Dean's Grand Rounds - One Pathway, Two Lives: integrating preconception and perinatal psychiatric care

Women in the perinatal period are at high risk for developing mental health problems, more than at any other time in their lives. Those with pre-existing psychiatric disorders may often suffer a relapse especially in the postpartum. In addition, pregnancy in women with pre existing psychiatric disorders is often associated with gestational diabetes , obesity , hypothyroidism and poor nutrition, this adds to challenge of treatment. Without the availability of integrated care, women often abruptly discontinue necessary psychiatric medications upon discovering they are pregnant leading to high relapse rates.

Globally women with psychiatric disorders slip through the cracks during the preconception period with most pregnancies being unplanned.

In the UK, community perinatal psychiatric services and specialist mother and baby units offer support. However, in South Asian countries the lack of integrated obstetric and psychiatric care as well as highly privatised services leads to siloed care for these women with lack of  insurance adding to the burden.

One successful model is the Perinatal Psychiatry Clinic at NIMHANS where women with psychiatric disorders are offered preconception advice and continuing care until 2 years postpartum. This also includes an inpatient Mother-Baby Unit.

This Dean's Grand Round focusses on the role of preconception care in women with psychiatric disorders and models of perinatal psychiatric care in South Asian countries.

Our discussions will be around current practice in the UK and South Asia for women with psychiatric disorders in the perinatal period as well as the challenges faced by psychiatrists and obstetricians related to preconception care. We will share lived experiences of women and the barriers faced by clinicians trained in the UK when they started specialised services in the Middle East and South Asia.

The aim of this session is to improve perinatal care by better liaison with GPs, obstetricians and paediatricians while working as perinatal psychiatrists.