Psychopathology during pregnancy and postpartum: characterization of a selected high risk Italian sample

Psychological distress is common during pregnancy but the field of perinatal-psychology and related research as well as health services have focused their attention essentially on the post-partunl period. New data suggest that stress and psychopathology during pregnancy may be associated with significant risks for the mother and the baby and may lead to detrimental effects for both. Maternal psychopathology is related to reduced quality of life, higher rate of risk behaviors, postpartunl psychopathology, and to a decline in the quality of dyadic relationship. Antenatal stress and psychological disease and their underlying neuroendocrine changes are associated with poor pregnancy and birth outcomes. Maternal stress and psychopathology together with fetal vulnerability and other ~ediating factors, such as pharmachological treatment, may determme long-term consequences by altering developmental processes, affecting the structural development of certain brain areas circuits, and systems, as well as brain functioning. ' ~fter h~ving studied a sample obtained from the general population, thIS study focused on a selected and high risk sample of women diagnosed with psychopathology and recruited from a center specialized in Women's lifecycle mood disorders (psicheDonna Center-Milan). General aim: The general aim of this study was threefold: - to study different manifestations ofpsychological illness as well as to detect risk and protective factors in this selected sample of pregnant and postpartunl women - to analyze the characteristics of these women in order to understand the mechanisms underlying the interaction between protective and risk factors which may predict the course of psychopathological manifestations across pregnancy and beyond. - to analyze, in follow-up, the choice and efficacy of pharmacological and-or psychotherapy treatment of these women. Methods: A sample of91 pregnant and postpartunl women was enrolled from the Center. Women were subjected to a test battery in order to evaluate: - ~ndex ofpregnancy specific-related anxiety (PRAQ-R, Huizink) - mdex of State Anxiety and of Trait Anxiety, as defined by Spielberger (STAI-Y, Spielberger) - ananmestic data and risk and protection factors (scale constructed ad hoc and PDPI, Tatano Beck) - index of depressionlpostpartunl depression (EPDS, Cox). Conclusions and Considerations: Differences were found between ~is sample and the one from the general population, not only m test scores but overall in the role played by risk and protection factors. The presence of pregnancy-related specific anxiety (detected by PRAQ-R) was found more in the general population: a working hypothesis as to the underlying cause was developed. Women recruited from the Center are characterized by a peculiar configuration of risk and protection factors, where a previous history of psychopathology seems to play a prominent role in defining the sample. This type of evidence indicates a possible new key point with respect to intervention and prevention, that is, the previous history of psychopathology. Consequently we need to consider the necessity of different approaches in the use of screening tools, and in the development of preventive measures and healing programs, and tailor all activities and interventions to the patient in order to be effective. This has lead to new evidence-based perspectives for intervention.