Psychiatric disorders in pregnancy

Psychiatric disorders are common in pregnancy and can be associated with a range of adverse outcomes, including maternal death. Early identification and, where appropriate, referral to a specialist mental health service, is the key to successful management. Women with more severe psychiatric disorders, such as bipolar affective disorder, schizophrenia and moderate to severe depression, benefit from a shared management approach involving obstetric, primary care and specialist mental health services, formalized within a written perinatal care plan. Large numbers of women take psychotropic medication during pregnancy, but when it represents an appropriate alternative to medication, timely psychological treatment is the preferred approach for a range of psychiatric disorders. When medication is used, it should be based on a risk/benefit analysis that takes appropriate notice of the dangers of stopping or avoiding medication as well as any risk to the exposed fetus. All decisions about the management of a psychiatric disorder should involve the pregnant women as a fully informed partner in a shared decision-making approach. This review summarizes general guidance on management for the obstetrician and issues arising in relation to a number of specific psychiatric disorders and specific psychiatric treatments.