Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000009.xml
Download PDF
Am J Perinatol 2003; 20(5): 239-248
DOI: 10.1055/s-2003-42342
DOI: 10.1055/s-2003-42342
Anxiety Disorders During Pregnancy and Postpartum
Further Information
Publication History
Publication Date:
18 September 2003 (online)
ABSTRACT
Approximately 30% of women experience some type of anxiety disorder during their lifetime. Women with these disorders may experience profound changes in their symptoms during pregnancy and the postpartum period. In addition, some evidence exists that anxiety disorders can affect pregnancy outcomes. It is important that physicians understand the course of these disorders during pregnancy and available treatments so they can appropriately counsel women who are or intend to become pregnant. This article reviews the literature on the course of anxiety disorders during pregnancy and the postpartum period and presents guidelines for management.
KEYWORDS
Anxiety - psychopathology - psychopharmacology
REFERENCES
- 1 Kessler R C, McGonagle K A, Ahao S. et al . Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry . 1994; 51 8-19
- 2 Beck A T, Emery G, Greenberg R L. Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books; 1985
MissingFormLabel
- 3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 2nd ed. Washington, DC: American Psychiatric Association; 1968
MissingFormLabel
- 4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 3rd ed. Washington, DC: American Psychiatric Association; 1980
MissingFormLabel
- 5 Regier D A, Narrow W E, Rae D S. The epidemiology of anxiety disorders: the Epidemiologic Catchment Area (ECA) experience. J Psychiatr Res . 1990; 2 3-14
- 6
Kessler R C, Amanda D, Bromet E, Hughes M, Nelson C B.
Posttraumatic stress disorder in the national co-morbidity survey.
Arch Gen Psychiatry .
1995;
52
1048-1060
MissingFormLabel
- 7 Resnick H, Kilpatrick D G, Dansky B. et al . Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol . 1993; 6 984-991
- 8
Magee W J, Eaton W W, Wittchen H U. et al .
Agoraphobia, simple phobia, and social phobia in the national comorbidity survey.
Arch Gen Psychiatry .
1996;
53
159-168
MissingFormLabel
- 9 Karno M, Golding J, Sorenson S. et al . The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry . 1988; 45 1094-1099
- 10 George D T, Ladenheim J A, Nutt D J. Effect of pregnancy on panic attacks. Am J Psychiatry . 1987; 144 1078-1079
- 11 Villeponteaux V A, Lydiard R B, Laraia M T, Stuart G W, Ballenger J C. The effects of pregnancy on preexisting panic disorder. J Clin Psychiatry . 1992; 53 201-203
- 12 Norcott C J, Stein M B. Panic disorder in pregnancy. J Clin Psychiatry . 1994; 55 539-542
- 13 Klein D F, Skrobala A M, Garfinkel R S. Preliminary look at the effects of pregnancy on the course or panic disorder. Anxiety 1994/. 1995; 1 227-232
- 14 Cohen L S, Sichel D A, Dimmock J A, Rosenbaum J F. Impact of pregnancy on panic disorder: a case series. J Clin Psychiatry . 1994; 55 284-292
- 15 Wisner K L, Peindl K S, Hanusa B H. Effects of childbearing on the natural history of panic disorder with comorbid mood disorder. J Affect Disord . 1996; 41 173-180
- 16 Cohen L S, Sichel D A, Faraone S V, Robertson L M, Dimmock J A, Rosenbaum J F. Course of panic disorder during pregnancy and the puerperium: a preliminary study. Biol Psychiatry . 1996; 39 950-954
- 17 Cohen L S, Sichel D A, Dimmock J A, Rosenbaum J F. Postpartum course in women with a preexisting panic disorder. J Clin Psychiatry . 1994; 55 289-292
- 18 Sholomskas D E, Wickamaratne P J, Dogolo L, O'Brien D W, Leaf P J, Woods S W. Postpartum onset of panic disorder: a conincidental event?. J Clin Psychiatry . 1993; 54 156-159
- 19 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington,
DC: American Psychiatric Association 2000
MissingFormLabel
- 20 Pollitt J. Natural history of obsessional states. BMJ . 1957; 1 194-197
- 21 Ingram I M. Obsessional illness in mental hospital patients. J Ment Sci . 1961; 107 382-402
- 22 Lo W H. A follow-up study of obsessional neurotics in Hong Kong Chinese. Br J Psychiatry . 1967; 113 823-832
- 23 Brandt K R, Mackenzie T B. Obsessive-compulsive disorder exacerbated during pregnancy: a case report. Int J Psychiatry Med . 1987; 17 361-366
- 24 Buttolph J L, Holland A D. Obsessive-compulsive disorders in pregnancy and childbirth. In: Jenike MA, Baer L, Minichiello WE, eds. Obsessive Compulsive Disorders: Theory
and Management 2nd ed. St. Louis: Mosby-Year-Book 1990: 89-95
MissingFormLabel
- 25 Neziroglu F, Anemone R, Yaryura-Tobias J A. Onset of obsessive compulsive disorder in pregnancy. Am J Psychiatry . 1992; 149 947-950
- 26 Williams K E, Koran L M. Obsessive-compulsive disorder in pregnancy, the puerperium, and the premenstruum. J Clin Psychiatry . 1997; 58 330-335
- 27 Sichel D A, Cohen L S, Dimmock J A, Rosenbaum J F. Postpartum obsessive compulsive disorder: a case series. J Clin Psychiatry . 1993; 54 156-159
- 28 Sichel D A, Cohen L S, Rosenbaum J F, Driscoll J. Postpartum onset of obsessive-compulsive disorder. Psychosomatics . 1993; 34 277-279
- 29 Maina G, Albert U, Bogetto F, Vaschetto P, Ravizza L. Recent life events and obsessive-compulsive disorder (OCD): the role of pregnancy/delivery. Psychiatry Res . 1999; 89 49-58
- 30 Hyman K C, Wignal F S, Roswell R. War syndromes and their evaluation: from the US civil war to the personal gulf war. Ann Intern Med . 1996; 125 398-405
- 31 Rhodes N, Hutchison S. Labor experiences of childhood sexual abuse survivors. Birth . 1994; 21 213-220
- 32 Allen S. A qualitative analysis of the process, mediating variables, and impact of traumatic childbirth. J Reprod Infant Psyc . 1998; 16 107-131
- 33 Ballard C G, Stanley A K, Brockington I F. Post-traumatic stress disorder (PTSD) after childbirth. Br J Psychiatry . 1995; 166 525-528
- 34 Wijma K, Soderquist J, Wijma B. Posttraumatic stress disorder after childbirth: a cross sectional study. J Anxiety Disord . 1997; 11 587-597
- 35 Reynolds J L. Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth. CMAJ . 1997; 156 831-835
- 36 Creedy D K, Shochet I M, Horsfall J. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth . 2000; 27 104-111
- 37 Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol . 2000; 95 487-490
- 38 Rizzardo R, Magni G, Cremonese C, Rossi R T, Cosentino M. Variations in anxiety levels during pregnancy and psychosocial factors in relation to obstetric complications. Psychother Psychosom . 1988; 49 10-16
- 39 Wadhwa P D, Sandman C A, Porto M, Dunkel-Schetter C, Garite T J. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstet Gynecol . 1993; 169 858-865
- 40 Bhagwanani S G, Seagraves K, Dierker L J, Lax M. Relationship between prenatal anxiety and perinatal outcome in nulliparous women: a prospective study. J Natl Med Assoc . 1997; 89 93-98
- 41 Sjostrom K, Valentin L, Thelin T, Marsal K. Maternal anxiety in late pregnancy and fetal hemodynamics. Eur J Obstet Gynecol Reprod Biol . 1997; 74 149-155
- 42 Teixeira J MA, Fisk N M, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ . 1999; 318 153-157
- 43 Groome L J, Swiber M J, Bentz L S, Holland S B, Atterbury J L. Maternal anxiety during pregnancy: effect on fetal behavior at 38 to 40 weeks of gestation. J Dev Behav Pediatr . 1995; 16 391-396
- 44 Seng J S, Oakley D J, Sampselle C M, Killion C, Graham-Bermann S, Liberzon I. Posttraumatic stress disorder and pregnancy complications. Obstet Gynecol . 2001; 97 17-22
- 45 Davidson J R. Pharmacotherapy of generalized anxiety disorder. J Clin Psychiatry . 2001; 62(suppl 2) 46-50
- 46 Koren G. Antihistamines are safe during the first trimester. Can Fam Physician . 1997; 43 33-34
- 47 Pastuszak A, Schick-Boschetto B, Zuber C. et al . Pregnancy outcome following first-trimester exposure to fluoxetine. JAMA . 1993; 296 2246-2248
- 48 Chambers C, Johnson K, Dick L, Felix R, Jones K. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med . 1996; 335 1010-1015
- 49 Goldstein D, Corbin L, Sundell K. Effects of first-trimester fluoxetine exposure of the newborn. Obstet Gynecol . 1997; 89 713-718
- 50 Kulin N A, Pastuszak A, Sage S R. et al . Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA . 1998; 279 609-610
- 51 Ericson A, Kallen B, Wiholm B. Delivery outcome after the use of antidepressants in early pregnancy. Eur J Clin Pharmacol . 1999; 55 503-508
- 52 Einarson A, Fatouye B, Sarkar M. et al . Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study. Am J Psychiatry . 2001; 158 1728-1730
- 53 Saks B R. Mirtazepine-treatment of depression, anxiety, and hyperemesis gravidarum in the pregnant patient: a report of 7 cases. Arch Women's Mental Health . 2001; 3 165-170
- 54 Cohen L, Rosenbaum J. Psychotropic drug use during pregnancy: weighing the risks. J Clin Psychiatry . 1998; 59 (suppl 2) 18-28
- 55 Seto A, Einarson T, Koren G. Pregnancy outcome following first trimester exposure to antihistamines: meta-analysis. Am J Perinatol . 1997; 14 119-124
- 56 Saxen I, Saxen L. Association between maternal intake of diazepam and oral clefts [letter]. Lancet . 1975; 2 498
- 57 Safra M J, Oakley C. Association between cleft lip with or without cleft palate and prenatal exposure to diazepam. Lancet . 1975; 2 478-480
- 58 Aarskog D. Association between maternal intake of diazepam and oral clefts [letter]. Lancet . 1975; 2 921
- 59 Laegreid L, Olegard R, Conrad N, Wahlstrom J. Abnormalities in children exposed to benzodiazepines in utero. Lancet . 1987; 1 108-109
- 60 Altshuler L L, Cohen L, Szuba M P. et al . Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry . 1996; 153 592-606
- 61 Dolovich L, Addis A, Vaillancourt J M, Power J D, Koren G, Eianrson T. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ . 1998; 317 839-843
- 62 Hartz S, Heinonen O P, Shapiro S. Antenatal exposure to meprobamate and chlordiazepoxide in relation to malformations, mental development and childhood mortality. N Engl J Med . 1975; 292 726-728
- 63 Delaney A G. Anaesthesia in the pregnant women. Clin Obstet Gynecol . 1983; 26 795-800
- 64 Rosenberg L, Mitchel A A, Parsells J L. Lack of relation of oral clefts to diazepam use during pregnancy. N Engl J Med . 1983; 24 1282-1285
- 65 Nordeng H, Lindemann R, Perminov K, Reikvan A. Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors. Acta Paediatr . 2001; 90 288-291
- 66 Stiskal J, Kulin N, Koren G, Ho T, Ito S. Neonatal paroxetine withdrawal syndrome. Arch Dis Child Fetal Neonatal Ed . 2001; 84 F134-F135
- 67 Cohen L, Heller V, Bailey J, Grush L, Ablon J, Bouffard S. Birth outcomes following prenatal exposure to fluoxetine. Biol Psychiatry . 2000; 48 996-1000
- 68 Marcus S M, Barry K L, Flynn H A, Tandon R, Gredon J F. Treatment guidelines for depression in pregnancy. Int J Gynaecol Obstet . 2001; 72 61-70
- 69 American Academy of Pediatrics. Use of psychoactive medication during pregnancy and possible effects on the fetus and newborn. Pediatrics . 2000; 105 880-887
- 70 Nulman I, Rovet J, Stewart D. et al . Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med . 1997; 336 258-262
- 71 Laegreid L, Hagberg G, Lundberg A. Neurodevelopment in late infancy after prenatal exposure to benzodiazepines: a prospective study. Neuropediatrics . 1992; 23 60-67
- 72 McElhatton P. The effects of benzodiazepine use during pregnancy and lactation. Reprod Toxicol . 1994; 8 461-475
- 73 Stika L, Elisova K, Honzakova L. et al . Effects of drugs in pregnancy on children's school behavior. Pharm Weekbl Sci . 1990; 12 252-255
- 74 Burt V, Suri R, Altshuler L, Stowe Z, Hendrick V, Munteam E. The use of psychotropic medications during breast-feeding. Am J Psychiatry . 2001; 158 1001-1009
- 75 Burch K J, Wells B G. Fluoxetine/norfluoxetine concentration in human milk. Pediatrics . 1992; 89 676-677
- 76 Isenberg K E. Excretion of fluoxetine in human breast milk [letter]. J Clin Psychiatry . 1990; 51 169
- 77 Jensen P, Olesen O, Bertelsen A, Linnet K. Citalopram and desmethlcitalopram concentration in breast milk and in serum of mother's infants. Ther Drug Monit . 1997; 19 236-239
- 78 Mammen O K, Perl J M, Rudolph G, Foglia J P, Wheeler S B. Sertraline and non-sertraline levels in 5 breastfed infants. J Clin Psychiatry . 1997; 58 100-103
- 79 Ohman R, Staffan H, Carleborg L, Spigset O. Excretion of paroxetine into breast milk. J Clin Psychiatry . 1999; 60 519-523
- 80 Schmidt K, Oleson O V, Jensen P N. Citalopram and breastfeeding; serum concentration and side effects in the infant. Biol Psychiatry . 1999; 47 164-165
- 81 Stowe Z N, Cohen L, Lee S. et al . Paroxetine in human breast milk and nursing infants. Am J Psychiatry . 2000; 157 185-189
- 82 Stowe Z N, Owen M J, Landry J C. et al . Sertraline and desmethylsertraline in human breast milk and nursing infants. Am J Psychiatry . 1997; 154 1255-1260
- 83 Epperson C N, Anderson G M, McDougle C J. Sertraline and breast-feeding. N Engl J Med . 1997; 336 1189-1190
- 84 Wisner K L, Perel J M. Serum nortriptyline levels in nursing mothers and their infants. Am J Psychiatry . 1991; 148 1234-1236
- 85 Wisner K L, Perel J M. Nortriptyline treatment of breast feeding of breast feeding women [letter]. Am J Psychiatry . 1996; 153 295
- 86 Llewellyn A, Stowe Z. Psychotropic medications in lactation. J Clin Psychiatry . 1998; 59 41-52
- 87 Patrick M J, Tilstone W J, Reavy P. Diazepam and breast feeding. Lancet . 1972; 1 542-543
- 88 Morselli P L, Principi N, Tognoni G. Diazepam elimination in premature and full term infants and children. J Perinat Med . 1973; 1 133-141
- 89 Elliot B W, Hill J F, Cole A P. Continuous pethidine/diazepam infusion during labour and its effects on the new born. Br J Obstet Gynaecol . 1974; 82 126-131