The clinical content of preconception care: women with psychiatric conditions

Department of Psychiatry, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 01/2009; 199(6 Suppl 2):S328-32. DOI: 10.1016/j.ajog.2008.09.001
Source: PubMed


For a substantial proportion of women, pregnancy can be complicated by the occurrence or reoccurrence of a psychiatric condition. Psychiatric disorders during pregnancy are associated with poor obstetric outcomes, higher risk of postpartum psychiatric illness, increased rates of substance abuse, lower participation in prenatal care, and adverse infant and family outcomes. As part of preconception care, providers should be vigilant and screen for psychiatric disorders among women of reproductive age, as the detection and appropriate management of these conditions can reduce the occurrence of adverse pregnancy and family outcomes. This manuscript reviews the treatment options and the risks and benefits of discontinuing, changing, or continuing psychotropic medications for women of reproductive age with common psychiatric disorders (depression and anxiety disorders, bipolar disorder, and schizophrenia) and offers recommendations for preconception care.

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    ABSTRACT: This article outlines guidelines for preconception counseling of women with schizophrenia. Preconception care creates the opportunity to address risky behaviors, change unhealthy lifestyles, enhance the patient's knowledge about the genetics of her disease and the risk for her offspring, improve parenting skills, mobilize resources and the necessary support system in a timely manner and ultimately improve the health and quality of life of both the woman and her offspring. Women with schizophrenia are in particular need of preconception interventions. They are at a high risk of relapse during pregnancy unless their illness is treated. Psychosis during pregnancy can lead to fetal distress, denial of pregnancy, failure to participate in prenatal care and to recognize the signs of labor. Women with schizophrenia are at high risk of fetal malformations, obstetrical and neonatal complications and postpartum psychosis. In addition, schizophrenia is associated with homelessness and low socioeconomic status. Moreover, women with schizophrenia have poor social support and often lose the custody of their children. Identification and treatment of women with severe mental illness prior to conception is essential to reducing negative outcomes.
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    ABSTRACT: The goal of prenatal care is a healthy pregnancy and prevention of adverse maternal and fetal outcomes. Women with schizophrenia who become pregnant pose unique challenges to the delivery of prenatal care and are at high risk for adverse perinatal outcomes. Pregnancy in these women should be considered high risk. Offspring of women with schizophrenia are genetically predisposed to developing schizophrenia. Obstetric complications such as diabetes, prematurity, and fetal growth retardation also place the offspring at greater risk for development of schizophrenia, regardless of the genetic vulnerability. Pregnant women with schizophrenia are at greater risk for inadequate prenatal care and known obstetric complications, which are further risk factors for schizophrenia in the offspring. Thus, the genetic and obstetric environment of the fetus predisposes to the development of schizophrenia. This risk may be mitigated by increased vigilance in providing prenatal care to these women and preventing or minimizing illness and treatment emergent complications during pregnancy. In this article we review: 1) the barriers to adequate prenatal care in women with schizophrenia, 2) factors associated with the illness and its treatment requiring attention and monitoring during prenatal visits, and 3) the multi-disciplinary, collaborative approach to the delivery of prenatal care for these women.
    No preview · Article · Jan 2010 · Current Women s Health Reviews
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