Psychosocial disturbances during and after pregnancy

The identification of patients at risk for psychologically mediated complications during and after pregnancy should be a part of obstetric care. Psychologic assessment can be incorporated into routine prenatal evaluation. Typically, patients who cope poorly during pregnancy have had previous emotional difficulty. Transient emotional disturbances during the early stages of pregnancy are not unusual. Treatment consists of providing support, education, and opportunity for the patient to ventilate her feelings. These interventions can be provided by the sensitive primary care physician who is willing and able to commit the time, to listen, and to communicate. Drug therapy should usually be avoided. Postpartum blues is common, occurring most often in those who experienced emotional distress during pregnancy and in those with a history of premenstrual tension. Management ideally begins before delivery. Treatment of postpartum depression or psychosis involves use of medication and/or psychotherapy. The effects of medication on breast milk must be considered.