In perinatal mood and anxiety disorders

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Perinatal mood and anxiety: Risk factors

Risk factors for mood and anxiety disorders

Biological factors

  • Past history of depression
  • Past history of postpartum depression – up to 50 per cent recurrence for subsequent pregnancies
  • Family history of mental illness – first-degree relative doubles the risk
  • Recent discontinuation of antidepressants – 75 per cent relapse
  • Medical or obstetrical problems
  • Substance use problems

Psychosocial factors

  • Unplanned pregnancy or ambivalent feelings about the pregnancy
  • Marital discord
  • Personality traits, for example, perfectionism
  • Return-to-work pressures
  • Sexual, physical, emotional abuse
  • Lower socioeconomic status, financial difficulties
  • Recent immigration

Consequences of untreated perinatal mood and anxiety disorders

Maternal consequences

  • Progression of the mental illness
  • Poor prenatal care
  • Risk of medical and obstetrical complications such as gestational diabetes, premature labour
  • Self-medication and substance abuse
  • Impaired bonding and maternal-infant interaction
  • Suicide and infanticide

Neonatal consequences

  • Preterm delivery
  • Poor neonatal adaptation – altered sleep, increased irritability, crying, lethargy
  • Lower birth weight, associated with increased uterine artery resistance
  • Greater right frontal EEG activation
  • Lower dopamine and serotonin levels
  • Lower scores on Brazelton Neonatal Behavioral Assessment Scale

Childhood and adolescent consequences

  • Anxiety and depression, withdrawal, somatic complaints (internalizing behaviours)
  • ADHD, aggression in boys, rule-breaking (externalizing behaviours)
  • Increased impulsivity
  • Lower scores on WISC-R intelligence subtests

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