Pregnancy and the postpartum period are widely considered periods of increased vulnerability to psychiatric disorders.1–12 Psychiatric disorders during pregnancy are associated with poor maternal health13–19 and inadequate prenatal care.20–22 Maternal psychiatric disorders during pregnancy and the postpartum period are also associated with numerous adverse outcomes for the offspring, including maladaptive fetal growth and development,22–36 poor cognitive development and behavior during childhood and adolescence,23–32 and negative nutritional and health effects.13, 33–38 For these reasons, accurate information about the mental health status of women during pregnancy and the postpartum period is urgently needed.

Most of what is known about psychiatric problems among pregnant women comes from findings among clinical samples, often without non-pregnant control groups. In these samples, the prevalence of psychiatric disorders ranges from 15% to 29%.15, 20–22, 39–47 Risk factors identified in these studies include lack of romantic partner, prior history of psychiatric disorder, and lifetime exposure to traumatic events. 22, 41, 42, 45, 48–50 Only 5% to 14% of women received treatment for the psychiatric disorder.15, 40, 41 However, no previous study used sampling methodology permitting accurate estimation of the prevalence of psychiatric disorders among pregnant women in the United States. Further, no previous study included non-pregnant women of comparable age drawn from the general population in order to identify the specific contribution of pregnancy or the postpartum period to the risk of psychiatric disorders. Many studies were limited by use of screening scales rather than diagnostic measures for DSM-IV criteria. Finally, prior studies assessed only mood and anxiety disorders rather than a broader range of psychopathology.

As the result of these gaps in research on mental disorders during pregnancy and the postpartum period, accurate national information on the mental health of pregnant women is lacking. Such information is needed for focused planning at the national and local level, and to inform the development of prevention and intervention programs. The current study addresses these critical gaps in knowledge. In a nationally representative sample of pregnant women, we present 12-month prevalence of DSM-IV psychiatric disorders, compare these with the prevalence of psychiatric disorders in non-pregnant women of childbearing age, identify risk factors for such disorders, and provide estimates of lifetime and 12-month rates of treatment-seeking among pregnant and non-pregnant women with DSM-IV psychiatric disorders.

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Psychiatric disorders in pregnant and postpartum women in the United States.

Identifying the women at risk of antenatal anxiety and depression: A systematic review.

Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries.

Although anxiety disorders are documented in the literature for new mothers (but less so for fathers), rates of postpartum caseness tend to include only those with depression when diagnostic interviews or self-report measures validated on such interviews are used. This methodology therefore underestimates the true percentage of women and men who experience significant psychological difficulties postpartum. This has implications for assessment, treatment and screening for postnatal mood disorders. Two studies were conducted on a total of 408 women and 356 men expecting their first child. They were recruited antenatally, and interviewed at 6 weeks postpartum using the Diagnostic Interview Schedule. DSM-IV criteria were applied to determine the presence since birth of depression (major or minor), panic disorder, acute adjustment disorder with anxiety (meeting the criteria for generalised anxiety disorder except for the duration criterion), and phobia. The inclusion of diagnostic assessment for panic disorder and acute adjustment disorder with anxiety increased the rates of caseness by between 57 and 100% for mothers, and 31-130% for fathers, over the rates for major or minor depression. Inclusion of assessment for phobia further increased the rates of disorder in both samples.

Diagnosing postpartum depression in mothers and fathers : Whatever happened to anxiety?

The purpose of this review is to examine the role of nutrition in perinatal depression. Perinatal (maternal) depression refers to major and minor episodes during pregnancy (termed antenatal) and/or within the first 12 months after delivery (termed postpartum or postnatal). Prevalence of antenatal depression can be as high as 20%, while approximately 12% to 16% of women experience postpartum depression. These are probably conservative estimates, as cases of maternal depression are underreported or underdiagnosed. Risk factors for depression include genetic predisposition and environmental factors, as well as a number of social, psychological, and biological factors. One biological factor given increasing consideration is inadequate nutrition. Credible links between nutrient deficiency and mood have been reported for folate, vitamin B-12, calcium, iron, selenium, zinc, and n-3 fatty acids. For maternal depression, the nutrient that has received the most attention from nutrition researchers has been the n-3 essential fatty acids. Numerous studies, such as randomized controlled trials, cohort studies, and ecological studies, have found a positive association between low n-3 levels and a higher incidence of maternal depression. In addition, nutrient inadequacies in pregnant women who consume a typical western diet might be much more common than researchers and clinicians realize. A number of studies have reported inadequate intakes of n-3, folate, B vitamins, iron, and calcium in pregnant women. Depletion of nutrient reserves throughout pregnancy can increase a woman's risk for maternal depression.

Perinatal Depression: Prevalence, Risks, and the Nutrition Link—A Review of the Literature

Objectives: To estimate the prevalence and risk factors for antenatal anxiety (AA) and antenatal depression (AD).

Prevalence of anxiety and depression during pregnancy in a private setting sample

To evaluate the association between nutritional risk and quality of life in community-dwelling elderly A cross-sectional study of individuals aged 60 years or older living in the Brazilian state of Minas Gerais was conducted Nutritional status was evaluated using the Mini Nutritional Assessment, and quality of life was determined using the WHOQOL-bref and WHOQOL-old The absolute and relative frequency distributions for each domain were calculated, and chi-square tests were used to examine the association between nutritional risk and quality of life (dichotomous variables) Poisson regression was used to perform univariate and multivariate analyses 789 (279%) of the 2823 elderly patients in the sample were at nutritional risk The risk of malnutrition was associated with the physical, environment, psychological, sensory abilities, social participation and intimacy domains of quality of life [(PR= 142, 95%CI 123-163); (PR= 128, 95%CI 112-147); (PR= 118, 95%CI 103-136); (PR= 136, 95%CI 120-154); (PR= 129, 95%CI 113-146); (PR= 114, 95%CI 101-129); respectively] The present findings contribute to the understanding of nutritional risk, and support the association between quality of life and nutritional status These factors should be considered in the diagnosis, monitoring and treatment of nutritional disorders, and may contribute to the prevention and reduction of nutritional risk in this especially vulnerable population

P. Rossi Menezes

Papers

Prevalence of anxiety and depression during pregnancy in a private setting sample

Nutritional Risk and Quality of Life in Community-Dwelling Elderly: A Cross-Sectional Study.