Pregnancy is often portrayed as a wonderful time in a woman’s life, filled entirely with happy and hopeful emotions. And it is, for some lucky women. But the reality for a large percentage of pregnant women doesn’t match this image.
A recent study published in the British Journal of Psychiatry bears this out. Researchers at King’s College London found that 1 in 4 pregnant women have mental health problems. These include depression (found in 11 percent), anxiety (15 percent), eating disorders (2 percent), obsessive-compulsive disorder (2 percent), post-traumatic stress disorder (just under 1 percent) and smaller incidences of bipolar disorder and other disorders.
The Massachusetts General Hospital Center for Women’s Mental Health says that women with histories of psychiatric illness who discontinue their medications during pregnancy are especially vulnerable. But all women are at risk for peripartum depression, which is not “the baby blues” that affect many women at some point in their pregnancy, but rather a longer-lasting and more debilitating illness.
[Read: Planning for a Safe Pregnancy.]
According to the World Health Organization, virtually any woman can develop mental disorders during pregnancy and in the first year after delivery, but certain factors — including poverty, migration, stress, exposure to violence, emergency and conflict situations, natural disasters and low social support — increase the risk.
The consequences are considerable. The WHO reports that a mother with depression may not eat healthfully, bathe or care for herself, which increases the risks of her own poor health. Suicide and, in rare cases, infanticide are also possible. The baby can be affected as well. Mental illness interferes with mother-infant bonding, breast-feeding and infant care, the WHO says.
Stress Is Harmful
What makes pregnancy so hard on a woman’s mental health? Part of it may come from that belief that women are supposed to love being pregnant. “In the old days it was thought that women were actually better during pregnancy. They were happy and excited,” says Dr. Leslie Hartley Gise, a psychiatrist and professor at the John A. Burns School of Medicine at the University of Hawaii. “But pregnancy can be a very stressful time from a psychosocial point of view.” Peripartum depression, which affects about 10 to 15 percent of pregnant women, is accepted as a major public health problem, she says.
Stress, it is well-known, is a primary risk factor for depression and other mental illnesses, and pregnancy is “a time of increased vulnerability,” says Dr. Shari I. Lusskin, clinical professor of psychiatry, obstetrics, gynecology, and reproductive sciences at the Icahn School of Medicine at Mount Sinai Medical Center. “Postpartum is another time of increased risk, because pregnancy and delivery is a state of constant change in the biochemistry of the body. That can unmask vulnerabilities in the brain.” Psychological disorders are brain-based medical conditions, she says, and when the biochemical environment changes during pregnancy and after birth, the brain is affected.
[See: The Best and Worst Exercises for Pregnant Women.]
But it’s not fair to blame hormones alone. “We don’t completely understand why some women are susceptible to hormone changes and some aren’t,” Gise says. “We are starting to look at genetic factors, but we’re not there yet.” And stress comes in many forms. “Change is stressful, even if it’s a good change,” she says, noting that half of pregnancies are unplanned, but even those that are wanted can add stress that comes from caring for a new baby, the transition to motherhood for new mothers — or the added responsibilities to those with children already. Any kind of stress has a direct effect on biochemistry.
Changes in body image during and after pregnancy are stressful for many women as well, especially those with a history of eating disorders, Lusskin adds. Then there are the possible issues of financial stress, work-related pressure and associated medical conditions such as gestational diabetes or high blood pressure. “And it is important to highlight the risk of domestic violence increases during pregnancy,” Lusskin says. According to the March of Dimes, partners may become abusive during pregnancy because they are upset about an unplanned pregnancy, stressed about financially support or jealous that the woman’s attention may shift from the partner to the baby.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
‘ First Commandment: Don’t Panic’
Left untreated, a mother’s mental illness can have long-term effects on fetal development and the child’s health later in life. “Women who are depressed may not get proper care” during pregnancy, Lusskin says. There is a risk of self-medication with alcohol, drugs and tobacco. Women who are already taking antidepressants or other psychotropic medications sometimes stop their meds because they worry about the effects on the developing fetus. This may set them up for relapse. Lusskin warns any pregnant or trying-to-get-pregnant woman not to change their medication without close consultation with their doctors first. “Any medication changes are best made before conception to prevent relapse,” she advises.
If a woman or her significant other thinks that mental health is becoming a concern, Gise says, “The first commandment is, don’t panic.” There are plenty of nonmedical approaches to dealing with mental illness during pregnancy. “Women should consider everything else first — talk therapy, meditation, acupuncture, light therapy, whatever,” she says. Diet and exercise changes may also help, depending on a doctor’s OK first. “The first choice is always something that is not chemical.” If you experience symptoms of depression most of the time for more than two weeks, and if you are losing interest in things that typically give you pleasure, that’s the time to see a mental health professional, she says.
“When everything goes smoothly, pregnancy can be a lot of fun, but most women experience something,” Lusskin says. Even morning sickness, if it’s severe, can increase the risk of depression, especially if the woman can’t keep her medications down. Her best advice for preparing for the potential mental health consequences of having a baby: “Get your ducks in row before you get pregnant.”
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Why Pregnancy Can Be Tough on a Mother’s Mental Health originally appeared on usnews.com
