Complications
A strong correlation exists between postpartum depression and impaired interaction and bonding between mother and infant. Infant exposure to maternal depression has negative behavioral, cognitive, and emotional consequences.[93][186] Affected infants demonstrate restricted facial expression and fewer interests. One longitudinal study of 2057 children followed up from age 5 months to 8 years showed that a wide range of ante- and peripartum risk factors, including maternal depression, act independently to increase the likelihood of persistently high levels of hyperactivity-impulsivity and inattention symptoms from infancy to middle childhood.[187]
Another longitudinal study followed up 9800 mothers for 18 years after childbirth. The analysis identified a cohort of mothers/offspring who were at particularly high risk for adverse long-term outcomes in both mother and child; mothers meeting criteria for moderate or severe postpartum depression at both 2 months and 8 months following delivery. When compared with the children of women with postpartum depression that was neither persistent nor severe, children in this cohort had a fourfold increased risk of behavioral problems at age 3-4 years, a twofold increased risk of having lower math test scores at age 16 years, and a sevenfold increased risk of depression at 18 years. Mothers in this cohort were at increased risk of experiencing high levels of depressive symptoms up to 11 years following childbirth.[188][189] These results emphasize the importance of screening for depression in the postpartum period, and of treating women with persistent and severe postpartum depression as a matter of clinical priority. Treatment of maternal depression reduces depression, anxiety, and disruptive behavior in the child, whereas no treatment results in worsening of these symptoms.[190][191][192][193]
A preliminary assessment of the risks of infanticide can be made by asking about three key areas:
The current mental state, including thoughts of suicide and of harming the baby
Any history of attempted suicide or harm to the baby
Situational and environmental factors that might increase or decrease risk.
Any psychotic symptoms substantially increase risk, particularly delusions or hallucinations that relate to the baby.
Refer the woman for a same-day emergency appointment so that a detailed risk assessment can be carried out if a significant risk of self-harm or harm to the baby is suspected.[74]
Assess the woman's current mental state, and any situational and environmental factors that might increase or decrease the risk of suicide.
Refer any patient at risk of self-harm for a same-day emergency appointment so that a detailed risk assessment can be carried out.[74]
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