Prevalence And Risk Factors Of Depression Related To Pregnancy And Puerperium At Benha Hospital University:

Rasha Mohamed Sobhey El-khouly

• More. attention needs to be directed to understanding the role of co -occurring risk factors, which may contribute both to onset andmaintenance of maternal depression and to the adverse childoutcomes.• Further studies for each of the significant risk factors individuallywith different methodology and with control of other risk factors.• It remains a topic for research to determine whether these factors areetiological or a mere association or a resultant of the psychologicalpathology.• There are great discrepancies between studies. It may be linked to thedifference in the sampling and the methods of assessment in differentstudies. So, the use of a standard rating scale specifically designed toassess PND as EPDS is recommended.• Use of EPDS as a screening measure is recommended. The scale iswell accepted both by the mothers and the nurses, and its usesignificantly increases the number of identified cases ofPND. In babyhealth office clinic nearly all postnatal women attend with theirchildren for immunization. So it well a suitable place for screening.• The majority of women with high level of depression in postnatalperiod also reported elevated symptom of depression at early, mid orlate pregnancy. So, it is possible to target a substantial percentage ofthose women who are at risk for PND. Screening for psychologicalmorbidity in late pregnancy may be useful in identifying women atrisk antenately who may develop PND.• In order to minimize the adverse effects of PND on the mothers andher family, intensified interdisciplinary collaboration between theprofessionals in the child health care system and those in general psychiatry is called for. Educational programmes should be offered tothem stressing on the differentiation between normal emotionalresponses and pathological mood states. A team of generalpractitioner, a psychiatrist, a psychologist and social worker should beregularly included in pre and postnatal care. They preparing themother for the conflict that she had to face concerning the concept ofpregnancy, delivery and her role inside and outside the household.• Women with first pregnancy may benefit from attending, togetherwith their spouse, special family classes offering them psychologicalsupport in facing the normal transition of becoming a parent.Psychological support, birth education and discussion about deliveryin early pregnancy will give a positive effect on fear of child birth.Some women may also benefit from continuing this support duringthe puerperium.• Strategies concerning how to develop antenatal care aimed atdecreasing maternal depression should also take the spouse intoaccount. Care should not be restricted to the mother but shouldinvolve the father and possibly other siblings to prepare the family forthe new comer.• The direction is for prevention of antenatal depression to decrease therisk of using pharmacological agents for the treatment of depressionduring pregnancy.• Preventive interventions might include antenatal guidance forparenting, counselling of gender role stress, and development ofsupport groups for postnatal couples in making a smoother transition.• Clinicians who come in contact with new mothers need to be alert tothe range of possible symptoms that postpartum depressed mothersmay experience so that these women are not left to suffer in silence ..Q$ 129 &• Antenatal focus on psychological wellbeing of the mothers may help toidentify women at risk of PND. 20%of sever PND would becamechronic and delay of treatment is the greatest risk factor in thedevelopment of chronic depression. Thus, special attention should begiven to women at risk to ensure early identification and adequatetreatment.• Normal vaginal delivery is recommended as it was found to bepositively correlated with satisfaction of delivery and decrease risk ofPND. Women with emergency cesarean section or sever pain should bepsychologically supported by staff during delivery .. Cesarean deliverycarries considerable disadvantages in terms of pain and trauma of anabdominal operation and complications associated with it. However, theCS rate is constantly on the rise. Hence, there is a need to evaluate theviews of women undergoing cesarean deliveries and to ascertain the roleof women in decision making regarding mode of delivery.• The strong association between not breastfeeding the baby and increasedrisk of PND may be an important observation which might help healthworkers at the maternity ward to identify women with depression whoneed extra care. Engorgement of breastfeeding is recommended if weconsidered its association with PND as a risk factor.• Attention must be given to anxiety symptoms as it has been neglected incontrast to depression in perinatal psychiatry although anxiety IS acommon disorder that responds well to psychological treatment.• Screening for depression is recommended for pregnant women withunintended pregnancy, with marital problems and with past psychiatrichistory.• Role of family physician in education of pregnant women to raise theirawareness.