Psychiatric disorders during pregnancy

Pregnancy and childbirth are a very joyful time for many families, but can also trigger or worsen mental health problems in some women.

Mental health problems impact the quality of life of pregnant women and contribute to maternal and perinatal outcomes. For women with underlying mental health illnesses, has an impact on the growth and development of the fetus. Some medications are toxic and may affect the child.

Although pregnancy has typically been considered a time of emotional well-being, recent studies suggest that up to 20% of women suffer from mood or anxiety disorders during pregnancy. High rates of relapse have also been observed in women with bipolar disorder. One study indicated that during the course of pregnancy, 70.8% of the women experienced at least one mood episode.

Hormonal fluctuations and changes in nutrition, exercise, and sleep during pregnancy can worsen pre-existing psychiatric conditions and introduce new problematic symptoms. High-risk pregnancies also can bring additional stress, resulting in anxiety and depression. Additionally, pregnancy is a time of great change in social relationships, which can also contribute to the emergence of emotional symptoms. Psychiatric conditions during pregnancy can present various challenges for an expecting mother.

There’s a higher risk of developing mental health problems in the conceiving mother if she is facing poverty, substance abuse, prior psychiatric disorders, previous unfortunate pregnancy outcomes, medical illnesses in the current pregnancy, extremes of age, and inadequate support systems. In addition to the obstetric, medical, and psychiatric history, it is important for the gynecologist to enquire about the condition of the current pregnancy, how the patient responded to previous pregnancy outcomes, and the socioeconomic status of the patient.

Mental health problems adversely affect the physical needs of both the mother and the growing fetus and compromise the ability of a mother to take care of the infant.

As WHO correctly states that ‘there can be no physical health without mental health’. It will be unfair on the part of healthcare workers to make any assumptions about the mental health state of any pregnant woman. Some women conceive under very difficult circumstances, where they may have been sexually abused, are unsure of the paternity of their child, or may have been under the influence of substances when they conceived. Such factors contribute to how women perceive the pregnancy, and the health-seeking behavior during this challenging period.

The demands and expectations of motherhood and the health of the infant contribute to the mental well-being of a mother. Having a medical illness that may require medication to be altered, may cause anxiety about the pregnancy and general wellness. Women also experience anxiety and depression prior to pregnancy about fertility, future pregnancy outcomes, and how pregnancy may impact their well-being. It is important for all pregnant women to be screened for mental health problems, a complete assessment of mood and emotional well-being should be included in the preconception, antenatal and postnatal visits. In settings where it is not possible to provide any mental health support, routine screening may be deferred if the risk of screening outweighs the benefits.

To ensure optimal care for psychiatric issues during pregnancy for women with pre-existing psychiatric conditions who are planning a pregnancy and women who develop psychiatric issues during pregnancy, it is very important that a team of specialists in multiple disciplines – including maternal-fetal medicine, psychiatry, psychology, and social work – be closely involved in the care of both the mother and the baby.

A detailed prenatal care plan should address the mother’s individual health issues. Ideally, medication adjustments and planning should be started before or early in the pregnancy. The mother’s symptoms should be carefully monitored by the team throughout pregnancy.

Depression commonly affects women during pregnancy and the postpartum period. Approximately one in eight women suffers from perinatal depression, and there are many women without a history of depression who develop symptoms during pregnancy. Unfortunately, perinatal depression is often underdiagnosed and undertreated. Depression screening should be performed throughout the pregnancy in both women with and without a history of depression.

Things you can try to help with your mental health during pregnancy

• Talk about your feelings to a friend, family member, doctor, or midwife.
• Try calming breathing exercises if you feel overwhelmed.
• Do physical activity if you can – it can improve your mood and help you sleep.
• Eat a healthy diet with regular meals.
• Try to attend antenatal classes to meet other pregnant people.

Remember not to practice this:

• Do not compare yourself to other pregnant people – everyone experiences pregnancy in different ways.
• Do not be afraid to tell your doctor how you are feeling – they are there to listen and support you.
• Do not use alcohol, cigarettes or drugs to try and feel better – these can make you feel worse and affect your baby’s growth and wellbeing.

Mental health awareness month encourages everyone to take time to learn more about maternal mental health, to be empowered with awareness and to start conversations that can improve and save lives.