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Approximately one out of five known pregnancies ends in a loss. Premature birth is similarly common, occurring in one in eight live births in the United States, and often resulting in long stays in the Neonatal Intensive Care Unit (NICU).These adverse obstetrical events are common reasons for psychiatric consultation in the pregnancy or post-partum periods. Such problems may be associated with mood or anxiety disorders, and themes such as bereavement, anger, guilt, detachment, and helplessness are prominent. Attachment between parent and infant from current or future pregnancies may be impacted.
Obstetrical challenges such as non-adherence to prenatal care and disordered eating behaviors are also common during pregnancy and the postpartum period. For example, a recent study found that 7.5% of women met criteria for any eating disorder in pregnancy and that up to 25% of pregnant women had significant weight and shape concerns. Additional data suggests an association between hyperemesis gravidarum and both depressive and anxiety disorders. Such obstetrical challenges can lead to serious birth complications or a negative impact on the overall growth and development of the baby.
Unfortunately, the short and long-term impact of these issues are greatly underestimated by health care professionals. Early identification of women at-risk for pregnancy and postpartum-related psychiatric disorders is critically important for both treatment and prevention.
This symposium will review the literature on prevalence and correlates of psychiatric symptoms in women with obstetrical complications. The role of the consulting psychiatrist in the evaluation and management of these patients will be explored and interventional strategies will be discussed.
Laurie Chameides, CSW (obstetrical social worker, Mount Sinai) will discuss a comprehensive perinatal bereavement program which includes crisis oriented grief education and counseling, individual and couples counseling, and a range of support groups for individuals who have experienced pregnancy loss. Dr. Madeleine Fersh (Attending, Consultation Psychiatry service, Mount Sinai) will discuss potential risk factors for non-adherence to prenatal care, including depression and substance abuse, and provide recommendations for how consultation psychiatrists should approach the evaluation and management of such patients. Adherence issues specific to HIV-positive pregnant women will be explored in detail. Dr. Carrie Ernst (Attending, Consultation Psychiatry service, Mount Sinai) will review the prevalence and correlates of psychiatric disorders in parents of premature infants who have been hospitalized in the NICU and discuss several potential interventional strategies to reduce or modify this stress response. Dr. Kimberly Klipstein (Director, Consultation Psychiatry service, Mount Sinai) will discuss the role of the psychiatrist in detection and management of disordered eating behaviors, such as severe restricting, hyperemesis, and binge eating, during the pregnancy and post-partum periods. Dr. Shari Luskin (Adjunct Associate Professor of Psychiatry, Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai) will serve as a discussant following the four presentations.
