Postpartum psychiatric disorders

Abstract

Pregnancy is a complex and vulnerable period that presents a number of challenges to women, including the development of postpartum psychiatric disorders (PPDs). These disorders can include postpartum depression and anxiety, which are relatively common, and the rare but more severe postpartum psychosis. In addition, other PPDs can include obsessive–compulsive disorder, post-traumatic stress disorder and eating disorders. The aetiology of PPDs is a complex interaction of psychological, social and biological factors, in addition to genetic and environmental factors. The goals of treating postpartum mental illness are reducing maternal symptoms and supporting maternal–child and family functioning. Women and their families should receive psychoeducation about the illness, including evidence-based discussions about the risks and benefits of each treatment option. Developing effective strategies in global settings that allow the delivery of targeted therapies to women with different clinical phenotypes and severities of PPDs is essential.

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Figure 1: Mechanisms of PPDs.
Figure 2: Management of first-onset PPDs.

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Acknowledgements

The authors thank A. Gemmill (Parent-Infant Research Institute) and H. Krohn (University of North Carolina at Chapel Hill) for their contributions to the preparation of this manuscript.

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Introduction (all); Epidemiology (T.M-O.); Mechanisms/pathophysiology (I.J. and S.M-B.); Diagnosis, screening and prevention (L.M.H., S.H. and J.M.); Management (S.V. and V.B.); Quality of life (J.M.); Outlook (all); Overview of Primer (S.M-B.).

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Correspondence to Samantha Meltzer-Brody.

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Competing interests

S.M-B. has received research grant support to the University of North Carolina at Chapel Hill from Sage Therapeutics and Janssen. L.M.H. is funded through a National Institute for Health Research (NIHR) Professorship in maternal mental health (NIHR-RP-R3-12-011). V.B. is supported by the Netherlands Organisation for Scientific Research (NWO) (VENI 91616036 and Clinical Fellowship 90715620) and the Early-Mid Career fellowship. I.J. is a Trustee of Action on Postpartum Psychosis and the Maternal Mental Health Alliance and is supported through the National Centre for Mental Health grant from Health and Care Research Wales. All other authors declare no competing interests.

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Meltzer-Brody, S., Howard, L., Bergink, V. et al. Postpartum psychiatric disorders. Nat Rev Dis Primers 4, 18022 (2018). https://doi.org/10.1038/nrdp.2018.22

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