antepartum depression scoring instrument

antepartum depression scoring instrument Mood and anxiety disorders profoundly affect the somatic and emotional experience
of the expectant mother during pregnancy. A prospective study of nearly 1,500 patients showed significant associations between depression and/or anxiety and increased nausea and vomiting, prolonged sick leave during pregnancy, and increased number of visits to the obstetrician, specifically, visits related to fear of childbirth and those related to contractions. Psychiatric diagnoses are also associated with an increased risk of inadequate prenatal care even when studies controlled for other known risk factors.
Early data did not indicate that antepartum depression (depression during pregnancy) is higher at any particular trimester during pregnancy or month in the first postpartum year. More recent data however, shows that 43 % of women with histories of unipolar depression will relapse
without treatment in pregnancy and the postpartum period, with half of such occurring by the third trimester. As the patient becomes pregnant and throughout pregnancy, the clinician must closely monitor for changes in thought, diurnal, and affective patterns that can mark an
abrupt worsening of mood and need for treatment adjustments.
Women who are pregnant or recently pregnant are less likely than their
non-perinatal counterparts to seek mental health services,much less comply with pharmacologic medications. Upon learning of their pregnancy, a significant proportion of women discontinue their psychiatric medication for fear of prenatal exposure of offspring
to these agents, thereby increasing the risk of depressive relapse during pregnancy or the puerperium .A 2006 study estimated that women
who discontinue antidepressant use have a fivefold increased rate of relapse of their depression by their third trimester compared to women who maintained treatment throughout pregnancy.Anxiety and its effects on perinatal outcomes have also received increased
attention. Rate of pregnant women suffering with significant anxiety symptoms is approximated at 13 % and is generally linked to comorbid depression. In addition, approximately one-third of all depressed women were diagnosed with comorbid Axis I disorders, most typically an anxiety disorder (panic disorder and PTSD) or, less frequently, a substance-related disorder. Additionally, significant prenatal anxiety has been shown to correlate to postnatal depression even after controlling for antenatal mood episodes.