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Perinatal mental health crucial

- By Wits University

The importance of looking after the mental health of parents during pregnancy and after childbirth, in order to promote the physical and mental wellbeing of both parents and child, is highlighted by researchers at Wits University, King’s College London, the University of Oxford and Cardiff University in a new Series of articles in The Lancet.

If left untreated, a parent’s mental disorder can be associated with psychological difficulties in the children.

Wits Honorary Professor in the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) in the School of Public Health and alumnus Alan Stein, currently the Head of the Child and Adolescent Psychiatry Unit at the University of Oxford, is the lead author of the third paper and co-editor of the Series, which was published last week.

Perinatal mental health disorders are common during pregnancy and the postnatal period – occurring in more than 10% of women in high income countries.  In low and middle income countries the rates are probably even higher.

A recent report revealed the UK long-term economic costs of perinatal mental disorders to society to be more than R130 billion a year. The burden of perinatal mental health disorders may be even greater in low and middle income countries because the loss of earning from an inability to work has a greater impact on the families’ health and nutrition.

Where resources are scarce, children are more at risk of being affected by perinatal mental health disorders and innovative strategies are needed to help tackle this problem.

“For many parents, the arrival of a child is a challenging time. The stigma around ante and postnatal mental illnesses can prevent people from getting the help they need. It’s important that people seek treatment promptly to prevent suffering and distress for the whole family.  We want the public to know that there are effective treatments out there,” says Louise Howard, Professor of Women’s Mental Health at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, lead author of paper 1 and co-editor of The Lancet Series.

This series discusses the full range of mental health disorders that can occur during pregnancy and after childbirth: how often they occur; their causes; the risks to mother and baby; treatments that are effective; and how we can prevent these disorders. Importantly, the authors draw attention to gaps in our knowledge and where more research is urgently required.

Paper 1: This paper summarises the evidence for risk factors for common non-psychotic mental disorders such as anxiety, depression, eating disorders and post-traumatic stress disorder (PTSD), during the perinatal period. Most research in the perinatal period has focused on postnatal depression and more research is needed to fully understand the other disorders. There is still some uncertainty about the extent of the risks of taking medication on the foetus or infant. The authors explain how to balance the risks and benefits of the different types of treatment including psychological interventions and medication.

“Many of the symptoms of perinatal mental illnesses such as antenatal and postnatal depression and anxiety can be treated effectively. The risks of leaving symptoms untreated could be more harmful to both mother and foetus or infant than risks of treatment. We hope the Series will help clinicians and women make informed decisions about the range of treatments that could be helpful for mental illness at this important time in life,” says Howard.

Paper 2 discusses the care of illnesses such as bipolar disorder and schizophrenia during the perinatal period. Childbirth can be a powerful trigger of severe mood disorders such as mania, severe depression and psychosis, particularly in women with a history of bipolar disorder. Suicide attempts are common in these circumstances and remain one of the leading causes of maternal death in high income countries. The authors advise that all women of reproductive age with a history of severe mental illness should be properly counselled about the risks and the care needed during pregnancy and after childbirth due to the risk of relapse.

“More research is crucial to understand what triggers psychotic episodes after childbirth so that we can predict women at risk and develop treatments that are safe to be administered for mother and baby,” says Professor Ian Jones from the Medical Research Council (MRC) Centre for Neuropsychiatric Genetics and Genomics at Cardiff University, and lead author of paper 2.

Paper 3 summarises the evidence for links between parental mental health disorders and the risk of low birth weight, prematurity, and later psychological disturbances in children. The ways in which particular perinatal mental health disorders are associated with specific aspects of child development are complex and not yet fully understood. Further investigations are important in order to reduce the risk to the child.

Considerable research has been undertaken to develop interventions but much more needs to be done especially in low and middle income countries. The authors add that most research has focused on disorders in mothers, but depression in fathers is more common than previously thought with emerging evidence suggesting that this is also associated with effects on children.

“Adverse effects of perinatal mental health disorders on children are not inevitable and many children are not adversely affected. Early identification and intervention are critical in preventing them. We need to treat both the parents’ symptoms and help with caregiving difficulties. Parents at risk of mental health disorders during or after pregnancy need to be identified early to try to prevent symptoms from affecting offspring,” says Stein.

For full Series paper 1, see: http://press.thelancet.com/perinatal1.pdf

For full Series paper 2, see: http://press.thelancet.com/perinatal2.pdf 

For full Series paper 3, see: http://press.thelancet.com/perinatal3.pdf

For the authors Commentary, see: http://press.thelancet.com/perinatalCMT.pdf

Stein recently delivered a public lecture at Wits titled: The impact of perinatal depression on child development: mechanisms and a global perspective, outlining the potential (reversible) risks to child cognitive development from those mothers suffering from postnatal depression, particularly in low-to-middle income countries, including South Africa which has a 20-29% rate of postnatal depression. Read more. 

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