What are PMH Disorders

The Baby Blues - Up to 85% of women will experience the “baby blues” after giving birth, tied to sudden shifts in hormones.

• Women who experience the baby blues may feel sad, have mood swings and crying episodes.
• The Blues are not considered a disorder as the symptoms often resolve within a few days. If symptoms persist, beyond two weeks, it’s likely the mother is suffering from depression.

Norhayati, M. N., Nik Hazlina, N. H., Asrenee, A. R., & Wan Emilin, W. M. A. (2015). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, 175, 34–52. https://doi.org/10.1016/j.jad.2014.12.041

Pregnancy and Postpartum Depression - Approximately 20 % of women experience clinical depression during and/or after pregnancy.

• Depression is treatable during pregnancy and postpartum.
• Symptoms can range from mild to severe and, mothers with pre-existing depression prior to or during pregnancy are more likely to experience postpartum depression.
• Pregnancy and postpartum depression are treatable and risk can also be mitigated.
• Symptoms generally include sadness, trouble concentrating, difficulty finding joy in activities once enjoyed, and difficulty bonding with the baby.

Van Niel, M. S., & Payne, J. L. (2020). Perinatal depression: A review. Cleveland Clinic Journal of Medicine, 87(5), 273–277. https://doi.org/10.3949/ccjm.87a.19054

Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., Eng, H. F., Luther, J. F., Wisniewski, S. R., Costantino, M. L., Confer, A. L., Moses-Kolko, E. L., Famy, C. S., & Hanusa, B. H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490–498 . https://doi.org/10.1001/jamapsychiatry.2013.87

Pregnancy and Postpartum General Anxiety - Approximately 20% of women develop an anxiety disorder during pregnancy or after childbirth.

• Anxiety is treatable during pregnancy and postpartum.
• Symptoms often include restlessness, racing heartbeat, inability to sleep, extreme worry about the “what ifs” - like what if my baby experiences SIDS, what if my baby falls, what if my baby has autism, etc.; extreme worry about not being a good parent/being able to provide for her family.

Fawcett, E. J., Fairbrother, N., Cox, M. L., White, I. R., & Fawcett, J. M. (2019). The prevalence of anxiety disorders during pregnancy and the postpartum period. The Journal of Clinical Psychiatry, 80(4). https://doi.org/10.4088/jcp.18r12527

Pregnancy and Postpartum OCD - The prevalence of maternal Obsessive Compulsive Disorder (OCD) ranges from 7.8% during pregnancy to 16.9% during the postpartum period.

• OCD includes obsessions (an unwanted thought or feeling) that a person has an urge to relieve through an action or a “compulsion.”
• OCD “obsessions” can include intrusive thoughts (see below for more information about intrusive thoughts).
• About 50% of women with OCD have intrusive/unwanted thoughts about intentionally harming their infant (e.g., throwing the baby).⁶
• It is important to note that although obsessions often contain alarming content they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children.

Fairbrother, N., Collardeau, F., Albert, A. Y., Challacombe, F. L., Thordarson, D. S., Woody, S. R., & Janssen, P. A. (2021). High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. The Journal of Clinical Psychiatry, 82(2). https://doi.org/10.4088/jcp.20m13398

Birth Related PTSD - The prevalence of postpartum PTSD is approximately 3% but increases for at-risk mothers to 15%.

• These women are plagued with intrusive memories and flashbacks of the event.

Grekin, R., & O’Hara, M. W. (2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clinical Psychology Review, 34(5), 389–401. https://doi.org/10.1016/j.cpr.2014.05.003

Postpartum Psychosis

• Postpartum psychosis occurs in approximately 1 to 2 out of every 1,000 deliveries.
• The onset is usually sudden, most often within the first 2 weeks postpartum.
• The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode.
• Postpartum Psychosis is considered a medical emergency due to the potential for a mom to harm herself or her baby.

Friedman, S. H., Reed, E., & Ross, N. E. (2023). Postpartum psychosis. Current Psychiatry Reports, 25(2), 65–72. https://doi.org/10.1007/s11920-022-01406-4

Intrusive Thoughts

• Up to 100% of women (and their partners) have “intrusive” thoughts surrounding childbirth/ the postpartum period.

• These thoughts may include thoughts of infant harm (e.g., dropping the baby or a woman herself harming her baby). These thoughts are unwanted (ego-dystonic) and recognized by the woman as inappropriate and concerning, (which is why these thoughts alone are not cause for alarm).

• It is important to note that although obsessions often contain alarming content they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children.

• Intrusive thoughts are not considered a “disorder.” When symptoms become persistent and are disabling, they are generally thought to be tied to OCD.

Brok, E. C., Lok, P., Oosterbaan, D. B., Schene, A. H., Tendolkar, I., & van Eijndhoven, P. F. (2017). Infant-related intrusive thoughts of harm in the postpartum period. The Journal of Clinical Psychiatry, 78(8). https://doi.org/10.4088/jcp.16r11083

Collardeau, F., Corbyn, B., Abramowitz, J., Janssen, P. A., Woody, S., & Fairbrother, N. (2019). Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: Study protocol. BMC Psychiatry, 19(1). https://doi.org/10.1186/s12888-019-2067-x