Präpartale Depression und Angst – Was ist relevant für den Geburtshelfer?

Purpose: Depression and anxiety disorders are the most common mental disorders and are widespread in our society. A considerable number of women suffer from these mental disorders either prior to, during or after pregnancy. They can cause severe complications during and after pregnancy. However, the prevalence and clinical presentation of depression and anxiety disorders during pregnancy have received little attention. In this article we review the medical literature as it relates to the prevalence and clinical presentation of depression and anxiety disorders during pregnancy. The aim of this study is to investigate the growing body of literature on maternal depression and anxiety during pregnancy. Its purpose is to present an overview of antenatal depression and anxiety and the clinical issues and implications involved. To develop a better understanding we describe the typical symptoms of these disorders and discuss the side effects on pregnant women and the developing fetus afterwards. The treatment options in clinical practice are explained, and the Edinburgh Postnatal Depression Scale (EPDS), which can be used as a simple screening instrument, is shown. Material and Methods: A search for empirical articles indexed in electronic databases (Medline, Pubmed) was conducted using combinations of the following search terms: pregnancy, childbirth, depression, postpartum, panic disorder, anxiety disorder, low birthweight, growth retardation, preterm birth or treatment. We included 59 articles published between 1986 and 2009. Results: A high level of depressive or anxiety symptoms during pregnancy were found in combination with fetal intrauterine growth retardation or preterm birth. A few studies were able to demonstrate an association. The pathomechanism remains partly unclear. Most likely those symptoms cause a change in the signalling pathway of cortisol, which has been demonstrated in animal research. It is not easy to establish a diagnosis during pregnancy. To differentiate between reactive symptoms and real psychopathology a psychiatrist or psychotherapist would often need to be involved. Treatment options range from supportive psychotherapy to treatment with antipsychotic drugs in severe cases. Conclusion: Depressive and anxiety disorders are the most common mental disorders in women during their reproductive years. The appearance of these disorders is heterogeneous. Making a diagnosis and treatment of the disorder is difficult during pregnancy. Given the growing evidence that depression, stress, anxiety and psychotropic medications all involve fetal exposure, pregnant women with depression or anxiety and their gynecologists face significant treatment dilemmas. Both treating and not treating the disorder can have negative side effects. Early detection of depression and anxiety disorders, confirmation of the diagnosis and early initiation of treatment options could limit prenatal complications and prevent their postpartum exacerbation.