Maternal Mental Illness Research Articles

Mental illness as a risk factor for uninsurance among mothers of infants.

The objective of this study was to assess the extent to which maternal prenatal mental illness is associated with mothers' health insurance status 12-18 months after giving birth. The sample consisted of 2,956 urban, mostly unwed, mothers who gave birth in 20 large U.S. cities between 1998 and 2000 and participated in the Fragile Families and Child Wellbeing birth cohort study. Multinomial logistic regression models were used to assess associations between maternal prenatal mental illness and whether the mother had private, public, or no insurance one year after the birth. Covariates included the mother's and child's physical health status, the father's physical and mental health status, and numerous other maternal, paternal, and family characteristics. Potential mediating factors were explored. The results showed that mothers with prenatal diagnosed mental illness were almost half as likely as those without mental illness diagnoses to have private insurance (vs. no insurance) one year after the birth. Among mothers who did not have a subsequent pregnancy, those with prenatal mental illness were less likely than those without mental illness diagnoses to have public insurance than to be uninsured. Screening positive for depression or anxiety at one year decreased the likelihood that the mother had either type of insurance. Policies to improve private mental health care coverage and public mental health services among mothers with young children may yield both private and social benefits. Encounters with the health care and social service systems experienced by pregnant and postpartum women present opportunities for connecting mothers to needed mental health services and facilitating their maintenance of health insurance.

Intérêt d’une base de données périnatales : mise à jour des courbes de morphométrie néonatale française

Maternal mental illness is associated with negative effects on the infant and child. Increased attention has been paid to the effects of specific perinatal disorders on parenting and interactions as an important mechanism of influence. OCD can be a debilitating disorder for the sufferer and those around them. Although OCD is a common perinatal illness, no previous studies have characterized parenting and mother infant interactions in detail for mothers with OCD.37 mothers with postpartum OCD and a 6 month old infant were compared with 37 community control dyads on a variety of measures of psychological distress and parenting. Observed mother-infant interactions were assessed independently.Obsessions and compulsions were reported in both groups, although they did not cause interference in the control group. Mothers with OCD were troubled by their symptoms for a mean of 9.6 hours/day. Mothers with OCD were less confident, reported more marital distress and less social support than healthy peers and were less likely to be breastfeeding. Infant temperament ratings did not differ. Mothers with OCD were rated as less sensitive in interactions than the comparison group, partly attributable to levels of concurrent depression.Maternal postpartum OCD is a disorder that can affect experiences of parenting and mother-infant interactions although this may not be driven by OCD symptoms. Longitudinal studies are required to assess the trajectory and impact of maternal difficulties as the infant develops.

International Adoption

International Adoption

Effect of maternal mental illness on pregnancy outcomes

Many pregnant women experience psychiatric disorders in their childbearing years. Emerging research shows mental illness not only affects the mother’s well-being but may also have significant effects on fetal outcomes. This review details what is known about the prevalence of mental illness during pregnancy as well as how such disorders may influence pregnancy outcomes. Maternal depression during pregnancy is an independent risk factor for low fetal birthweight and premature delivery, but other illnesses, such as anxiety disorders, eating disorders and psychotic illness, may also predict adverse birth outcomes. Possible behavioral, genetic and neuroendocrine mechanisms for these relationships are presented. Principles of treatment for psychiatric disorders during pregnancy are also discussed, with an emphasis on the role of the obstetrical provider.

Parental mental illness and fatal birth defects in a national birth cohort

BACKGROUND: Few large studies describe links between maternal mental illness and risk of major birth defect in offspring. Evidence is sparser still for how effects vary between maternal diagnoses and no previous study has assessed risk with paternal illnesses. METHOD: A population-based birth cohort was created by linking Danish national registers. We identified all singleton live births during 1973-1998 (n=1.45 m), all parental psychiatric admissions from 1969 onwards, and all fatal birth defects until 1 January 1999. Linkage and case ascertainment were almost complete. Relative risks were estimated using Poisson regression. RESULTS: Risk of fatal birth defect was elevated in relation to history of any maternal admission and also with affective disorders specifically, although the strongest effect found was with maternal schizophrenia. The rate was more than doubled in this group compared to the general population [relative risk (RR) 2.34, 95% confidence interval (CI) 1.45-3.77], which also represented a significant excess risk compared with all other admitted maternal disorders (p=0.018). Risk of death from causes other than birth defect was no higher with schizophrenia than with other maternal conditions. There was no elevation in risk of fatal birth defect if the father was admitted with schizophrenia or any other psychiatric diagnosis. CONCLUSIONS: There are many possible explanations for a higher risk of fatal birth defect with maternal schizophrenia and affective disorder. These include genetic effects directly linked with maternal illness, lifestyle factors (diet, smoking, alcohol and drugs), poor antenatal care, psychotropic medication toxicity, and gene-environment interactions. Further research is needed to elucidate the causal mechanisms.

The neglected ‘m’ in MCH programmes – why mental health of mothers is important for child nutrition

In most societies, mothers are the primary providers of nutrition and care to young children. This is a demanding task, and poor physical or mental health in mothers might be expected to have adverse consequences on their children's health, nutrition and psychological well-being. Child nutrition programmes do not adequately address maternal mental health. In this article, we consider the evidence from less developed countries on whether maternal mental health influences child growth, with respect to evidence from both observational studies and from clinical trials. We estimate how much of the burden of undernutrition might be averted in one setting, and propose that promoting maternal mental health and treating maternal mental illness offer important new opportunities to tackle the twin scourges of maternal ill-health and child undernutrition.

Parental mental illness and fatal birth defects in a national birth cohort

Few large studies describe links between maternal mental illness and risk of major birth defect in offspring. Evidence is sparser still for how effects vary between maternal diagnoses and no previous study has assessed risk with paternal illnesses. A population-based birth cohort was created by linking Danish national registers. We identified all singleton live births during 1973-1998 (n=1.45 m), all parental psychiatric admissions from 1969 onwards, and all fatal birth defects until 1 January 1999. Linkage and case ascertainment were almost complete. Relative risks were estimated using Poisson regression. Risk of fatal birth defect was elevated in relation to history of any maternal admission and also with affective disorders specifically, although the strongest effect found was with maternal schizophrenia. The rate was more than doubled in this group compared to the general population [relative risk (RR) 2.34, 95% confidence interval (CI) 1.45-3.77], which also represented a significant excess risk compared with all other admitted maternal disorders (p=0.018). Risk of death from causes other than birth defect was no higher with schizophrenia than with other maternal conditions. There was no elevation in risk of fatal birth defect if the father was admitted with schizophrenia or any other psychiatric diagnosis. There are many possible explanations for a higher risk of fatal birth defect with maternal schizophrenia and affective disorder. These include genetic effects directly linked with maternal illness, lifestyle factors (diet, smoking, alcohol and drugs), poor antenatal care, psychotropic medication toxicity, and gene-environment interactions. Further research is needed to elucidate the causal mechanisms.

An exploratory study of the relationship between mother–infant interaction and maternal cognitive function in mothers with mental illness

There is evidence for a deleterious effect of maternal mental illness on mother–infant interaction. Presence of mental illness and lowered maternal cognitive function independently predict quality of interaction, but their combined effect on interaction is unclear. A pilot study was conducted to explore the relationship between maternal serious mental illness (SMI), cognitive function, and mother–infant interaction. Six mothers with SMI (two with schizophrenia and four with depression) and 12 mothers with no psychiatric history were recruited, together with their infants (all aged between 5 and 18 weeks). Mother–infant interaction was assessed using the Crittenden Care Index. The Cognitive Drug Research computerised assessment battery provided measures of memory and attention. In support of previous literature, mothers with SMI were significantly less sensitive during interactions with their infants. They also demonstrated impairment relative to controls on an index of speed of memory processing. A hierarchical regression model revealed that presence of maternal mental illness was a significant predictor of maternal sensitivity, but when speed of memory processing was accounted for, the strength of this relationship was reduced, suggesting that the relationship between maternal mental illness and mother–infant interaction may be partially mediated by level of cognitive function. Further study is warranted.

Treatment of Perinatal Mood and Anxiety Disorders: A Review

To review the nonpharmacologic and pharmacologic treatment modalities for perinatal mood and anxiety disorders and to discuss the importance of weighing the risks and the benefits of exposing the fetus or baby to maternal mental illness as opposed to exposure to antidepressant medications. We conducted a literature search of the PubMed and MEDLINE databases. Key words included the following: perinatal, pregnancy, postpartum, depression, anxiety, pharmacologic, nonpharmacologic, psychotherapy, and treatment. Recent literature reflects that both pharmacologic and nonpharmacologic treatments for perinatal women are associated with positive and negative outcomes. No treatment decision was found to be risk-free. The detrimental effects of untreated mental illness on the mother, as well as on the baby, highlight the need for treatment intervention. The long-term effects of exposure to either medications or maternal mental illness are unknown, as yet. Women with perinatal depression and anxiety disorders require timely and efficient management with a goal of providing symptom relief for the suffering mother while simultaneously ensuring the baby's safety. Although knowledge in the area of appropriate intervention is constantly evolving, rigorous and scientifically sound research in the future is critical.

Possible Delayed Speech Acquisition With Clozapine Therapy During Pregnancy and Lactation

Back to table of contents Previous article Next article LETTERFull AccessPossible Delayed Speech Acquisition With Clozapine Therapy During Pregnancy and LactationD.N. Mendhekar M.D.,D.N. Mendhekar M.D.Search for more papers by this author,Published Online:1 Apr 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail SIR: Most of the study by Ernst and Goldberg 1 reported perinatal outcome with clozapine therapy with no focus on neurodevelopment. Here, I report a case of a woman with schizophrenia who continued clozapine treatment throughout her 9 months of pregnancy and during lactation. 2 This report also highlights neurodevelopmental aspects, particularly speech of the baby. Case Report“Mrs. B,” a 30-year-old woman, had been suffering with schizophrenia for the past 10 years. Her illness was continuous with partial remission and exacerbation and did not much improve on various typical antipsychotic drugs. Therefore, a regimen of clozapine, 25 mg per day, was started and was increased to 100 mg per day over a period of 2 weeks.After remaining stabilized on clozapine for 6 months, she became pregnant. It was not a planned pregnancy, but the couple decided to continue despite the possible risks to the fetus with antipsychotic drugs. Her routine laboratory investigations, including blood glucose, hemoglobin, and white blood cell count were within normal limits.Mrs. B attended an antenatal clinic every 4 to 6 weeks beginning in the third month of pregnancy until her delivery. She gained weight normally throughout pregnancy, was concerned, but had positive attitude toward pregnancy. Her nutritional care was good. She continued on the same dose of clozapine and did not exhibit an exacerbation or a behavior that could harm her fetus throughout her pregnancy.At 9 months and 2 days of gestation, she delivered a baby girl weighing 2.95 kg without any perinatal complication. Until the baby was 1 year old, she was breast-fed by her mother, who continued on the same dose of clozapine. The baby had normal developmental milestones, except for speech. She began to use consonants m, k, p, and b at the age of 1 year and started using combined syllables, like ba-ba and da-da, at the age of one-and-a-half years. At the age of 2 years she spoke only six to eight words. She would speak only 12 to 15 words until the age of 3 years and she also exhibited stuttering. Even intervention by a speech therapist did not render better results. At the age of 4, she acquired speaking skills in small sentences by joining two or three words, and she would repeat small sentences that she heard. By the end of 5 years, she gained normal fluent speech. Relevant investigations including audiometric analysis were within normal limits. ENT examination ruled out local pathology. There was no history of impaired mother-child relationship, familial phonological disorder, or bilingual environment.Comment Most probably, this baby fulfills the criteria of phonological disorder or may have exhibited delayed onset of speech. At least 3% of preschool children present with this disorder of unknown origin, which is often referred as developmental or functional. 3 In my case, the patient was treated only with clozapine throughout her pregnancy. However, it is difficult to draw conclusions that speech difficulty in this child is a possible consequence of pre- and postnatal exposure to clozapine or a consequence of maternal mental illness because schizophrenia in the mother implies an increased risk for poor perinatal outcome. 4 Further studies should address the magnitude of neurodevelopmental difficulties with clozapine. GB Pant Hospital, Delhi, India

Possible Delayed Speech Acquisition With Clozapine Therapy During Pregnancy and Lactation

Back to table of contents Previous article Next article LETTERFull AccessPossible Delayed Speech Acquisition With Clozapine Therapy During Pregnancy and LactationD.N. Mendhekar M.D.,D.N. Mendhekar M.D.Search for more papers by this author,Published Online:1 Apr 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail SIR: Most of the study by Ernst and Goldberg 1 reported perinatal outcome with clozapine therapy with no focus on neurodevelopment. Here, I report a case of a woman with schizophrenia who continued clozapine treatment throughout her 9 months of pregnancy and during lactation. 2 This report also highlights neurodevelopmental aspects, particularly speech of the baby. Case Report“Mrs. B,” a 30-year-old woman, had been suffering with schizophrenia for the past 10 years. Her illness was continuous with partial remission and exacerbation and did not much improve on various typical antipsychotic drugs. Therefore, a regimen of clozapine, 25 mg per day, was started and was increased to 100 mg per day over a period of 2 weeks.After remaining stabilized on clozapine for 6 months, she became pregnant. It was not a planned pregnancy, but the couple decided to continue despite the possible risks to the fetus with antipsychotic drugs. Her routine laboratory investigations, including blood glucose, hemoglobin, and white blood cell count were within normal limits.Mrs. B attended an antenatal clinic every 4 to 6 weeks beginning in the third month of pregnancy until her delivery. She gained weight normally throughout pregnancy, was concerned, but had positive attitude toward pregnancy. Her nutritional care was good. She continued on the same dose of clozapine and did not exhibit an exacerbation or a behavior that could harm her fetus throughout her pregnancy.At 9 months and 2 days of gestation, she delivered a baby girl weighing 2.95 kg without any perinatal complication. Until the baby was 1 year old, she was breast-fed by her mother, who continued on the same dose of clozapine. The baby had normal developmental milestones, except for speech. She began to use consonants m, k, p, and b at the age of 1 year and started using combined syllables, like ba-ba and da-da, at the age of one-and-a-half years. At the age of 2 years she spoke only six to eight words. She would speak only 12 to 15 words until the age of 3 years and she also exhibited stuttering. Even intervention by a speech therapist did not render better results. At the age of 4, she acquired speaking skills in small sentences by joining two or three words, and she would repeat small sentences that she heard. By the end of 5 years, she gained normal fluent speech. Relevant investigations including audiometric analysis were within normal limits. ENT examination ruled out local pathology. There was no history of impaired mother-child relationship, familial phonological disorder, or bilingual environment.Comment Most probably, this baby fulfills the criteria of phonological disorder or may have exhibited delayed onset of speech. At least 3% of preschool children present with this disorder of unknown origin, which is often referred as developmental or functional. 3 In my case, the patient was treated only with clozapine throughout her pregnancy. However, it is difficult to draw conclusions that speech difficulty in this child is a possible consequence of pre- and postnatal exposure to clozapine or a consequence of maternal mental illness because schizophrenia in the mother implies an increased risk for poor perinatal outcome. 4 Further studies should address the magnitude of neurodevelopmental difficulties with clozapine. GB Pant Hospital, Delhi, India

Neonatal Outcomes After Prenatal Exposure to Selective Serotonin Reuptake Inhibitor Antidepressants and Maternal Depression Using Population-Based Linked Health Data

Prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants and maternal depression both alter neonatal health, and distinguishing the effects of each influence remains challenging. To determine whether exposure to SSRIs and depression differs from exposure to maternal depression alone. Using population health data, records of neonatal birth outcomes were linked to records of maternal health and prenatal maternal prescriptions for SSRIs. Population of British Columbia, Canada. Mothers and their infants, representing all live births during a 39-month period (N = 119,547) (1998-2001). Outcomes from infants of depressed mothers treated with SSRIs (SE-D) were compared with outcomes from infants of depressed mothers not treated with medication (DE) and nonexposed controls. To control for maternal mental illness severity, propensity score matching was used to identify a comparison group of DE mothers who were similar to the SE-D mothers in characteristics in the year preceding and during pregnancy. Fourteen percent of mothers were diagnosed as having depression during their pregnancy, and the incidence of prenatal SSRI exposure increased from 2.3% to 5.0% during a 39-month period. Birth weight and gestational age for SE-D infants were significantly less than for DE infants, as was the proportion of infants born at less than 37 weeks (95% confidence interval [CI], -1 to -64, -0.25 to -0.45, and -0.009 to -0.04, respectively), although differences in the incidence of birth weight less than the 10th percentile for gestational age were not significant. An increased proportion of SE-D infants had neonatal respiratory distress (13.9% vs 7.8%), jaundice (9.4% vs 7.5%), and feeding problems (3.9% vs 2.4%) compared with DE infants (95% CI of difference, 0.042-0.079, 0.003-0.334, and 0.005-0.025, respectively). When outcomes were compared between SE-D and propensity score-matched DE neonates, SE-D was associated with increased incidence of birth weight below the 10th percentile and rates of respiratory distress. With linked population health data and propensity score matching, prenatal SE-D exposure was associated with an increased risk of low birth weight and respiratory distress, even when maternal illness severity was accounted for.

Prenatal Exposure to Maternal Genital and Reproductive Infections and Adult Schizophrenia

Objective: In this birth cohort study, the authors examined the relation between prenatal exposure to maternal genital/reproductive (G/R) infections and schizophrenia in offspring. Method: The birth cohort consisted of 7,794 offspring of pregnancies with prospectively acquired data on maternal G/R infections from obstetric records. The authors diagnosed 71 cases of schizophrenia and other schizophrenia spectrum disorders in this cohort. The relationship between maternal G/R infections and schizophrenia risk was modeled. Results: Exposure to G/R infections during the periconceptional period was associated with a significantly increased risk of schizophrenia and other schizophrenia spectrum disorders, with adjustment for maternal race, education, age, and mental illness. Conclusions: Maternal G/R infection during periconception appears to increase the risk of schizophrenia in offspring.

Prenatal Exposure to Maternal Genital and Reproductive Infections and Adult Schizophrenia

In this birth cohort study, the authors examined the relation between prenatal exposure to maternal genital/reproductive (G/R) infections and schizophrenia in offspring. The birth cohort consisted of 7,794 offspring of pregnancies with prospectively acquired data on maternal G/R infections from obstetric records. The authors diagnosed 71 cases of schizophrenia and other schizophrenia spectrum disorders in this cohort. The relationship between maternal G/R infections and schizophrenia risk was modeled. Exposure to G/R infections during the periconceptional period was associated with a significantly increased risk of schizophrenia and other schizophrenia spectrum disorders, with adjustment for maternal race, education, age, and mental illness. Maternal G/R infection during periconception appears to increase the risk of schizophrenia in offspring.

Involvement in the Child Welfare System Among Mothers With Serious Mental Illness

This study sought to determine the association between maternal schizophrenia and major affective disorders (serious mental illness) and child custody arrangements in a sample of Medicaid-eligible mothers. Medicaid eligibility and claims data were merged with data from the child welfare system in Philadelphia for 1995 to 2000. The sample comprised 4,827 female residents of Philadelphia between the ages of 15 and 45 as of 1996, who were initially eligible for Medicaid through Aid to Families With Dependent Children between 1995 and 1996 and who had at least one family member younger than 18 years at the beginning of the study period. Logistic regression was used to determine association between maternal mental illness and involvement in the child welfare system. Among the 4,827 mothers, 7.2 percent had a serious mental illness and 4.4 percent had other psychiatric diagnoses. More than 14 percent of mothers with serious mental illness received child welfare services, compared with 10.8 percent of those with other psychiatric diagnoses, and 4.2 percent of those without a diagnosis. After the analyses adjusted for a past inpatient episode, race or ethnicity, and age, mothers with serious mental illness were almost three times as likely to have had involvement in the child welfare system or to have children who had an out-of-home placement. The results suggest the urgent need for increased planning and coordination between the child welfare and mental health systems, including provision of parenting support as part of mental health treatment for mothers.

Involvement in the Child Welfare System Among Mothers With Serious Mental Illness

Involvement in the Child Welfare System Among Mothers With Serious Mental Illness

The Mental Health of Children Exposed to Maternal Mental Illness and Homelessness

In recent years a number of reports have documented an increase in the number of homeless families in the US. Using a sample of 195 mothers who were veterans of the US armed forces we assessed the association of maternal homelessness and clinical status, with measures of children's mental health, school enrollment and attendance. Although maternal homelessness had no significant association with children's reported emotional problems it had a profound effect on school enrollment and attendance. Mothers' mental health status, history of incarceration and cumulative history of trauma, as well as children's exposure to trauma and their self-esteem were the factors most strongly associated with measures of children's emotional problems. The study suggests that preventive interventions are needed to minimize the effects of exposure to trauma, both in the community and at home, as well as family interventions to address both the mother's and child's emotional and physical needs. A longitudinal study is needed to understand better the association between residential instability and children's mental health.

Medications for Panic Disorder and Generalized Anxiety Disorder During Pregnancy

Approximately 30% of women experience some type of anxiety disorder during their lifetime. In addition, some evidence exists that anxiety disorders can affect pregnancy outcomes. This article reviews the literature on the course of generalized anxiety disorder (GAD) and panic disorder during pregnancy and the postpartum period and presents guidelines for management. An English language electronic search of relevant studies using PubMed (January 1, 1985-January 2004) was performed using the search terms anxiety and pregnancy, maternal mental illness, panic and pregnancy, psychotropic medications in pregnancy, and treatment options in pregnancy. Review articles and primary pharmacologic treatment articles were selected for discussion. Despite the extensive use of psychotropic drugs such as antidepressants during pregnancy, there is a scarcity of information regarding the effect of such exposure on the developing fetus. Review articles and primary pharmacologic treatment trials were analyzed and incorporated into the review based on adequate methodology, completeness of data, and information on pregnancy outcome. It is important that physicians understand the course of these disorders during pregnancy and available treatments so they appropriately counsel women who are or intend to become pregnant. The goal of treatment during pregnancy and lactation is sufficient treatment for syndrome remission. To minimize the potential for neonatal withdrawal and maternal toxicity after delivery, vigilant monitoring of side effects is indicated. Also, if possible, nonpharmacologic treatment, such as cognitive-behavioral therapy, should be first-line treatment in pregnant women with GAD or panic disorder.

Parenting programs for women with mental illness who have young children: a review

Objective: To provide an overview of the literature relevant to, and describing, parenting programs for women with mental illness who have young children. Method: A literature search was undertaken, including MEDLINE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and EMBASE: Psychiatry. Searches were limited to English journals and books and to the last five years in the first instance, with earlier literature considered where appropriate. Results: Maternal mental illness can impact negatively on a child's life, especially where an insecure attachment is formed between mother and baby during the important early developmental years. The potential sequelae of maternal mental illness for children include impaired cognitive development, behavioural difficulties and increased risk of psychiatric disorder. Effective parenting skills are suggested to be a protective factor against these sequelae. However, the effects of parenting programs for women with mental illness have not been empirically tested, so that the potential long-term benefits of such interventions are not known. Conclusions: Parenting skills training for women with mental illness may be a useful selective preventive intervention. It is unlikely generic programs will be suitable. Rather, interventions for women with a mental illness will need to address the commonly experienced parenting problems as well as the more specific needs of women with mental illness.

Parenting Programs for Women with Mental Illness who have Young Children: A Review

To provide an overview of the literature relevant to, and describing, parenting programs for women with mental illness who have young children. A literature search was undertaken, including MEDLINE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and EMBASE: Psychiatry. Searches were limited to English journals and books and to the last five years in the first instance, with earlier literature considered where appropriate. Maternal mental illness can impact negatively on a child's life, especially where an insecure attachment is formed between mother and baby during the important early developmental years. The potential sequelae of maternal mental illness for children include impaired cognitive development, behavioural difficulties and increased risk of psychiatric disorder. Effective parenting skills are suggested to be a protective factor against these sequelae. However, the effects of parenting programs for women with mental illness have not been empirically tested, so that the potential long-term benefits of such interventions are not known. Parenting skills training for women with mental illness may be a useful selective preventive intervention. It is unlikely generic programs will be suitable. Rather, interventions for women with a mental illness will need to address the commonly experienced parenting problems as well as the more specific needs of women with mental illness.