[Peripartum management plan for patients with mental illnesses : Strategies to reduce the risk of postpartum relapse].

BACKGROUND: Transition to parenthood is challenging but for women with a history of recurrent psychiatric disorders becoming a mother has a number of additional issues. Women with a history of mood disorders or psychoses are at increased risk for exacerbation in the vulnerable postpartum period and fear the potential risk of medication during pregnancy for the unborn child as much as they fear a relapse. In these difficult situations women and their families seek advice and support from mental health providers and obstetricians.

METHODS AND RESULTS: Based on the treatment of 420 mentally ill women with a desire to have children and pregnancy and prospective documentation of 196 pregnancies over the last 10 years (2006-2016) the authors developed the Bonn concept of peripartum management (BKPM). The plan was designed to reduce the incidence and severity of postpartum relapses in women suffering from psychiatric disorders. Factors to be considered include antenatal and postpartum medication as well as reduction of stress and stimuli, sleep preservation, social support and help from the partner in caring for the baby. Of the 196 women in the BKPM only 4.6 % (n = 9) experienced a severe postpartum relapse with hospitalization. Additionally, the informed consent discussion with patient and partner as part of the peripartum management plan showed positive effects on how women and their families experienced autonomy and safety during pregnancy and postpartum.

DISCUSSION: Careful planning and monitoring with a structured perinatal management plan can reduce the risk of relapse in the perinatal period and thus support women with a history of mental disorder in the transition to motherhood. Therefore, the management concept employed in Bonn contributes to the major goal of current peripartum psychiatric care in developing effective prevention strategies for women at high risk.