brainThe importance of looking after the mental health of parents during pregnancy and after childbirth, in order to promote the physical and mental wellbeing of both parents and child, has been highlighted by new research from King’s College London and the University of Oxford.

Mental illnesses are among the most common complications of pregnancy and the postnatal period – occurring in more than 10% of women in high income countries and higher rates in low income countries.

As part of a series the researchers identified the range of mental illnesses that can occur during pregnancy and after childbirth: how often they occur; their causes; the risks to mother and baby; treatments that are effective; and how we can prevent these disorders. Importantly, the authors also draw attention to gaps in our knowledge and where more research is urgently required.

Lead author Louise Howard, Professor of Women’s Mental Health at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, said: “For many parents, the arrival of a child is a challenging time.

"The stigma around ante and postnatal mental illnesses can prevent people from getting the help they need. It’s important that people seek treatment promptly to prevent suffering and distress for the whole family. We want the public to know that there are effective treatments out there."

Additional impact on families' health
A recent report revealed the UK long-term economic costs of perinatal mental disorders to society to be £8 billion a year. The burden may be a lot greater in low and middle income countries where perinatal health disorders are more common and because a loss of earning from inability to work may have an additional impact on the families’ health and nutrition.

Children in low and middle income countries, where resources are scarce, are more at risk of being affected by parental perinatal mental illnesses and will need innovative strategies to help tackle this problem.

There are 3 key papers cataloguing the findings in The Lancet, as follows:
Paper 1
This paper summarises the evidence about risk factors for non-psychotic mental illnesses such as anxiety, depression, eating disorders and post-traumatic stress disorder, during the perinatal period. These illnesses are common but because most research has largely focused on postnatal depression we know less about the other illnesses. There is still uncertainty about the extent of the risks of taking medication on the foetus or infant, and the authors explain how to weigh up risks and benefits of the different types of treatment including psychological interventions and medications.

Professor Howard said: “Many of the symptoms of perinatal mental illnesses such as antenatal and postnatal depression and anxiety can be treated effectively. The risks of leaving symptoms untreated could be more harmful to both mother and foetus or infant than risks of treatment. We hope the Series will help clinicians and women make informed decisions about the range of treatments that could be helpful for mental illness at this important time in life.”

Paper 2
This discusses the care of illnesses such as bipolar disorder and schizophrenia during the perinatal period. Childbirth can be a powerful trigger of severe mood disorders such as mania, severe depression and psychosis, particularly in women with a history of bipolar disorder. Suicide attempts are common in these circumstances and remain one of the leading causes of maternal death in high income countries. The authors advise that all women of reproductive age with a history of severe mental illness should be properly counselled about the risks and the care needed during pregnancy and after childbirth due to the risk of relapse.

Professor Ian Jones from the Medical Research Council Centre for Neuropsychiatric Genetics and Genomics at Cardiff University, and lead author of paper 2, said: "More research is crucial to understand what triggers psychotic episodes after childbirth so we can predict women at risk and develop treatments that are safe to be administered for mother and baby."

Paper 3
The final paper summarises the evidence for links between parental mental disorders and the risk of low birthweight, prematurity and later psychological disturbances in children. Why and how particular perinatal illnesses are associated with specific aspects of child development are complex and not yet fully understood. Further investigations of this issue are important in order to reduce the risk to the child. Considerable research has been undertaken to help develop interventions but much more needs to be done especially in low and middle income countries. The authors add that most research has focussed on illnesses in mothers, but depression in fathers is more common than previously thought and emerging evidence suggests this can also have an effect on children.

Professor Alan Stein, head of child and adolescent psychiatry at the University of Oxford, lead author of paper 3, said: "Adverse effects of perinatal mental disorders on children are not inevitable. Early identification and intervention are critical in preventing them. We need to treat both the parent’s symptoms and help with caregiving difficulties. Parents at risk of mental health disorders during or after pregnancy need to be identified early to try to prevent symptoms from affecting offspring."