(201) Perspectives on addressing and treating bipolar disorder in the obstetric setting

Abstract: Background/Significance:

Mood and anxiety disorders, including bipolar disorder (BD), affect 20% of perinatal individuals. This period carries a high risk of new-onset or exacerbation of BD. Recommendations suggest obstetric clinicians screen for BD during the perinatal period, especially prior to initiating pharmacotherapy, yet this is often challenging. Perinatal Psychiatry Access Programs (Access Programs) have emerged across the country to help obstetric professionals meet the needs of perinatal individuals with mental health conditions. The study objective was to elicit obstetric professional perspectives on barriers and facilitators to managing BD in perinatal patients, and how Access Programs may help or hinder these processes.

Methods:

We conducted three focus groups with obstetric professionals with and without exposure to the nation’s first Access Program, the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. MCPAP for Moms uses training, psychiatric consultations, and provision of resources and referrals to help MA obstetric professionals meet the psychiatric needs of their patients. Focus groups discussed experiences in addressing BD with or without the help of an Access Program, as well as barriers, facilitators, and solutions to caring for perinatal individuals with BD. Qualitative data were coded and analyzed by two independent coders; emergent themes were examined across exposure groups.

Results:

Thirty-one obstetric professionals (7 unexposed, 24 exposed to MCPAP for Moms) participated. All obstetric professionals reported wanting to address BD. Participants with exposure to MCPAP for Moms reported screening for BD more frequently than those without (74% vs. 29% respectively). Identified themes included: (1) educational gaps for obstetric professionals around perinatal BD; (2) challenges for obstetric professionals in assessing patients for BD; (3) MCPAP for Moms being a facilitator to addressing BD; and (4) importance of continued outreach to obstetric professionals and destigmatization.

Discussion:

Barriers to receiving adequate mental health care abound for perinatal individuals with BD, resulting in many being under- or inappropriately treated. Given this, obstetric professionals are increasingly being asked to take a leading role in caring for these patients. Though many barriers exist, Perinatal Psychiatry Access Programs, such as MCPAP for Moms, may help to increase obstetric professionals’ ability, comfort, and effectiveness in caring for their patients with BD.

Conclusions/Implications:

Perinatal Psychiatry Access Programs may be a useful tool to facilitate obstetric professionals in bridging gaps in mental health care for perinatal patients with BD.

References:

ACOG Committee Opinion No. 757: Screening for Perinatal Depression. Obstet Gynecol. 2018;132(5):e208-e212.

Byatt N, Carter D, Deligiannidis KM, et al. Position Statement on Screening and Treatment of Mood and Anxiety Disorders During Pregnancy and Postpartum. American Psychaitric Association. 2018.

Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 2007;164(12):1817-1824.