Mental illness is common in pregnancy

What effects can pregnancy have on mental illness?

Before continuing with your mental illness therapy during pregnancy, you should consult a doctor.

As a person with a mental disorder, you may be concerned that pregnancy could harm you or the child. In every woman, pregnancy leads to multifaceted physical and mental changes. The effects, for example on an existing schizophrenia or bipolar disorder, have so far been little researched.

Some women experience a slight improvement in their symptoms. Others report deterioration because, for example, they feel overwhelmed by the stresses and strains of pregnancy. Whether again Episodes of illness occur during pregnancy primarily depends on whether treatment that has been successful up to that point is discontinued or continued.

What influence does the mother's mental disorder have on the child's development?

It is difficult to give a clear answer to this question. One of the reasons for this is that the various mental disorders differ greatly in their effects. Schizophrenia is one of the most serious mental illnesses.

There are studies about their influence on developing life that have found an increased risk for the child. This can reduce the birth weight and increase the postpartum mortality rate.1 The latter can also apply if the father has schizophrenia. The scientists do not blame the genes for this, but rather the difficult socio-economic circumstances under which many people with schizophrenia live, as well as the mother's health behavior. It is known that, for example, schizophrenic mothers smoke cigarettes more often than mentally healthy mothers during pregnancy.

Stop taking medication or continue taking it?

Basically, there is always the risk of a relapse (relapse) in the case of a mental illness if the medication is discontinued. This applies regardless of pregnancy. However, research has shown that women with bipolar disorder who were well on lithium therapy and symptom-free prior to pregnancy were three times more likely to relapse after birth (12 to 15 months after weaning) than non-pregnant women with bipolar disorder.2 These results could suggest that therapy should not be interrupted due to pregnancy.

But what influence do psychotropic drugs have on the unborn child? Numerous studies have been carried out on this subject, some with contradicting results. You can find a compilation of the drug risks in pregnancy and during breastfeeding for psychotropic drugs and almost a thousand other drugs on the Internet portal of the Pharmacovigilance and Advice Center for Embryonic Toxicology at the Charité in Berlin. However, under no circumstances should you stop taking the medication without consulting your doctor!

Talk to your doctor about the possible risks

Only with knowledge of the previous course of the disease can a doctor decide individually and in consultation with you whether the medication should be temporarily slowly discontinued during pregnancy, the dose reduced or the therapy continued as before. The risk and the possible effects of a renewed outbreak of the disease must be considered, for example hallucinations, delusions and lack of sleep or the risk of increased nicotine and alcohol consumption. These symptoms of the disease may harm the child more than the lowest possible dose of maintenance therapy could do. When the risk and benefit are weighed up, if there is a high risk of relapse, it is often more sensible to continue therapy with only one substance in a low dose than to discontinue the medication completely.

Psychiatrists and gynecologists should exchange ideas

The vast majority of children of parents with mental disorders are healthy. And mentally ill mothers can look after their children just as well as other women, provided that the disease is therapeutically well controlled or stable. If you are affected, contact your doctor or psychiatrist and get detailed advice on your pregnancy. It is also important for the gynecologist to find out about the mental illness and possible therapy with psychotropic drugs. Ideally, the psychiatrist and gynecologist should exchange ideas in order to identify harmful behavior, signs of relapse, or pregnancy problems as early as possible.

1Nilsson E, Hultman CM, Cnattingius S, et al. Schizophrenia and offspring’s risk for adverse pregnancy outcomes and infant death. Br J Psychiatry. 2008; 193 (4): 311-5
2Viguera AC, Nonacs R, Cohen LS, et al. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. At J Psychiatry. 2000; 157 (2): 179-84