Psychiatric disorders in pregnancy

The course and treatment of illnesses during pregnancy can generate considerable clinical anxiety as the clinician assesses the risks and benefits of intervention against a backdrop of limited information and myriad review articles that provide less than definitive direction. This clinical decision is complicated further by the mandate of do no harm and the desire of many women to protect the child at all costs. There is widespread acceptance that some conditions warrant treatment secondary to the potential adverse impact of the illness (eg, hyperemesis, hypertension, infection, and epilepsy). In contrast, the treatments for some illnesses are continued in absence of evidence that such conditions pose a significant risk to the pregnancy (eg, allergies and insomnia). The location of psychiatric illnesses along this continuum of medical severity or risk is unclear, complicated further by the lack of objective tests and the subjective nature of many of the symptoms, thereby leading to reliance on clinical judgment with respect to the need for intervention. Given the high rate of psychiatric morbidity in women of reproductive years, it is important to clarify the course, potential impact, and treatment options for psychiatric illnesses during pregnancy. The importance of extending this information to all subspecialties is evident: the birth rate in the United States has topped the 4 million mark annually; approximately 50% of these pregnancies represent inadvertent