Psychiatric Disorders of Obstetrical Patients: A Paradigm for Risk Assessment and Collaborative Management

Mood and anxiety disorders are relatively common during pregnancy and postpartum. If these go unrecognized and untreated, a host of adverse outcomes can occur. Herein, we propose an approach where obstetricians assess the presence and severity of psychiatric disorders by clinical assessment plus simple patient questionnaires, typically requiring less than two minutes to complete. The process categorizes the condition as either mild, moderate, or severe. We propose guidelines to inform treatment, including when to consider referral to a mental health specialist, and when to involve a neonatologist during the pregnancy, because of the risk that the neonate will require neonatal intensive care unit (NICU) admission. We believe this approach systematizes patient assessment, helps direct decision-making, facilitates appropriate treatment, fosters communication between obstetric, psychiatric, and neonatal clinicians, and could improve maternal and neonatal outcomes.