Psychiatric disorders in pregnancy

Psychiatric disorders are common in the general population of women of childbearing age. They probably do not have a substantially higher incidence in pregnancy, but they are independently associated with a range of adverse pregnancy outcomes. These include prematurity, low birth weight and an increase in the rate of major malformations.Whilst maternal death arising as a consequence of psychiatric disorder is relatively uncommon, it continues to feature prominently as one of the leading preventable contributors to maternal mortality in the developed world. Conversely, the inappropriate attribution of physical complaints to underlying psychiatric disorder, and the misdiagnosis of delirium as psychiatric disorder, have both been associated with maternal mortality from undiagnosed physical causes.Milder psychiatric disorders presenting in pregnancy can be managed by primary care services, where access to psychological treatments can often be speedier. Women with more severe disorders need specialist care, ideally from a perinatal mental health service sitting within a perinatal mental health network that incorporates a mother and baby unit.Women and their partners should be fully involved in discussions about mental health treatment choices and the balance of risks involved, including the background rate of adverse outcomes that can occur by chance. Decisions about medication should be carefully documented and summarized in a letter written in plain English that is copied to the woman for her information.