Pregnancy and Psychiatry

Psychiatric conditions during pregnancy can present challenges. Hormonal fluctuations and changes in nutrition, exercise, and sleep during pregnancy can worsen pre-existing psychiatric conditions and introduce new psychiatric symptoms. High-risk pregnancies also can bring additional stress, resulting in anxiety and depression. Additionally, pregnancy is a time of great change in social relationships, which can also contribute to the emergence of emotional symptoms.

At Brigham and Women’s Hospital (BWH), our Women’s Wellness during Pregnancy and Beyond Program offers highly specialized care for women with psychiatric disorders before, during, and after pregnancy. Our multidisciplinary team of experts, including maternal-fetal medicine (high-risk pregnancy) specialists, psychiatrists, psychologists, social workers, and nurses is dedicated to delivering the highest level of care for both the mother and her baby.

Pregnancy and Psychiatry

Pre-existing Psychiatric Conditions

Pre-existing psychiatric conditions may include:

  • Anxiety
  • Depression
  • Bipolar disorder
  • Schizophrenia
  • Reactions to prior pregnancy loss or traumatic birth
  • Other issues, such as eating disorders and substance abuse
Psychiatric Conditions Arising During and After Pregnancy

Psychiatric conditions that arise during and after pregnancy may include:

  • Anxiety
  • Depression
  • Psychosis
  • Reactions to pregnancy, pregnancy loss or complications
  • Other issues
Optimal Care for Psychiatric Conditions and Pregnancy

Untreated psychiatric illness during pregnancy can pose risks to the mother and the baby. Women with pre-existing psychiatric conditions who are planning a pregnancy and women who develop psychiatric issues during pregnancy require specialized care. In these cases, it is very important that a team of specialists in multiple disciplines – including maternal-fetal medicine, psychiatry, psychology, and social work – be closely involved in the care of both the mother and the baby.

Preconception Planning

For women with pre-existing psychiatric conditions, planning with the medical team should begin before conception in order to understand how to best manage conditions during pregnancy. Adjustments in lifestyle, medication, behavioral therapies, and other recommendations may be made prior to conception to help prevent the increase or return of psychiatric symptoms during pregnancy. The team will also work with the mother to weigh the risks and benefits of medications to make informed decisions regarding medication use during pregnancy, looking at what is most appropriate for both the mother and the baby. Mothers should not reduce or discontinue medications on their own.

Prenatal Care

A detailed prenatal care plan should address the mother’s individual health issues. Ideally, medication adjustments and planning are started before or early in the pregnancy. The mother’s symptoms should be carefully monitored by the team throughout pregnancy.

Depression commonly affects women during pregnancy and the postpartum period. Approximately one in eight women suffers from perinatal depression, and there are many women without a history of depression who develop symptoms during pregnancy. Unfortunately, perinatal depression is often underdiagnosed and undertreated. Depression screening should be performed throughout the pregnancy in both women with and without a history of depression.

Brigham and Women’s Hospital partners with Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) to prevent, identify, and manage depression in pregnant and postpartum women.

Watch a video about MCPAP for Moms.

Delivery and Postpartum Care

The risk of depression is highest in the postpartum period. Our specialists work with mothers to make thoughtful plans around the baby’s birth and postpartum period to optimize maternal and family well being. This may include psychosocial supports, and initiating or changing medications. Optimizing mothers’ health will provide the best outcomes for themselves, their babies and families.

Women’s Wellness During Pregnancy and Beyond

As part of the Women’s Wellness during Pregnancy and Beyond Program, experts in maternal-fetal medicine at Brigham and Women’s Hospital work closely with specialists in the Women's Mental Health Program at BWH and Brigham and Women's Faulkner Hospital to meet the unique needs of women with depression, anxiety, and other mental health problems during pregnancy and at other stages of life. Women's hormones, reproductive cycle changes, and life experiences can influence their vulnerability to emotional disturbances, as well as impact decisions about medications, psychotherapy, and other forms of treatment.

Our team of clinicians has specialized training and expertise in treating women with these and other issues:

  • Psychiatric symptoms during pregnancy and the postpartum period, with close collaboration between psychiatrists and high-risk pregnancy specialists;
  • Reactions to infertility or pregnancy loss;
  • Reactions to medical complications or complications of pregnancy.

The BWH and Brigham and Women's Faulkner Hospital Women's Mental Health Program is associated with the Department of Psychiatry and the Women’s Health Center of Excellence at Brigham and Women's Hospital – a national center of expertise in women's health that incorporates innovative clinical, teaching, and research programs.

Appointments and Locations

To schedule an appointment or to learn more about our services, please contact us at (617) 732-4840.

Our program is located at:

Brigham and Women’s Hospital
75 Francis Street
Boston, MA 02115

Psychiatric Conditions and Pregnancy Program Leaders

Nicole A. Smith, MD, MPH
Division of Maternal-Fetal Medicine

Leena P. Mittal, MD
Department of Psychiatry

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