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Pregnancy and breastfeeding in mental health policy: a narrative review

Published online by Cambridge University Press:  18 August 2023

E. McGuire*
Affiliation:
Sligo Leitrim Mental Health Service, Sligo University Hospital, Sligo, Ireland
S. Murray
Affiliation:
Department of Liaison Psychiatry, University Hospital Waterford, Waterford, Ireland
R. M. Duffy
Affiliation:
Specialist Perinatal Mental Health Service, Rotunda Hospital, Dublin, Ireland
*
Corresponding author: Eimear McGuire; Email: eimear.mcguire4@hse.ie

Abstract

Objectives:

Mental health difficulties are often exacerbated during the perinatal period. Policy and guidelines are increasingly being used to enhance the quality of healthcare. We conducted a literature review of published research relating to pregnancy and breastfeeding in mental health policy.

Methods:

Relevant terms were searched in Medline, CINAHL, APA PsycINFO and EMBASE for articles published in English from 1970 until 2020. Only papers that referenced policy, guidance, legislation or standards were included. While a systematic approach was used, the nature of the results necessitated a narrative review.

Results:

Initially, 262 papers were identified, 44 met the inclusion criteria. Reproductive health is given sparse consideration in research relating to mental health policy. Despite this, some key areas emerged. These included: the need for proactive preconception psychoeducation, proactive screening of mothers of infants and young children for perinatal mental health issues, enhanced prescribing practice for women of child-bearing age, enhanced monitoring during pregnancy, development of safe modification of coercive practices should they need to be employed in emergency circumstances and targeted measures to reduce substance misuse. Themes that arose relating to breastfeeding and bonding are also described.

Conclusions:

Female reproductive health is often ignored in research relating to mental health policy, guidelines and standards. These tools need to be harnessed to promote good healthcare. Reproductive health should be included in the care plan of all mental health patients. These topics need to be integrated into existing relevant policies and not isolated to a separate policy.

Type
Original Research
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

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Footnotes

EM and SM are first co-authors.

References

Aftab, A, Shah, AA (2017). Behavioral emergencies: special considerations in the pregnant patient. Psychiatric Clinics of North America 40, 435448. https://doi.org/10.1016/j.psc.2017.05.017.Google Scholar
Amy, JJ, Rowlands, S (2018). Legalised non-consensual sterilisation - eugenics put into practice before 1945, and the aftermath. Part 1: USA, Japan, Canada and Mexico. European Journal of Contraception Reproductive Health Care 23, 121129.Google Scholar
Anderson, KN, Lind, JN, Simeone, RM, Bobo, WV, Mitchell, AA, Riehle-Colarusso, T, et al. (2020). Maternal use of specific antidepressant medications during early pregnancy and the risk of selected birth defects. JAMA Psychiatry 77, 12461255.Google Scholar
Atturu, H, Odelola, D, Etuk, E, Harris, SP (2013). Breaking bad news – a valproate reaudit. European Neuropsychopharmacology 23, S368S369. https://doi.org/10.1016/S0924-977X(13)70581-9.Google Scholar
Austin, MP, Highet, N (2011). The Guidelines Expert Advisory Committee. Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Beyond Blue: The National Depression Initiative: Melbourne.Google Scholar
Bulik, CM, Sullivan, PF, Fear, JL, Pickering, A, Dawn, A, McCullin, M (1999). Fertility and reproduction in women with anorexia nervosa: a controlled study. Journal of Clinical Psychiatry 60, 130135.Google Scholar
Ces, A, Falissard, B, Glangeaud-Freudenthal, NMC, Sutter-Dallay, AL, Gressier, F (2018). Pregnancy in women with psychotic disorders: Risk factors associated with mother-baby separation. Archives of Women’s Mental Health 21, 699706 Google Scholar
Chambers, GM, Randall, S, Mihalopoulos, C, Reilly, N, Sullivan, EA, Highet, N, et al. (2018). Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia. Australian Health Review 42, 514521. https://doi.org/10.1071/AH17118.Google Scholar
Davis, LL, Shannon, S, Drake, RG, Petty, F (2001). The treatment of bipolar disorder during pregnancy. In Yonkers, K. & Little, B. (Eds.), Management of psychiatric disorders in pregnancy. (pp. 122133). Oxford University Press.Google Scholar
Dikmen-Yildiz, P, Ayers, S, Phillips, L (2017). Screening for birth-related PTSD: psychometric properties of the Turkish version of the Posttraumatic Diagnostic Scale in postpartum women in Turkey. European Journal of Psychotraumatology 8, 1306414.Google Scholar
du Toit, E, Jordaan, E, Niehaus, D, Koen, L, Leppanen, J (2018). Risk factors for unplanned pregnancy in women with mental illness living in a developing country. Archive of Women’s Mental Health 21, 323331.Google Scholar
European Medicines Agency (2018). Medicinal products containing substances related to valproate. Pharmacovigilance Risk Assessment Committee: London.Google Scholar
Franko, DL, Blais, MA, Becker, AE, Delinsky, SS, Greenwood, DN, Flores, AT, et al. (2001). Pregnancy complications and neonatal outcomes in women with eating disorders. American Journal of Psychiatry 158, 14611466.Google Scholar
Frayne, J, Nguyen, T, Allen, S, Hauch, Y, Liira, H, Vickery, A (2019). Obstetric outcomes for women with severe mental illness: 10 years of experience in a tertiary multidisciplinary antenatal clinic. Archives of Gynecology and Obstetrics 300, 889896. https://doi.org/10.1007/s00404-019-05258-x.Google Scholar
Gilbert, H (2010). Kristina’s Story (Antipsychotic medication use during pregnancy). Australian and New Zealand Journal of Psychiatry 44, A45A45 Google Scholar
Goldspink, R, Pumipi, T, Dey, S, Menkes, DB (2020). Sodium valproate prescription to women of childbearing age in a New Zealand inpatient psychiatric unit. Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists 28, 555558. https://doi.org/10.1177/1039856220934317.Google Scholar
Gonzales, N, Quinn, DK, Rayburn, W (2014). Perinatal catatonia: a case report and literature review. Psychosomatics 55, 708714. https://doi.org/10.1016/j.psym.2014.01.009.Google Scholar
Gopalan, P, Moses-Kolko, E, Valpey, R, Shenai, N, Smith, E (2019). Benzodiazepine withdrawal in pregnant women with opioid use disorders: An observational study of current clinical practices at a tertiary obstetrical hospital. General Hospital Psychiatry 57, 2933.Google Scholar
Gotlib, D, Perelstein, E, Kurlander, J, Zivin, K, Riba, M, Muzik, M (2016). Guideline adherence for mentally ill reproductive-aged women on treatment with valproic acid: a retrospective chart review. Journal of Clinical Psychiatry 77, 527534. https://doi.org/10.4088/JCP.15m10046.Google Scholar
Grube, M (2005). Inpatient treatment of women with postpartum psychiatric disorders – the role of the male partners. Archives of Womenʼs Mental Health 8, 163170 Google Scholar
Guedes, TG, Moura, ERF, Evangelista, DR, da Conceicao, MAV (2009). Reproductive aspects in women with mental disorder. Revista Enfermagem UERJ 17, 153158 Google Scholar
Halligan, SL, Murray, L, Martins, C, Cooper, PJ (2007). Maternal depression and psychiatric outcomes in adolescent offspring: a 13-year longitudinal study. Journal of Affective Disorders 97, 145154.Google Scholar
Hammond, J and Lipsedge, M (2015). Assessing Parenting Capacity in Psychiatric Mother and Baby Units: A case report and review of literature. Psychiatria Danubia 27, S71S83 Google Scholar
Heiman, HJ, Smith, LL, McKool, M, Mitchell, DN, Roth Bayer, C (2015). Health policy training: a review of the literature. International Journal of Environmental Research and Public Health 13, 20. https://doi.org/10.3390/ijerph13010020.Google Scholar
Hilder, L (2013) Population audit of perinatal mental health co-morbidity, New South Wales 2000-2006. Journal of Paediatrics and Child Health 49, 5980.Google Scholar
Horowitz, JA, Murphy, CA, Gregory, KE, Wojcik, J (2009). Community-based postpartum depression screening: results from the CARE study. Psychiatric Services 60, 14321434.Google Scholar
Hurt, LD, Ray, C (1985). Post-partum disorder: Mother-infant bonding on a psychiatric unit. Journal of Psychosocial Nursing and Mental Health Service 23, 1520.Google Scholar
Institute of Medicine (2000). To err is human: Building a safer health system. National Academy Press, Institute of Medicine, Committee on Quality of Health Care in America: Washington, DC.Google Scholar
Jankovic, J, Parsons, J, Jovanović, N, Berrisford, G, Copello, A, Fazil, Q, et al. (2020). Differences in access and utilisation of mental health services in the perinatal period for women from ethnic minorities-a population-based study. BMC Medicine 18, 245. https://doi.org/10.1186/s12916-020-01711-w.Google Scholar
Johnson, R, Browne, K, Hamilton-Giachritsis, C (2006). Young children in institutional care at risk of harm. Trauma Violence Abuse 7, 3460. https://doi.org/10.1177/1524838005283696.Google Scholar
Jones, S, McDonald, L, Melville, J (2015). Prescribing sodium valproate to women of childbearing age-an audit THE INTERNATIONAL MARCÉ SOCIETY FOR PERINATAL MENTAL HEALTH BIENNIAL SCIENTIFIC CONFERENCE. Archives of Womenʼs Mental Health 18, 269408. https://doi.org/10.1007/s00737-014-0488-6.Google Scholar
Kelly, E, Sharma, V (2010) Diagnosis and treatment of postpartum bipolar depression. Expert Review of Neurotherapeutics 10, 10451051. https://doi.org/10.1586/ern.10.81.Google Scholar
Kennedy, D (2007). Antipsychotic drugs in pregnancy and breastfeeding. Australian Prescriber 30, 162163.Google Scholar
Kitamura, T, Shima, S, Sugawara, M, Toda, MA (1996). Clinical and psychosocial correlates of antenatal depression: a review. Psychotherapy and Psychosomatics 65, 117123 Google Scholar
Ladavac, A, Dubin, W, Ning, A, Stuckeman, P (2007). Emergency management of agitation in pregnancy. General Hospital Psychiatry 29, 3941 Google Scholar
Langan Martin, J, McLean, G, Cantwell, R, Smith, DJ (2016). Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study. BMJ Open 6, e008758. https://doi.org/10.1136/bmjopen-2015-008758.Google Scholar
Lee, WS, Mihalopoulos, C, Chatterton, ML, Chambers, GM, Highet, N, Morgan, VA (2019). Policy impacts of the Australian national perinatal depression initiative: psychiatric admission in the first postnatal year. Administration and Policy in Mental Health and Mental Health Services Research 46, 277287 https://doi.org/10.1007/s10488-018-0911-9.Google Scholar
Marks, M, Lovestone, S (1995). The role of the father in parental postnatal mental health. British Journal of Medical Psychology 68, 157168.Google Scholar
Martin, L, Raignoux, S, Gaudoneix, M, Beauverie, P (2013). Overview of the prevalence and care of pregnant women in a psychiatric hospital. International Journal of Clinical Pharmacy 35, 5.Google Scholar
Matthey, S, Barnett, B, Ungerer, J, Waters, B (2000). Paternal and maternal depressed mood during the transition to parenthood. Journal of Affective Disorders 60, 7585.Google Scholar
May, A (2014). The challenges of treating catatonia in pregnancy 2014 American Neuropsychiatric Association Annual Meeting Abstracts. The Journal of Neuropsychiatry and Clinical Neurosciences 26, 5. https://doi.org/10.1176/appi.neuropsych.262abstract.Google Scholar
Mazer-Poline, C, Fornari, V (2009). Anorexia nervosa and pregnancy: Having a baby when you are dying to be thin—case report and proposed treatment guidelines. International Journal of Eating Disorders 42, 382384. https://doi.org/10.1002/eat.20607.Google Scholar
McGuire, E, Curtis, C, Duffy, RM (2020). Fertile ground: reproductive health consideration in mental health ward policy. Irish Journal of Psychological Medicine 28, 16. https://doi.org/10.1017/ipm.2020.27.Google Scholar
Mental Health Commission (2006). Quality framework mental health services in Ireland [Online] (https://www.mhcirl.ie/File/qframemhc.pdf). Accessed 04 January 2020.Google Scholar
Miller, L, Finnerty, M (1996). Sexuality, pregnancy, and childbearing among women with schizophrenia-spectrum disorders. Psychiatric Services 47, 502505.Google Scholar
Mongan, D, Reynolds, S, Fanagan, S, Long, J (2007). Health-Related Consequences of Problem Alcohol Use. Overview 6. Dublin: Health Research Board.Google Scholar
Munk-Olsen, T, Laursen, TM, Pedersen, CB, Mors, O, Mortensen, PB (2006). New parents and mental disorders: a population-based register study. JAMA 296, 25822589.Google Scholar
Murray, L, Cooper, PJ (1996). The impact of postpartum depression on child development. International Review of Psychiatry 8, 5563.Google Scholar
Nam, JY, Choi, Y, Kim, J, Cho, KH, Park, E-C (2017). The synergistic effect of breastfeeding discontinuation and cesarean section delivery on postpartum depression: A nationwide population-based cohort study in Korea. Journal of Affective Disorders [Internet] 218, 5358.Google Scholar
Newman, K, Thamban, MSS (2015). Our experience in the use of anti-psychotics in pregnancy. Archives of Women’s Mental Health 18, 331332. https://doi.org/10.1007/s00737-014-0488-6.Google Scholar
Nicholson, J, Nason, MW, Calabresi, AO, Yando, R (1999). Fathers with severe mental illness: Characteristics and comparisons. American Journal of Orthopsychiatry 69, 134141 Google Scholar
Nicholson, J, Sweeney, EM, Geller, JL (1998). Mothers with mental illness: I. The competing demands of parenting and living with mental illness. Psychiatric Services 49, 635642.Google Scholar
O’Connor, MJ & Whaley, SE (2007). Brief intervention for alcohol use by pregnant women. American Journal of Public Health 97, 252258. https://doi.org/10.2105/AJPH.2005.077222.Google Scholar
O’Connor, TG, Heron, J, Glover, V (2002). The ALSPAC Study Team. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Journal of the American Academy of Child & Adolescent Psychiatry 41, 14701477.Google Scholar
Ødegård, Ø (1980). Fertility of psychiatric first admissions in Norway. Acta Psychiatrica Scandinavica 62(3), 212220. https://doi.org/10.1111/j.1600-0447.1980.tb00609.x.Google Scholar
Ødegård, Ø (1980). Fertility of psychiatric first admissions in Norway. Acta Psychiatrica Scandinavica 62, 212220. https://doi.org/10.1111/j.1600-0447.1980.tb00609.x Google Scholar
Ornoy, A, Weinstein-Fudim, L, Ergaz, Z (2017) Antidepressants, antipsychotics, and mood stabilizers in pregnancy: what do we know and how should we treat pregnant women with depression. Birth Defects Research 109, 933956.Google Scholar
Pacchiarotti, I, León-Caballero, J, Murru, A, Verdolini, N, Furio, MA, Pancheri, C, et al. (2016). Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder. European Neuropsychopharmacology 26, 15621578.Google Scholar
Paulson, JF, Sharnail, D, Bazemore, MS (2010). Prenatal and postpartum depression in fathers and its association with maternal depression. JAMA 303, 19611969.Google Scholar
Pearson, V (1995). Population policy and eugenics in China. British Journal of Psychiatry 167, 14.Google Scholar
Rodriguez-Cabezas, L, Clark, C, Yang, A, Pendergrast, T, Miller, E, Wisner, K (2017). Put your oxygen mask on first-perinatal psychiatric emergencies: a reproductive psychiatrist’s perspective. Obstetrics & Gynecology 129, 93S.Google Scholar
Rowan, P, Greisinger, A, Brehm, B, Smith, F, McReynolds, E (2012). Outcomes from implementing systematic antepartum depression screening in obstetrics. Archives of Women’s Mental Health 15, 115120 Google Scholar
Rowan, PJ, Duckett, SA, Wang, JE (2015). State mandates regarding postpartum depression. Psychiatric Services 66, 324328. https://doi.org/10.1176/appi.ps.201300505.Google Scholar
Rybakowski, J, Cubała, WJ, Gałecki, P, Rymaszewska, J, Samochowiec, J, Szulc, A, et al. (2019). Recommendations of the Polish Psychiatric Association regarding the treatment of affective disorders in women of childbearing age. Part II: Bipolar disorder. Psychiatria polska, 53, 263276. https://doi.org/10.12740/PP/103555.Google Scholar
Sadock & Sadock (2000). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
Sawati, AT, Wijesiriwardena, A (2013). An audit into the management of risks for perinatal mental illness-a district general hospital experience BJOG. An International Journal of Obstetrics and Gynaecology 120, 427.Google Scholar
Sharif, S, Shangaris, P, Jefferies, C, Gangopadhyay, R, Pann, M (2016). Screening for perinatal mental health and medical personnel awareness in a London Hospital. Scientific Abstracts Reproductive Sciences 23, 201A.Google Scholar
Solari, H, Dickson, KE, Miller, L (2009). Understanding and treating women with schizophrenia during pregnancy and postpartum—Motherisk Update 2008. The Canadian Journal of Clinical Pharmacology 16, e23e32 Google Scholar
Stein, A, Pearson, RM, Goodman, SH, Rapa, E, Rahman, A, McCallum, M, et al. (2014). Effects of perinatal mental disorders on the fetus and child. Lancet 384, 18001819.Google Scholar
Thibaut, F, Chagraoui, A, Buckley, L, Gressier, F, Labad, J, Lamy, S (2019). WFSBP and IAWMH Guidelines for the treatment of alcohol use disorders in pregnant women. The World Journal of Biological Psychiatry 20, 1750. https://doi.org/10.1080/15622975.2018.1510185.Google Scholar
Turella, E, Donolato, A, Ciulli, B, Riolo, R (2016). Postpartum depression: From a screening project to a regular support program among a maternity population. Psychiatrische Praxis 38. https://doi.org/10.1055/s-0031-1277925.Google Scholar
United Nations (2006). Convention on the rights of persons with disabilities. United Nations: Geneva.Google Scholar
Viguera, AC, Whitfield, T, Baldessarini, RJ, Newport, DJ, Stowe, Z, Reminick, A, et al. (2007). Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. American Journal of Psychiatry 164, 1817–24.Google Scholar
Winans, EA (2001). Antipsychotics and breastfeeding. Journal of Human Lactation: Official Journal of International Lactation Consultant Association 17, 344347. https://doi.org/10.1177/089033440101700408.Google Scholar
Wisner, KL, Sit, D, McShea, MS, Rizzo, DM, Zoretich, RA, Hughes, CL, et al. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 70, 490498.Google Scholar
Xiaong Lai, HM, Cleary, M, Sitharthan, T, Hunt, GE (2015). Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990-2014: A systematic review and meta-analysis. Drug and Alcohol Dependence 154, 113. https://doi.org/10.1016/j.drugalcdep.2015.05.031.Google Scholar
Zhu, Y, Zhang, C (2016). Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Current Diabetes Reports 16, 7. https://doi.org/10.1007/s11892-015-0699-x.Google Scholar