Course of Illness and Treatment Updates for Bipolar Disorder in the Perinatal Period.

PURPOSE OF REVIEW: The perinatal period is a time of increased vulnerability for people with bipolar disorder (BD). The purpose of this review is to provide an update of the literature from the last 3 years regarding course of illness and treatments for BD in the perinatal period to guide clinical care. RECENT FINDINGS: Postpartum manic and depressive episodes are emerging as having a unique presentation that may differentiate them from non-perinatal mood episodes. Many important updates regarding medication treatment in the perinatal period have been published recently that have considered the risks of untreated illness versus treatment risks in this population.' Despite significant research, there are still gaps in knowledge regarding safety and efficacy of medications for the mother and child. Crucial future areas of study include improved screening guidelines, randomized controlled trials examining medication safety in pregnancy and lactation, and efficacy of nonpharmacologic treatments.

Telehealth adaptation of perinatal mental health mother-infant group programming for the COVID-19 pandemic.

The COVID-19 pandemic and ensuing isolation stressed pregnant and postpartum women and their families pervasively. This necessitated addressing young families' mental health needs while protecting both patients and providers from COVID-19 exposure. Our experience of rapidly adapting Pregnancy, Maternal Postpartum Peer Support, and Mother-Infant Postpartum Group interventions to high-quality telehealth modalities elucidates benefits and challenges of mother-infant dyadic treatment amidst the pandemic. This study compares 2019 in-person and 2020 telehealth services during the period from mid-March through mid-December in each year. Initial program Warmline contacts were similar across years despite pandemic-related restrictions, with 2020 program contacts surpassing the 147 unique patient outreaches during the commensurate 2019 period. Pregnancy Group enrollment remained consistent. Maternal Postpartum Peer Support Group participation increased with transition to telehealth with 27 individuals with over 100 group-based visits in 2020. Twenty-five mother-infant Postpartum pairs initially enrolled in the 12-week multicomponent Mother-Infant Therapy Group (M-ITG) during 2019 in-person services, and 16 completed the program (36% non-completion rate). During 2020 telehealth, 15 of 18 mother-infant pairs completed the program (17% non-completion rate); a greater than 50% reduction in non-completion. We further compare pre-/post-pandemic onset M-ITG participant demographics, enrollment, and Edinburgh Postnatal Depression Scale (EPDS) scores.

La pandemia COVID-19 y el consecuente aislamiento estresó a mujeres embarazadas y en postparto y a sus familias de manera generalizada. Esto requirió abordar asuntos de salud mental de familias jóvenes mientras que se protegía tanto a pacientes como proveedores de estar expuestos al COVID-19. Nuestra experiencia de adaptar rápidamente el Embarazo, el Apoyo entre Iguales al Postparto Materno y las intervenciones de grupo Madre-Infante en Postparto, a modalidades de telesalud de alta calidad, esclarece beneficios y retos del tratamiento a la díada madre-infante en medio de la pandemia. El estudio compara el servicio presencial en 2019 y de telesalud en 2020 durante el período de mitad de marzo a mitad de diciembre en cada año. Los contactos iniciales de programas de apoyo emocional telefónico con alguien en igual circunstancia (Warmline) fueron similares a lo largo de los dos años a pesar de las restricciones de la pandemia, con más contactos de programas de 2020 que las específicas 147 actividades de contacto a pacientes durante el período similar en 2019. La inscripción en grupos de embarazo se mantuvo consistente. La participación en grupos de Apoyo entre Iguales al Postparto Materno aumentó con la transición a la telesalud, con 27 individuos y más de 100 visitas con base en el grupo en 2020. Veinticinco pares de Madre-Infante en Postparto se inscribieron al inicio en el Grupo de Terapia Madre-Infante de 12 semanas y múltiples componentes (M-ITG) durante los servicios en persona de 2019 y 16 completaron el programa (36% tasa de incompletos). Durante la telesalud del 2020, 15 de los 18 pares de madre-infante completaron el programa (17% tasa de incompletos); una reducción de más del 50% en incompletos. Además, comparamos, antes y después de la pandemia, datos demográficos, inscripción y puntajes en la Escala de Edimburgo de Depresión Postnatal de participantes que iniciaron el M-ITG.

La pandémie du COVID-19 et l'isolation qui s'en est suivie a stressé les femmes enceintes et postpartum et leurs familles de façon générale. Il a donc fallu prendre en compte les besoins de santé mentale des jeunes familles tout en protégeant à la fois les patients et les praticiens de toute exposition au COVID-19. Notre expérience d'adaptation rapide du Soutien Maternel par Pair à la Grossesse et Postpartum ainsi que des interventions de groupe Postpartum Mère-Bébé en modalités de télésanté de haute qualité illustrent les bénéfices et les défis du traitement dyadique mère-bébé en pleine pandémie. Cette étude compare l'année 2019 en personne et les services de télésanté de 2020 durant la période de la mi-mars jusqu'à la mi-décembre de chaque année. Les contacts du programme initial Warmline ont été les mêmes au fil de ces deux années en dépit des restrictions liées à la pandémie, avec des contacts du programme de 2020 surpassant la communication à 147 patients uniques durant la même période de 2019. Le groupe de grossesse enregistré est demeuré constant. La participation de groupe de Soutien par Pair Postpartum a augmenté avec la transition à la télésanté avec 27 individus avec plus de 100 visites basées sur le groupe en 2020. Vingt-cinq paires Postpartum Mère-Bébé se sont initialement inscrites dans le Groupe de Thérapie Mère-Bébé de 12 semaines à plusieurs composants (M-ITG) durant les services en personne de 2019 et 16 ont terminé le programme (36% de taux d'inachèvement). Durant la télésanté 2020, 15 des 18 paires mère-bébé ont complété le programme (17% de taux d'inachèvement); un taux de réduction de 50% plus grand pour l'inachèvement). Nous comparons par ailleurs les données démographiques des participants M-ITG avant et après le début de la pandémie, les inscriptions et les scores de l'Echelle de Dépression Postnatale d'Edinbourg.

Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care.

Objectives: Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care. Methods: Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records. Results: Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation. Conclusions: These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.