WOMEN'S MENTAL HEALTH SERIES: Pregnancy and Mental Health

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For me, motherhood had been a wonderful experience and I am sure, most women will agree with me. Despite the challenges and changes associated with pregnancy, and afterwards being a mother, I am sure I would not want it otherwise. 

However, although I was overjoyed on first seeing the growing baby on ultrasonography and hearing the beating heart on Doppler, I was not prepared with the changes that pregnancy can bring in one’s body and mental state.

Many of these changes are normal, physiological changes associated with pregnancy, but many times these may also be symptoms of underlying mental health conditions like mood disorders and anxiety disorders.

Maternal mental health is an important but often ignored aspect of pregnancy. It must be born in mind that antenatal mental health not only affects the mother but the baby as well.



What do numbers say?

In the developed countries, around 7-15% pregnant women report mental disorders, whereas in the developing world, around 15% pregnant women report so.

Different mental illnesses in pregnancy 

The commonly reported disorders are depression followed by anxiety disorders (panic attacks, generalised anxiety disorder etc), obsessive compulsive disorder (OCD) and even psychosis in rare cases. Some women may experience distress due to ambivalence towards pregnancy or have difficulties in adjusting to the bodily changes brought by pregnancy. 

Factors contributing to mental illness during pregnancy

A variety of factors can put expectant mothers at risk of mental illness. The most consistent factor is having a past history of depression. Many may experience worsening of symptoms due to abrupt stoppage of medication or changes in medication blood levels due to pregnancy related factors.

Psychosocial factors play significant roles as quality of marital relationship, domestic violence during pregnancy, perceived lack of social support or partner support, adjustment to motherhood, previous history of still birth or the desire for a male child can increase maternal vulnerabilities and subsequent mental disorders.

On the other hand social support and self-confidence in women are considered as protective factors.

Effects of poor maternal mental health

Pregnant women with common mental disorders are less likely to seek antenatal care which may lead to poorer physical health, nutritional deficiencies like anaemia, low weight gain, undiagnosed hypertension or hypothyroidism or other physical conditions which all lead to poor child health like low birth weight, premature birth, neonatal mortality. 

The detrimental effects may continue beyond the neonatal period into early childhood years and affect the child’s behavioral, cognitive and emotional development. 

What can be done?

Screening for common mental disorders during antenatal care will help to detect them early on in pregnancy. In cases of confusion, referral to mental health experts can bridge this lacuna.

It can also allay the uncertainty whether alteration in sleep and appetite or fatigue are part of pregnancy or symptoms of underlying mental disorders.  This will also minimize the risk of worsening symptoms in the post-partum period.

There are medications available for more severe conditions and can be started after thorough discussion and consultation with psychiatrists, especially perinatal experts. Many pregnant women are apprehensive about medications but underestimate the risk of untreated depression or other mental health conditions.

For those unwilling for medications or whose conditions can be managed on non-pharmacological interventions alone, supportive psychotherapy, cognitive-behaviour therapy, mindfulness based therapies can help pregnant women deal with the changes during pregnancy and lead to a better outcome for both mother and babies.

-Dr. Suhasini Das, MD, FIPS

 

 

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