PREGNANCY AND POSTPARTUM MENTAL HEALTH STUDY GROUP

PREGNANCY AND POSTPARTUM MENTAL HEALTH STUDY GROUP

This study group will have two "branches" one is formal review of the scientific literature on the topics under discussion. The other branch is the in-depth multidisciplinary discussion of actual clinical cases evaluated/treated by the clinical staff at the Maternal /Infant Project of the Topeka and Shawnee County Health department.

General references

Brockington I. Motherhoood and Mental Health. 1996. Oxford University Press

Solchany J. Promoting Maternal Mental Helath During Pregnancy. 1998. Seattle. Ncast Press.

Yonkers, K. Little B.Management of Psychiatric disroders in Pregnancy 2001. London. Arnold.

PROGRAM OF PRESENTATIONS

Sesion 1 . Stress During Pregnancy. Effects on the mother and the fetus.

Objectives
1)    discuss the main effects of stress on the pregnant woman's physical and emotional health, and its effects on the pregnancy
2)    describe the main physiological mechanisms for transmission of stress from mother to fetus
3)    characterize the negative effects of stress on the organization and functioning of the developing fetus

References:

Mulder EJH, Robles de Medina PG, Huizink AC, Van den Bergh, BRH, Buitelaar JK, Visser GHA. Prenatal maternal stress: effect s on pregnancy and the (unborn) child. Early Human Development 2002. Vol. 70. 2-14

O’Connor, TG, Heron J, Golding J, BeveridgeM, Glover V. Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years: report from the Avon Longitudinal Study of Parents and Children .British Journal of Psychiatry, 2002.vol. 180. 502-508

Teixeira JMA, Fisk NM, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. British Medical Journal. 1999. Vol. 318. 153-157

Wasser, SK. Stress and reproductive failue: an evolutionary approach with applications to premature labor. American Journal of Obstetrics and Gynecology, 1999. Vol. 180. S272-274

Session 2. CASE PRESENTATION

Session 3 . Pregnancy and the father
Objectives

1)    Describe the main emotional effects fathers experience during the partner's pregnancy
2)    Characterize some of the emotional and behavioral difficulties commonly seen in fathers during a difficult pregnancy
3)    Describe phenomena like "couvade" and its equivalents

References

Finnbogadottir H, Crang Svalenius E, Persson EK.Expectant first-time fathers' experiences of pregnancy. Midwifery. 2003 Jun;19(2):96-105.

Buist A, Morse CA, Durkin SMen's adjustment to fatherhood: implications for obstetric health care: J Obstet Gynecol Neonatal Nurs. 2003 Mar-Apr;32(2):172-180

Ekeus C, Christensson K. Socioeconomic characteristics of fathers of children born to teenage mothers in Stockholm, Sweden. Scand J Public Health. 2003;31(1):73-76

Session 4. Cultural factors during pregnancy

Objectives
1)    Describe the main cultural factors clinicians should take into account during pregnancy in terms of preparation for a positive outcome
2)    Identify the main stressors associated with immigrant women/families during pregnancy, particularly in Latino, African and Asian families
3)    Characterize some culturally baed health practices and culture-bound emotional disturbances during pregnancy

References

Barclay L, Kent D. Recent immigration and the misery of motherhood: a discussion of pertinent issues. Midwifery. 1998 Mar;14(1):4-9. Review

Lewis JA.Jewish perspectives on pregnancy and childbearing. Am J Matern Child Nurs. 2003 Sep-Oct;28(5):306-12

Maldonado-Duran, J.M., Munguia -Wellman, M., Lubin, S., Lartigue, T. Latino Families in the Perinatal Period. Cultural Issues in Dealing with the Health Care System. Great Plains Research. 2002. Vol 12. No 1. 75-100

Richens Y.Building bridges: involving Pakistani women. Pract Midwife. 2003 Sep;6(8):14-7

Session 5. CASE PRESENTATION

Session 6. Depression during pregnancy and Postpartum depression

Objectives
1)    Describe the epidemiology and main risk and protective factors connected with depression during pregnancy and postpartum period
2)    Identify treatment/intervention strategies to deal with depression during pregnancy and in the postpartum period
3)    Identify the effects of depression during pregnancy and the postpartum period for the infant and child

References

Andersson L, Sundstrom-Poromaa I, Bixo M, Wulff M, Bondestam K, Strom M.Point prevalence of psychiatric disorders during the second trimester of pregnancy: apopulation-based study. Am J Obstet Gynecol. 2003 Jul;189(1):148-54

Stuart S, O'Hara MW, Gorman LL.The prevention and psychotherapeutic treatment of postpartum depression. Arch Women Ment Health. 2003 Aug;6(Supplement 2):S57-S69. Epub 2003

Session 7 CASE PRESENTATION

Session 8 . Trauma and sexual abuse in childhood, effects and manifestations during pregnancy

Objectives
1)    Identify the main manifestations of posttraumatic phenomena during pregnancy and their impact on the pregnant woman and the fetus
2)    Describe the effects that a history of sexual abuse can have in the course of pregnancy, delivery and postpartum period
3)    Describe strategies for intervention and sympton relieve for the pregnant woman

References

Ayers S. Assessing psychopathology in pregnancy and postpartum.J Psychosom Obstet Gynaecol. 2001 Jun;22(2):91-102.

Farley, M. Keaney JC Physical symptoms, somatization, and dissociation in women survivors of childhood sexual assault.Women Health. 1997;25(3):33-45.

Seng JS, Oakley DJ, Sampselle CM, Killion C, Graham-Berman S, Liberson L. Posttraumatic stress disorder and pregnancy complications. Obstet Gynecol. 2001 Jan;97(1):17-22

Session 9. CASE PRESENTATION

Session 10. The "somatizing" and psychosomatic patient during pregnancy

Objectives
1)    Characterize Briquet's disorder and and other psychosomatic conditions when they concur with a pregnancy
2)    Identify the main risk factors for somatization disorder, and the possible effects on the fetus and infant
3)    Describe strategies for coping and intervention with the "somatizing patient' during pregnancy

References

Bitzer J . Somatization disorders in obstetrics and gynecology. Arch Women Ment Health. 2003 Apr;6(2):99-107

Hotopf M, Mayou R, Wadsorth M, Wessely S. Childhood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study.
Am J Psychiatry. 1999 Nov;156(11):1796-800

Session 11 CASE PRESENTATION

Session 12 . Anxiety disorders during pregnancy

Objectives
1) To describe the most common anxiety disorders during pregnancy, e,g. panic disorder, obsessive compulsive disorder
2) Identify the effects of anxiety on the course of the pregnant woman, the pregnancy, the foetus and the family as a whole
3) Describe intervention strategies, psychosocial and pharmacological.

References

Moses-Kolko, EL, Feintuch MG. Perinatal Psychiatric Disorders:A Clinical Review.. Current Problems in Obstetrics and Gynecology. 2002. Vol. 25. No. 3. 61-112

O'Connor TG, Heron J, Golding J, Glover V; ALSPAC Study Team Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. J Child Psychol Psychiatry. 2003 Oct;44(7):1025-36.

Levine RE, Oandasan AP, Primeau LA, Berenson AB Anxiety disorders during pregnancy and postpartum. Am J Perinatol. 2003 Jul;20(5):239-48.

Session 13. CASE PRESENTATION

Session 14 Domestic violence during pregnancy
Objectives
1)To describe the main features of domestic violence in different cultures, including epidemiological evidence
2) To describe the main situations leading to domestic violence between partners
3)Identify the main strategies for intervention and detection of domestic violence during pregnancy

References

Hindin MJ. Understanding women’s attitudes toward wife beating in Zmbabwe.Bulletin of he World Health Organiztion. Vol, 81. No. 7.

McGrath ME, Hogan JW, Peipert JF. A prevalence survey of abuse and screening for abuse in urgent care patients.Obstetrics and Gynecology, 1998. Vol. 91. 511-514

Pelzer, K, Mashego TA, Mateba M. Attitudes and practices of doctors toward domestic violence victims in South Africa.Health Care for Women International, 2003. vol. 24. 149-157

Session 15 CASE PRESENTATION

Session 16. Unwanted pregnancy and unwanted child

Objectives
1) Identify the common reactions and behaviors in the face of an unwanted pregnancy
2) Describe the situations that commonly lead to an unwanted pregnancy and the effects on the mother

3) Describe psychosocial intervention strategies in unwanted pregnancy

References

David HP,Dytrych Z, Matejek Z. Born Unwanted: Observations From the Prague Study. American Psychologist, 2003. V. 58, Number 3

Crosby RA, DiClemente RJ, Wingood GM, Rose E, Lang D. Correlates of unplanned and unwanted pregnancy among African-American female teens. Am J Prev Med. 2003 Oct;25(3):255-258.

Session 17. CASE PRESENTATION

Session 18. Pregnancy during the teenage years

1)    Describe the epidemiology of teenage pregnancy in the US and other countries
2)    Identify the main developmental conflicts between adolescence and pregnancy
3)    Describe succesful programs/ interventions to help the pregnant teenager

References

Rentschler DD.Pregnant adolescents' perspectives of pregnancy.Am J Matern Child Nurs. 2003 Nov-Dec;28(6):377-383

Pfitzner MA, Hoff C, McElligott KPredictors of repeat pregnancy in a program for pregnant teens. J Pediatr Adolesc Gynecol. 2003 Apr;16(2):77-81

Session 19. CASE PRESENTATION

Session 20 . Bipolar disorder in the mother during pregnancy

Objectives
1)       Describe the phenomenology/clinical manifestations of bipolar disorder during pregnancy
2)       Identify the main risks for the mother and the fetus, emphasizing the issues of psychopharmacology
3)       Describe psychosocial and pharmacological strategies for intervention with bipolar disorder during pregnancy

References

David LL, Shannon S, Drake RG, Petty F. The treatment of bipolar disorder during pregnancy.InYonkers K, Little B. (eds.). Management of Psychiatric Disorders in Pregnancy. 2001. London. Arnold. 122-133

Session 21 CASE PRESENTATION

Session 22 . Pregnancy and delivery while imprisoned or in jail

1)    Identify the main psychosocial situations leading to concurrent imprisonment and pregnancy
2)    Describe the psychosocial issues during pregnancy, for the future mother/family
3)    Characterize strategies for support/intervention for the mother who is imprisoned

References

Kitzinger S. Birth in prison. The rights of the baby. Pract Midwife. 1999 Jan;2(1):16-18.

Martin SL, Rieger RH, Kupper LL, Meyer RE, Qaqish BFThe effect of incarceration during pregnancy on birth outcomes. Public Health Rep. 1997 Jul-Aug;112(4):340-6.

Wismont JM . The lived pregnancy experience of women in prison. J Midwifery Womens Health. 2000 Jul-Aug;45(4):292-300.

Session 23. CASE PRESENTATION

Session 24 Psychosocial isolation during pregnancy

Objectives

1)    Describe the main factors leading to social isolation during pregnancy in industrialized countries
2)    Identify the effects of psychosocial support and extended family on the pregnancy and its course
3)    Describe methods/strategies to provide psychosocial support during pregnancy

References

Solchany J, Sligar K, Barnard K. Promoting Maternal Role Attainment an Attachment During Pregnancy: The Parent-Child Communication Coaching Program. In: Maldonado-Duran, JM. (ed.) Infant and Toddler Mental Health. 2002. American Psychiatric Press.