An Update on Mood and Anxiety Disorders During Pregnancy and the Postpartum Period

Because women in the childbearing years are vulnerable to mood and anxiety disorders, physicians in all patient care specialties need to be familiar with the prevalence and course of these disorders, particularly during pregnancy and the postpartum period. Systematic prospective data are limited on the onset of mood and anxiety disorders during pregnancy and the postpartum period as well as on the risk of relapse during these time periods in women with prior histories of the disorders.

The literature on mood and anxiety disorders during pregnancy is frequently complicated by the use of various methodologies, procedures, and study populations, and inconsistencies in the postpartum time frame (up to 6 months after delivery) make the literature on epidemiology of postpartum disorders difficult to interpret.

This article is an update of available information about the prevalence and course of mood and anxiety disorders in women during pregnancy and the postpartum period.
(Primary Care Companion J Clin Psychiatry 2000;2:217–222)

Mood and anxiety disorders in women frequently begin during the childbearing years. Yet, systematic prospective data are limited on the prevalence of mood and anxiety disorders during pregnancy as well as on the risk for relapse in women with prior histories of the disorders. In a recent prospective longitudinal study¹ of 417 pregnant women in England in which depression was measured by the Edinburgh Postnatal Depression Scale, 41 women (9.8%) were depressed during pregnancy and 31 women (7.4%) were depressed at 3 months postpartum.

Because women are vulnerable to mood and anxiety disorders, physicians in all patient care specialties need to be familiar with the prevalence and course of these disorders, particularly during pregnancy and the postpartum period.

Many women who have mood and anxiety disorders are treated with psychotropic medications and may be taking such drugs when they conceive. To some extent, any drug or chemical substance administered to the mother is able to cross the placenta unless it is destroyed or altered during metabolism,² and the impact of psychotropic medications on the developing fetus is always of concern.³ However, discontinuing psychotropic medications can lead to relapse,^4–8 and the symptoms common to psychiatric disorders may confer additional risk to the fetus.^9–11

Thus, although the use of psychotropic medications is appropriate in many clinical situations, pharmacologic treatment should include thoughtful weighing by the clinician of the risk of prenatal exposure versus the risk of relapse following drug discontinuation.

This article is an update of available information about the prevalence and course of mood and anxiety disorders in women during pregnancy and the postpartum period.