Understanding and treating women with schizophrenia during pregnancy and postpartum--Motherisk Update 2008

This article provides a synopsis of clinically relevant data pertaining to sexuality, pregnancy, the postpartum period, parenting and family planning in women with schizophrenia. Based on this information, we propose recommendations for the non-pharmacological management of these patients. Along with the deinstitutionalization of people with severe and persistent mental illness, there has been a concurrent increase in relative fertility in women with schizophrenia.Understanding the nature and experience of sexuality in women with schizophrenia helps elucidate the context in which pregnancies occur.Schizophrenia does not diminish sexual desire or activity. However, the quality and relational context of sexuality may be markedly different.Pregnancy appears to worsen mental health in a subset of women with schizophrenia. Psychotic denial of pregnancy is a symptom that poses especially high risks for poor outcomes if not addressed. Psychoeducation can reduce the risks of pregnancy complications for women with schizophrenia. Short-term, focused psychotherapy can be useful for some pregnant women with schizophrenia. Some modifications need to be made in the inpatient treatment of pregnant patients with schizophrenia. In the postpartum period, women can be especially susceptible for acute exacerbation of their schizophrenia. With regards to parenting, many women will provide intermittent parenting for their children while others will lose custody of their children. Those mothers with schizophrenia who do raise their children may face unique challenges in parenting.Both positive and negative symptoms can interfere with the demands of being a parent.A comprehensive parenting assessment of the patient can provide guidance for the implementation of supportive services. Proactive family planning could reduce the high rate of unwanted pregnancies, as women with schizophrenia tend to have more limited knowledge of their contraceptive options.