Chapter 4 82 Introduction The perinatal period is a vulnerable period for women with psychiatric diagnoses and their offspring. First and foremost, the perinatal period can negatively impact maternal mental health1-3. Women with previous psychiatric disorders such as psychotic, bipolar, and depressive disorders have a considerable risk of relapse in the peripartum period1,2,4,5. Moreover, studies also established severe maternal and neonatal adverse consequences6-8. Mothers with psychiatric disorders are at higher risk of admission to an intensive care unit, unplanned cesarean section, gestational diabetes, preeclampsia, induced labor, and have lower rates of breastfeeding6,7,9. Neonates more often have low 5-minute Apgar scores, low birthweight or are born preterm6,9,10. Besides, psychiatric disorders may increase the risk for unintended pregnancies (UPs)11. Similarly, UPs are associated with various adverse outcomes such as increased risk for depression in mothers12,13, lower rates of breastfeeding14,15 and preterm birth and low birthweight in neonates16,17. In a systematic review and meta-analysis, we demonstrated an increased risk for UPs in women with psychiatric diagnosis compared to women without psychiatric diagnosis (n=2650, 11 studies)11. The overall weighed prevalence of UPs was 65% in women with psychiatric diagnoses. There are various factors that may attribute to the UP risk in women with psychiatric disorders such as victimization by sexual violence18 or disruption of menstrual cycles19,20. Additionally, advanced planning capabilities, required for adequate use of contraceptive methods and family planning, might be diminished in women with psychiatric disorders20,21. Although possible adverse consequences of both UPs and psychiatric disorders have been studied separately, the impact of UPs on maternal and neonatal outcomes in women with psychiatric disorders has not been studied so far. The present study elaborates on previous literature by primarily investigating the incidence of UPs amongst women with various current/past psychiatric diagnoses versus women without psychiatric diagnoses. The secondary aim is to compare maternal and neonatal outcomes between women with UPs versus non-UPs who delivered in the hospital and to assess the modifying role of current/past psychiatric diagnoses in the association between pregnancy intention and maternal/neonatal outcomes. We hypothesize that women with both psychiatric diagnoses and UPs have the highest risk for adverse outcomes compared to women without psychiatric diagnoses or with intended pregnancies.
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