Considerations in managing personality disorder in the perinatal period

There is limited evidence about perinatal outcomes in females with personality disorder. While many people with personality disorder successfully navigate pregnancy and the perinatal period, data show that females who have severe personality disorder with a borderline pattern are more likely to:

• have chaotic and stressful lives, lack support from a partner or a stable extended family network, have problem drug use and experience intimate partner violence. Consequently, detection of a pregnancy may be delayed, antenatal care may not be consistently accessed, and obstetric outcomes may be poorer. Increased risk of preterm labour and lower Apgar scores (a measure of the neonate’s condition immediately after birth) have been reported
• experience or anticipate giving birth as traumatic
• struggle with parenting and have difficulty bonding with or caring for their child—severe impairment may result in:
  • admission to a parent–infant psychiatric unit—females with severe personality disorder with a borderline pattern are overrepresented in these units
  • impaired psychological development in the child—children of parents with severe personality disorder with a borderline pattern appear to be more likely to have attachment and psychological disorders
  • notification to child protection services because of concerns about the child’s wellbeing.

The principles of managing personality disorder in the perinatal period are similar to the principles described here, with the following additional requirements:

• the perinatal period is a time of high psychosocial stress and presents extra challenges to a person with personality disorder. It is crucial for the person to have a management plan that includes robust psychosocial interventions (ideally, specific to the perinatal period) and optimises their social (eg significant others) and professional (eg mental health service) supports—child protection monitoring may be required
• seek advice about managing a person with severe personality disorder during the perinatal period from a specialist perinatal mental health or personality disorder service¹
• as with patients who are not pregnant or breastfeeding, drugs have a limited role in treating personality disorder; if a psychotropic is used, see Principles of psychotropic use during pregnancy or Principles of psychotropic use while breastfeeding for considerations
• if possible, provide psychoeducation to the patient and if they consent, ideally, their significant other(s)—openly discuss the potential effects of personality disorder upon the parent–infant relationship
• for people with severe personality disorder, intensive support of the parent–infant relationship is often required—there are psychosocial group treatments specifically developed for parents with personality disorder.