Reproductive risk: its role in maternal mental health

For many women, pregnancy and childbirth are not without substantial risk in terms of new-onset, recurrent or existing mental disorder. This has consequences not only in terms of poor maternal mental health but also in terms of increased pregnancy- and delivery-related morbidity and can have a significant negative impact on the well-being of the fetus or neonate. New-onset disorders such as postnatal depression and puerperal psychosis have been recognised for some considerable time but it is also becoming apparent that, with the exception of anorexia nervosa, severe intellectual disability and possibly schizophrenia, conception rates among women with all types of mental disorder are the same as those in the general population. In high-income countries, the widespread use of atypical antipsychotics, most of which do not impair reproductive function, may lead to increased conception rates in women with schizophrenia. In addition, pregnancy and childbirth are multifactorial stressors which may render women with previous mental disorders vulnerable to a recurrence. Hence it is no surprise that studies in urban, low-income and ethnically diverse populations in the USA estimate that around a third of pregnant women are suffering from a mental disorder when substance misuse is included (e.g. Kim et al, 2006).