August 3, 2021

During Pregnancy, Don’t Forget Your Mental Health

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7
min read

Pregnancy and childbirth can be happy and even magical experiences, but they can also be challenging and filled with anxiety. For many new or expectant moms, the physical changes and emotional stresses of the perinatal period – the weeks before and after childbirth – can take a toll on their mental health. 

Perhaps the most widely recognized example of this is postpartum depression, which begins in the weeks following delivery. But depression and other mood disorders can occur any time before or after the birth of a baby. For some women, a mental health condition may be the continuation or recurrence of a symptom that existed before pregnancy. For others, it may show up in pregnancy for the first time. Disorders occurring during pregnancy are often referred to as prenatal or antenatal, meaning before birth. 


Symptoms

Pregnancy’s an emotional time, with lots of ups and downs. It’s important to know the difference between normal emotions and a serious mental health condition. Like most pregnant women, you probably worry about lots of things, including your baby’s health or the changes occurring in your own body and appearance. A mental health condition like generalized anxiety disorder (GAD) is different.

Symptoms of GAD may include:

  • Panic attacks, or abrupt episodes of intense fear with no apparent cause 
  • Rapid or deep breathing, hyperventilation
  • Repeated thoughts or fears that something will happen to the baby 
  • Unwarranted worrying
  • Nighttime restlessness or difficulty sleeping 


Similarly, most women have a day or two when they feel down. An occasional blue mood is very different from major depressive disorder (MDD). The first sign of MDD is a sad mood that lasts all day on most days and persists for at least two weeks.  

Symptoms of MDD may include:

  • Loss of interest or pleasure in activities that you used to enjoy
  • Lack of energy or feeling tired all of the time
  • Withdrawal from friends and loved ones 
  • Feelings of worthlessness, helplessness or guilt 
  • Difficulty with concentration and memory 
  • Sleeping too little or too much 
  • Thoughts of death or self-harm


Causes

Physiological and hormonal changes associated with pregnancy as well as the physical and emotional stresses of pregnancy and preparation for childbirth are thought to trigger or worsen mental health conditions. 

Although any woman can experience serious anxiety or depression during pregnancy, you may be more at risk if you:  

  • Have experienced depression or other mental health conditions in the past
  • Have an immediate family member with depression or other mental health disorder
  • Are a single or teenage mom  
  • Are a woman of color
  • Lack access to quality health care 
  • Don’t have adequate health insurance 
  • Have an unplanned or unwanted pregnancy 
  • Have been physically or sexually abused or are a survivor of domestic violence 
  • Have undergone a major life stressor, such as a divorce or death of a loved one
  • Struggle financially or live in poverty
  • Live in an unsafe neighborhood
  • Are exposed to systemic racism
  • Lack a support system of family and friends
  • Have a substance use disorder
  • Have diabetes, either existing or beginning during pregnancy (gestational diabetes)
  • Have pregnancy complications or are expecting multiple babies 


Diagnosis 

Screening for depression and anxiety should be part of regular prenatal care. If your doctor asks questions about your mental health, be sure to answer honestly.  

Unfortunately, not all expectant moms get mental health screenings. If your doctor doesn’t ask and you’re feeling anxious or depressed, don’t be afraid to speak up. You shouldn’t be embarrassed or ashamed to seek help when you need it, especially when it affects both you and your baby.


Treatments

There are many effective treatments for mental health conditions. Treatment will ideally involve your primary physician, prenatal care provider (the obstetrician or doctor who provides your pregnancy care), and a mental health professional, such as a psychologist, therapist, or social worker.  

Counseling, or psychotherapy, is the cornerstone of therapy during pregnancy. Two types, in particular, have proven useful for antenatal mental disorders:  

  • Cognitive behavioral therapy (CBT) helps change problematic thinking and behavior patterns. In studies, CBT was especially helpful for antenatal anxiety and depression.
  • Interpersonal psychotherapy (IPT) which focuses on improving difficulties in relationships that cause you distress. 


Other treatments may include: 

  • Support groups, either in person or online, with other expectant moms to share experiences and feelings. 
  • Acupuncture, which involves placing fine needles at strategic points on the body. An analysis of 29 trials of treatments for depressive and anxiety disorders in pregnant women found acupuncture successfully relieved depression for some patients. 
  • Body-oriented (also known as mind-body) interventions, such as deep-breathing techniques and meditation. 
  • Medications, including antidepressants, anti-anxiety medications, or mood stabilizers.

You and your doctor should consider treatment decisions carefully. It’s important to weigh the potential risk of the medications against the risks of untreated depression. Many drugs can pass through the placenta to your baby. Certain antidepressants may cause miscarriage, low birth weight, premature birth, or some congenital disabilities. If you’re already taking medication for a condition that existed before pregnancy, it’s important not to stop treatment without speaking with your doctor. 

 

Complications for Mom and Baby 

Treating mental health conditions that occur in pregnancy is important not only for the mother but also for her baby. A growing body of research suggests that a mother’s mental health during pregnancy can affect her baby’s developing brain and may influence her child’s psychological state later on.   

Depression during pregnancy could potentially lead to developmental, learning, and behavioral concerns in children. The children of mothers who were depressed during pregnancy may also be at greater risk of mental health conditions later in life. 

Depression during pregnancy may also increase the risk a baby will: 

  • Be born prematurely, before 37 weeks of pregnancy.
  • Be small for their gestational age, meaning they weigh less than they should before birth.
  • Have a low birth weight – less than five pounds, eight ounces at birth. 
  • Be more irritable and less active than babies of mothers without depression. 

For expectant mothers, an untreated mental health condition can detract from the joy of pregnancy, make it difficult to prepare for the baby’s arrival, and to breastfeed or properly care for her newborn. Antenatal mental health conditions may also persist or worsen after childbirth.


When to See a Doctor

If you’re pregnant and experience symptoms of anxiety or depression, speak with your doctor or midwife. They can help you get treatment so pregnancy and new parenthood can be the happy time you and your baby deserve.

SOURCES:

Med.Stanford.edu: “Pregnancy and Mental Health.” 

Marchofdimes.org: “Depression During Pregnancy.”

Mayoclinic.org: “Depression during pregnancy: You're not alone.”

Apa.org: “What is Cognitive Behavioral Therapy?”

Div12.org: Diagnosis: “Depression; Treatment: Interpersonal Psychotherapy for Depression.”

MDEdge.com: “Psychiatric illness during pregnancy.”

Share.upmc.com: “Black Maternal Mental Health: The Challenges Facing Black Mothers.”

My.clevelandclinic.org: “Panic Disorder.” 

Nimh.nih.gov: “Generalized Anxiety Disorder: When Worry Gets Out of Control.”

Psychiatry.org: “What Is Obsessive-Compulsive Disorder?"

Plos One: “Interventions to treat mental disorders during pregnancy: A systematic review and multiple treatment meta-analysis.”

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