Unintended pregnancies as a burden for women with psychiatric diagnoses

Objective: Developments in psychiatric treatment have allowed women with psychiatric diagnoses to interact more in social life. As more women with psychiatric diagnosis are becoming mothers or planning to be, maintenance of psychotropic drugs, to have become a current topic. Half of the pregnancies occurred unplanned. But this may lead to abrupt drug discontinuation which is a risk factor for relapse into an ongoing psychiatric disease, leading pregnant women to reintroduce drugs during this period. In this study, women with psychiatric diagnoses are assessed in terms of sociodemographic characteristics, possible perinatal complications with hospitalization rates among unintended pregnancies and vice versa.

Methods: A prospective study was conducted in Bakirkoy Prof. Dr. Mazhar Osman Mental and Neurological Diseases Research and Training Hospital. The total sample consisted of 100 pregnancy histories of inpatients admitted for psychosis, bipolar disorder or unipolar depression according to to DSM-IV criteria. All women were assessed with their clinical and sociodemographic variables.

Results: The number of assessed pregnancies were 100. Thirteen of those pregnancies were reported to be unintended. Five of the mothers (38%) had schizophrenia, 8 were bipolar or unipolar; there was no statistical significance. The two groups did not differ in terms of age, history of alcohol or substance use, education or economic circumstances (p>0.05), and drug compliance (p>0.05) also did not differ. The duration of illness, total length of stay, number of pregnancies, total number of live births, (p>0.05) did not differ. Also relation of psychiatric illness in terms of pregnancy, rate of psychotropic drug exposure in the beginning of pregnancy, gestational age as psychiatric symptoms reoccur, number of hospitalizations during pregnancy, duration of stay and necessity for ECT, number of suicidal attempts all showed no statistical difference (p>0.05). Interestingly, the mentioned variables also showed no statistical difference. Besides perinatal complications, congenital anomaly rate, gestational weight and age at birth did not differ between these two groups (p>0.05). But in the postpartum period, mothers who got pregnant unintentionally needed psychotropic medication more than other group (p<0.005), whereas the treatment duration was significantly longer (1.2±1.7 versus 0.8±2.4 months) (p<0.004). The rate of mothers capable of looking after their offspring by themselves was significantly lower (p<0.05) and fewer women were living together with the father of the offspring before and after pregnancy (p<0.05) in the unplanned pregnancy group.

Conclusion: Unintended pregnancies seem to be a significant burden for women in the psychiatric group, especially in bipolar and schizophrenic individuals. But, as cultural differences becomes apparent during the perinatal period, exigencies may differ from one cultural setting to another. In our study, statistical significance came to the fore during the postpartum period. This group needed more medication and prolonged hospitalization in the postpartum period. As women who got pregnant unintentionally show to need support for the offspring’s care, this must be part of counseling before delivery. As the postpartum period seems to be vital for the unintended pregnancy group, a postpartum psychiatric consultation must be made.