Reassuringly, these syndromes appear to be relatively benign and short-lived, resolving within 1 to 4 days after birth without any specific medical intervention.

Another limitation is that few studies have attempted to assess maternal mood during pregnancy or at the time of delivery. There is ample evidence to suggest that depression or anxiety in the mother may contribute to poor neonatal outcomes, including premature delivery and low birth weight, and it is important to evaluate the contribution of maternal mood to neonatal outcomes.

Importantly, neonatal effects have been reported with both untreated mood and anxiety disorders, as well as with medication, and limited studies have adequately teased out these variables. One important consideration is that discontinuation of or reductions in the dosage of mediation in the latter part of pregnancy may increase the risk of postpartum depression, as the postpartum period is a time of increased vulnerability to psychiatric illness and depression or anxiety during pregnancy has been associated with postpartum depression.

Another concern has been that maternal SSRI use may be associated with a higher than expected number of cases of persistent pulmonary hypertension of the newborn PPHN. These findings taken together bring into question whether there is an association at all and suggest that, if there is a risk, it is much lower than that reported in the original report.

To date only two studies have systematically investigated the impact of exposure to antidepressants in utero on development and behavior in humans. The authors concluded that their findings support the hypothesis that fluoxetine and tricyclic antidepressants are not behavioral teratogens and do not have a significant effect on cognitive development, language or behavior. For women with bipolar disorder, maintenance treatment with a mood stabilizer during pregnancy can significantly reduce the risk of relapse.

However, many of the medications commonly used to treat bipolar disorder carry some teratogenic risk when used during pregnancy. Concerns regarding fetal exposure to lithium, have typically been based on early reports of higher rates of cardiovascular malformations e.

Compared to lithium, prenatal exposure to some anticonvulsants is associated with a far greater risk for organ malformation. Of all of the medications used for psychiatric disorders, the one with the greatest potential of serious birth defects is valproate valproic acid, Depakote. Prenatal exposure to valproic acid has also been associated with characteristic craniofacial abnormalities, cardiovascular malformation, limb defects and genital anomalies, as well as other central nervous system structural abnormalities.

In the same study, lamotrigine use discussed below did not affect neurocognitive development. One report has raised concerns regarding potential teratogenicity of topiramate Topamax. However, there is a growing body of information the reproductive safety of lamotrigine Lamictal , and this may be a useful alternative for some women.

Data from the Registry did not show an elevated risk of malformations associated with lamotrigine exposure. In a comparison group of , unexposed births, the prevalence rate for oral clefts was 0. However, other registries have not demonstrated such a significant increase in risk for oral clefts. It is important to put this risk into perspective. If we assume that the findings from the North American registry are true, the absolute risk of having a child with cleft lip or palate is about 0.

Atypical antipsychotic agents discussed in greater detail below are commonly used often to manage the acute symptoms of bipolar illness, as well as for maintenance treatment. While the data regarding the reproductive safety of these newer agents is limited, no studies thus far have indicated any teratogenic risk associated with this class of medications.

For this reason, some women may choose to use an atypical antipsychotic agent during pregnancy especially during the first trimester in order to avoid using a known teratogen, such as lithium or valproic acid. The consequences of prenatal exposure to benzodiazepines have been debated for over twenty years. Three prospective studies support the absence of increased risk of organ malformation following first trimester exposure to benzodiazepines. This risk— if it exists — is calculated to be 0.

Currently, no systematic data are available on the reproductive safety of non-benzodiazepine anxiolytic agents such as buspirone and hypnotic agents zolpidem Ambien and zalepion Sonata. In addition to the atypical antipsychotic medications described above, recent studies have not demonstrated teratogenic risk associated with high-or medium-potency neuroleptic medications; however, a recent meta-analysis of the available studies noted a higher risk of congenital malformations after first trimester exposure to low-potency neuroleptic agents.

Atypical antipsychotic medications are increasingly being used to treat a spectrum of psychiatric disorders, including psychotic disorders and bipolar disorder, as well as treatment refractory depression and anxiety disorders. The first and largest published prospective study on the reproductive safety of the atypical agents provided reassuring data regarding the risk of malformations in the first trimester, although aripiprazole Abilify was not among the medications studied.

Investigators prospectively followed a group of women taking olanzapine Zyprexa , risperidone Risperdal , quetiapine Seroquel , or clozapine Clozapine and compared outcomes to controls without exposure to known teratogens. There were no differences between the groups in terms of risk for major malformations, or rates of obstetrical or neonatal complications.

These recommendations were derived from adverse event reporting. While this may signal a potential problem associated with exposure to antipsychotic medications, it does not yield accurate information regarding the prevalence of an adverse event.

Consultations regarding treatment options can be scheduled by calling our intake coordinator at Currently we are conducting several studies related to depression and pregnancy.

All pregnant women between the ages of with a history of psychiatric illness are eligible to enroll in the registry. Are you pregnant? Do you own a smart phone? Ruta Nonacs T September 12th, The New U. Weighing the Risks Women with histories of psychiatric illness frequently come in for consultations regarding the use of psychotropic medications during pregnancy. What are the Risks of Medication Exposure?

Risk of Long-Term Effects Although the data suggest that some medications may be used safely during pregnancy if clinically warranted, our knowledge regarding the long-term effects of prenatal exposure to psychotropic medications is incomplete. Antidepressants and Pregnancy Of all the antidepressants, fluoxetine Prozac is the best characterized antidepressant. Mood Stabilizers For women with bipolar disorder, maintenance treatment with a mood stabilizer during pregnancy can significantly reduce the risk of relapse.

Anti-Anxiety Medications The consequences of prenatal exposure to benzodiazepines have been debated for over twenty years.

A series of 26 cases. However, full disclosure of both the risk and benefits of various antidepressant medications should be made to the patient and, if possible, her partner prior to starting any pharmacological treatment. In addition to the atypical antipsychotic medications described above, recent studies have not demonstrated teratogenic risk associated with high-or medium-potency neuroleptic medications; however, a recent meta-analysis of the available studies noted a higher risk of congenital malformations after first trimester exposure to low-potency neuroleptic agents. There are no data on either first-onset social phobia or pre-existing social phobia in pregnancy. The information regarding the course of bipolar disorder in pregnancy is limited. Acta Psychiatr Scand ; Several key psychosocial correlates may also contribute to depression during pregnancy: a negative attitude toward the pregnancy, a lack of social support, maternal stress associated with negative life events, and a partner or family member who is unhappy about the pregnancy.

Psychiatric disorders in pregnancy

Psychiatric disorders in pregnancy.

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Arch Gen Psychiatry. Information about the epidemiology of these conditions in this population is lacking. In addition, currently pregnant women had a lower risk of having any mood disorder than nonpregnant women.

The only exception was the significantly higher prevalence of major depressive disorder in postpartum than in nonpregnant women. Age, marital status, health status, stressful life events, and history of traumatic experiences were all significantly associated with higher risk of psychiatric disorders in pregnant and postpartum women. Lifetime and past-year treatment-seeking rates for any psychiatric disorder were significantly lower among past-year pregnant than nonpregnant women with psychiatric disorders.

Groups of pregnant women with particularly high prevalence of psychiatric disorders were identified. Low rates of maternal mental health care underscore the need to improve recognition and delivery of treatment for mental disorders occurring during pregnancy and the postpartum period. Pregnancy and the postpartum period are widely considered to be periods of increased vulnerability to psychiatric disorders.

Many studies were limited by use of screening scales rather than diagnostic measures for DSM-IV criteria. Finally, previous studies assessed only mood and anxiety disorders rather than a broader range of psychiatric disorders. As the result of these gaps in research on mental disorders during pregnancy and the postpartum period, accurate national information on the mental health of pregnant women is lacking.

Such information is needed for focused planning at the national and local level, and to inform the development of prevention and intervention programs. The current study addresses these critical gaps in knowledge. In a nationally representative sample of pregnant women, we present month prevalence of DSM-IV psychiatric disorders, compare these with the prevalence of psychiatric disorders in nonpregnant women of childbearing age, identify risk factors for such disorders, and provide estimates of lifetime and month rates of treatment seeking among pregnant and nonpregnant women with DSM-IV psychiatric disorders.

This included persons living in households and the following noninstitutional group quarters: boarding houses, rooming houses, nontransient hotels and motels, shelters, facilities for housing workers, college quarters, and group homes.

Blacks, Hispanics, and young adults aged 18 to 24 years were oversampled. Data were adjusted to account for oversampling and respondent and household nonresponse. The overall survey response rate consists of 3 parts. Household nonresponse occurred when no interview was obtained from the household and a sample person was never selected. Person nonresponse occurred when a sample person was selected but was not interviewed.

The NESARC estimates were adjusted at the household and person level to account for nonresponse from refusals, absences, and unlocated housing units. The weighted data were then adjusted using the Decennial Census, to be representative of the US civilian population for a variety of sociodemographic variables. Women in the NESARC were asked whether they were pregnant at the time of the interview and whether they had been pregnant at any point in the preceding 12 months.

Of these, did not know their past-year pregnancy status and were removed from the analysis. Of these women, 72 reported currently having no children.

All potential NESARC respondents were informed in writing about the nature of the survey, the statistical uses of the survey data, the voluntary aspect of their participation, and the federal laws that rigorously provided for the strict confidentiality of the identifiable survey information. Respondents consenting to participate after receiving this information were interviewed. The research protocol, including informed consent procedures, received full ethical review and approval from the US Census Bureau and the US Office of Management and Budget.

Interviews were conducted by approximately professional lay interviewers from the US Census Bureau. On average, the interviewers had 5 years of experience in the administration of census and other health-related national surveys. Training was standardized under the direction of the National Institute on Alcohol Abuse and Alcoholism. All interviewers completed a 5-day self-study course followed by a 5-day in-person training session at one of the US Census Bureau's regional offices.

For quality control purposes and to assess the accuracy of the interviewers' performance, respondents were readministered 1 to 3 sections of the NESARC interview to verify answers.

Socioeconomic measures included education, personal annual income, and insurance type. To be consistent with previous research, women were categorized as being older than 25 years or 25 years or younger.

Axis I diagnoses included in the AUDADIS-IV can be separated into 3 groups: 1 substance use disorders including alcohol abuse or dependence, any drug abuse or dependence, and nicotine dependence ; 2 mood disorders including major depressive disorder, dysthymia, and bipolar disorder ; and 3 anxiety disorders including panic disorder, social anxiety disorder, specific phobia, and generalized anxiety disorder.

We also included variables measuring any substance use, any alcohol use, and any tobacco use in the past 12 months. The reliability of the alcohol consumption and drug use measures have been documented elsewhere. Also, respondents were classified as having a history of trauma and victimization in the past 12 months if they had personally been the victim of a crime or attempted crime, such as having been beaten up, mugged, or attacked by a stranger or someone they knew; hit; threatened; or forced to have sex.

To estimate rates of mental health service utilization, respondents with psychiatric disorders were classified as receiving treatment if they sought help from a counselor, therapist, physician, or psychologist, or from an emergency department; if they were hospitalized for psychiatric reasons at least 1 night; or if they were prescribed medications.

Treatment utilization questions were disorder-specific. Analyses were conducted on those who were diagnosed as having the disorder of interest in the time frame under consideration. For instance, prevalence of past-year treatment seeking for a mood disorder was calculated among those with a past-year diagnosis of a mood disorder by means of treatment utilization questions specifically asked about treatment for a mood disorder.

Weighted cross-tabulations were used to calculate prevalence rates for each study group. A series of logistic regression analyses yielded odds ratios, indicating associations between pregnancy status and 1 sociodemographic characteristics, 2 each specific month psychiatric disorder, and 3 month and lifetime mental health service utilization.

In these 3 sets of analyses, nonpregnant women served as the reference group. The logistic regression analyses of the associations between pregnancy status and each month psychiatric disorder are presented without adjustment, and also adjusted for sociodemographic characteristics, previous history of that disorder occurring prior to the past 12 months , overall health, and number of stressful life events.

Finally, a series of logistic regression analyses yielded odds ratios indicating associations between sociodemographic characteristics and any month psychiatric disorder among pregnant women, using pregnant women without any month psychiatric disorder as the reference group.

We present herein the analyses conducted on the largest group past-year pregnant women and indicate the main differences with the analyses of the other 2 samples currently pregnant women and postpartum women. The distributions of sociodemographic characteristics by pregnancy status are shown in Table 1.

Twelve-month prevalence of psychiatric disorders ranged from 0. Adjusted odds ratios revealed that past-year pregnant women were significantly less likely than nonpregnant women to have been diagnosed as having any substance use disorder, including alcohol and other drug use disorders and nicotine dependence, and any psychiatric disorder. Past-year pregnant women also had lower rates of any alcohol use and any tobacco use, but not any illicit drug use.

Being 18 to 25 years old; never being married or being widowed, separated, or divorced; and reporting pregnancy complications, current stressful life events, breakup of a romantic relationship, and history of trauma or victimization within the past 12 months were associated with higher rates of psychiatric disorders in past-year pregnant women. The odds of past-year treatment seeking for mood disorders among women with a past-year diagnosis of a mood disorder were significantly lower in past-year pregnant women than in nonpregnant women Table 4.

Important exceptions were as follows: 1 the prevalence of major depressive disorder, which was not different between past-year pregnant and nonpregnant women, was significantly higher in postpartum women when the adjusted odds ratios were considered; 2 in contrast to past-year pregnant women, currently pregnant women had a significantly decreased likelihood of having any mood disorder compared with nonpregnant women; and 3 the prevalence of social anxiety disorder, which was not significantly different between past-year pregnant and nonpregnant women, was significantly lower in postpartum women compared with nonpregnant women.

This is, to our knowledge, the first study to examine the prevalence and correlates of mental disorders and mental health treatment seeking in a nationally representative sample of pregnant and postpartum women. Although high rates of psychiatric disorders have been reported in clinical samples of pregnant and postpartum women, 40 , 41 , 61 - 64 the specific contribution of pregnancy to the prevalence of psychiatric disorders in women of childbearing age had not been previously examined.

In our study, the overall month rate of psychiatric disorders in pregnant and postpartum women was high, but no differences were found in the overall prevalence of specific psychiatric disorders between past-year pregnant and postpartum and nonpregnant women, except for the prevalence of substance use disorders, which was lower in past-year pregnant and postpartum women than in nonpregnant women of childbearing age.

Clinical studies have suggested that trimester of pregnancy affects the rates of psychiatric symptoms, with some studies suggesting an exacerbation of psychiatric disorders in the first 2 trimesters of pregnancy, 65 while others have reported greater rates of depressive disorders during the second and third trimesters of pregnancy. Including only women during their first, second, or third trimester of pregnancy might have resulted in higher or lower estimates, according to trimester, of the prevalence of mental disorders among pregnant women than the ones reported herein.

Nevertheless, the high prevalence of psychiatric disorders in pregnant women stresses the need for continued work to identify the causes and develop effective treatments for mental disorders among pregnant and postpartum women.

Past-year pregnant and postpartum women were significantly less likely than nonpregnant women to use any substance, except illicit drugs. Use of illicit drugs was slightly but not significantly less likely among past-year pregnant and postpartum women.

Nonetheless, substance use by pregnant women is a leading preventable cause of mental, physical, and psychological problems in infants and children. Although the overall prevalence of psychiatric disorders appears to be similar among currently pregnant, postpartum, and nonpregnant women, 2 important exceptions were the elevated risk of major depressive disorder during the postpartum period and the decreased likelihood of having any mood disorder in currently pregnant women.

Biological eg, hormonal as well as psychological and social role changes associated with childbirth may increase the risk of major depressive disorder during the postpartum period.

Our findings underscore the need for systematic screening and treatment of postpartum women to ensure their health and the health of their offspring. Our novel finding that currently pregnant women are significantly less likely than nonpregnant women to have a mood disorder suggests either a protective effect of pregnancy or an effect of pregnancy selection on rates of any mood disorder. The cross-sectional design of the NESARC does not permit differentiation of the effects of pregnancy selection from pregnancy itself on rates of psychiatric disorder and treatment.

However, by controlling for previous psychiatric disorders, our analyses should have minimized this possibility. Prospective studies that compare pregnant women with women who attempt but fail to become pregnant may also be biased by potential psychiatric disorders related to pregnancy failure.

Risk factors for psychiatric disorders and substance use among pregnant women are consistent with those identified in the general population 67 - 74 and clinical samples of pregnant women. Our study extends previous findings by documenting that pregnancy complications are also associated with significantly higher risk of psychiatric morbidity in pregnant women.

Identification of these groups at increased risk of psychiatric disorders should help alert all clinicians who treat pregnant and postpartum women and their children and aid in focusing targeted prevention and early treatment interventions in these populations.

Pregnant women with psychiatric disorders seldom reported having sought mental health treatment. This observation is consistent with a recent report that pregnant women are less likely than nonpregnant women to receive inpatient or outpatient psychiatric treatment 9 and that mental health symptoms and diagnoses are significantly undetected and underrecorded in pregnant women who receive prenatal care in obstetrics clinics.

Patients and health care providers may view psychiatric symptoms as a normative response to the physiologic and psychosocial changes during this period. Mental health screening during routine prenatal and obstetric care may improve the detection of psychiatric disorders.

First, information on pregnancy status was based on self-report and not confirmed by pregnancy test. Second, because the NESARC sample included only individuals 18 years or older, information was unavailable on adolescents, who may be at increased risk of developing psychiatric disorders during pregnancy, although rates of adolescent pregnancy have recently declined.

Other recent studies 9 may be better powered to examine the occurrence of these disorders owing to their larger sample sizes, although they are limited by the risk of Berkson bias.

Our study, on the other hand, counterbalances this limitation by its ability to examine the occurrence of disorders that have not resulted in admission or treatment and direct interview of pregnant, postpartum, and nonpregnant women. Fourth, the assessment of month symptoms in currently pregnant women may have included women who were early in pregnancy, and therefore reporting symptoms largely or entirely from months prior to pregnancy.

This would reduce the apparent differences in prevalence between the nonpregnant and the pregnant subgroups. Fifth, the NESARC did not specifically assess the amount of obstetric care received by pregnant and recently postpartum women, information that would be helpful to add to future large-scale epidemiologic studies.

Sixth, the NESARC did not collect data on month of pregnancy, time elapsed since delivery, use of psychotropic medication during pregnancy or puerperium, pregnancy outcomes, or specific complications. It is possible that some of the women included in the postpartum group may have had a miscarriage or abortion.

However, our data suggest that women with pregnancy complications have a greater prevalence of psychiatric disorders than other pregnant women. Exclusion of women with a miscarriage or abortion from the analyses would have resulted in lower estimates of mental disorders than the ones reported herein, suggesting that our analyses do not underestimate the prevalence of psychiatric disorders among pregnant women.

Seventh, information on substance use and substance use disorders was based on self-report and not confirmed by objective methods. Some discrepancies have been found between self-reported and objectively measured rates of drug use in pregnant women in antenatal care. Despite these limitations, the NESARC constitutes the largest nationally representative survey to date to include information on psychiatric disorders in pregnant women.

Pregnancy is traditionally viewed as a stressful period that may provoke mental illness. In this study, groups of pregnant women with particularly high prevalence of psychiatric disorders were identified ie, pregnant women aged years who were living without a partner, widowed, separated, divorced, and never married; pregnant women who experienced pregnancy complications, stressful life events, and trauma or victimization; and pregnant women with overall poor health. Low rates of mental health service use were identified in this study regardless of pregnancy status.

However, past-year treatment seeking for any month mood disorder in past-year pregnant and postpartum women, and for any month anxiety disorder in past-year pregnant women, was significantly lower than in nonpregnant women of childbearing age. Given the critical importance of this life period for mothers and their offspring, urgent action is needed to increase detection and treatment of psychiatric disorders among pregnant and postpartum women in the United States.

Psychiatric disorders in pregnancy

Psychiatric disorders in pregnancy