Pre-pregnancy check-ups are promoted as a way to improve pregnancy outcomes by identifying risk factors…
Pregnancy and mental health
How can pregnancy affect mental health?
Pregnancy can be a time of great change. While it can be joyful and very exciting, it can also place extra stress on both women and men, which can lead to an increased risk of mental health problems.
Around 9% of women are affected by depression during pregnancy.  It is not clear how many women experience an anxiety disorder, but symptoms of both conditions often occur together.
Depression and anxiety
Symptoms of depression can include:
- Low mood, feeling numb, empty or miserable;
- Increased crying or feeling close to tears;
- Anger and irritability;
- Not being interested in things you normally enjoy;
- Difficulty coping with your normal routine;
- The inability to sleep (insomnia), or sleeping more than usual;
- Changes in appetite (overeating or not eating enough);
- Feelings of inadequacy, guilt, hopelessness, or of being a failure;
- Lack of energy, feelings of exhaustion;
- Difficulty concentrating or feeling forgetful, and;
- Thoughts of self-harm or suicide.
Symptoms of anxiety can include:
- Worry, fear and stress that continually interrupts your thoughts and interferes with your activities;
- Persistent muscle tension, chest tightness or heart palpitations;
- Difficulty relaxing and sleeping, and;
- Panic attacks.
The physical and hormonal changes that occur in pregnancy can make it difficult to recognize signs and symptoms of depression and/or anxiety.
Depression and/or anxiety may be a problem for you if symptoms are:
- Persistent and lasting for more than two weeks, and;
- Disrupting your life or are distressing.
Factors that can increase the risk include:
- Having a history of mental health problems prior to pregnancy;
- Having a family history of mental health problems;
- Problems with alcohol and drug use;
- A history of physical, psychological or sexual abuse;
- An unwanted or unexpected pregnancy;
- A lack of practical and emotional support, or serious relationship difficulties;
- Recent major life-events that have caused stress, such as losing a job, or the death of a family member or close friend;
- Other medical conditions including severe morning sickness;
- A general tendency to be anxious and worry;
- A tendency to be a perfectionist or self-critical;
- Multiple pregnancy, and;
- Pregnancy during adolescence.
Other mental health problems that can be related to pregnancy
The baby blues refer to symptoms that can occur in many women in the week after birth. They can include rapid changes in mood, crying, anxiety and sleep problems. The exact cause of the baby blues is not clear, but they are thought to be linked to rapid hormone changes after birth, as well as the stress of dealing with labor and caring for a newborn.
In most cases, the symptoms of the baby blues improve without treatment within days to weeks. It is important to ensure that you have strong family and friend supports around during this period of change.
Postpartum or postnatal depression can also occur after birth, but involves symptoms of depression that are more severe and can last much longer than the baby blues.
The symptoms of postnatal depression are similar to those during pregnancy and:
- Can be serious and very distressing;
- May interfere with the developing relationship between a mother and her baby;
- May include anxieties or fears about the baby, and;
- May include thoughts of self-harm, suicide or harming the baby.
Sometimes also known as puerperal psychosis or postpartum psychosis, this is a rare mental health condition that usually develops within a couple of weeks of childbirth, although it can occur up to 12 weeks after childbirth. Sometimes early symptoms may occur during pregnancy.
Postnatal psychosis is a serious mental health condition that requires immediate treatment. Women with postnatal psychosis can be at increased risk of harming themselves or their baby.
Grief following the loss of a pregnancy or baby
Mental health issues for expectant fathers
Pregnancy can be a challenging and stressful time for expectant fathers and this may lead to a higher risk of anxiety and depression. Research has also shown that new fathers are at an increased risk of experiencing depression when their partners have depression.
Methods for diagnosis
If you are thinking about self-harm, suicide or harming your baby (or someone you know is showing these signs), getting help quickly is important and can help to save lives.
In situations where there is immediate danger of suicide or harm to a child, you can call 911 for help.
Other ways of getting help for a mental health problem include:
- Speaking to a doctor, midwife or mental healthcare provider, and;
- Calling an appropriate mental health crisis helpline.
Women are often routinely 'screened' or asked about any mental health problems they may be experiencing during pregnancy by their doctors and midwives. By asking you about your symptoms, your healthcare provider can assess how severe they are.
Blood tests may be recommended to identify any medical conditions that may cause similar symptoms to depression and anxiety. These can include anemia and thyroid conditions (hypothyroidism and hyperthyroidism).
Understanding what to expect with pregnancy can help to reduce worry and depression. It can also help you to learn about depression and anxiety. Doctors, midwives and other health professionals can answer your questions and help provide reassurance regarding issues you might be worried about.
Psychological therapy is sometimes referred to as 'talking therapy' and describes the process of treating a mental illness by helping people to understand their condition and manage their symptoms.
For women with severe symptoms, medications may be recommended. Antidepressants can be effective in reducing symptoms of both depression and anxiety, which can have a negative effect on the baby's development and the mother's wellbeing. However, all medications are prescribed with caution to limit potential side effects to the unborn or newborn baby. Your doctor can discuss the risks and benefits of medications and find the best option that suits you.
If you have been taking medication for a mental health condition and become pregnant, it is important to speak to your doctor or psychiatrist as soon as possible - and before stopping any of your medications. If you suddenly stop taking medications, it can cause withdrawal symptoms or may make your mental health condition worse. Medical professionals can advise what treatment options will be most suitable for you during pregnancy.
Complementary treatments (such as St John's Wort) are sometimes suggested for depression and anxiety; however, they may not be safe during pregnancy. Your doctor can advise you on the safety of complementary treatments.
Looking after your general health and wellbeing is very important during pregnancy and a range of lifestyle measures can help to relieve symptoms of anxiety and depression.
These can include:
- A healthy diet;
- Focusing on reducing stress, and;
- Regular appropriate physical activity.
You can check with your doctor or midwife prior to making any changes to your lifestyle that might affect your pregnancy (for example, making sure exercise is safe and suitable for your situation).
Depression and anxiety can contribute to:
- Poor nutrition during pregnancy;
- Increased use of alcohol and tobacco, and;
- Reduced attendance at antenatal care appointments.
Anxiety and depression during pregnancy have also been related to:
- Lower birth weight;
- An increased risk of premature birth, and;
- Changes in hormones that may affect the long-term development and health of the baby.
Women who have untreated depression during pregnancy may be more likely to experience postnatal depression after the baby is born.
In some cases, mental health conditions such as anxiety and depression can persist for a long time and affect many aspects of a person's life. However, effective treatments are available and they can help you to feel better and get on with enjoying your life and your new baby.
Anyone can get anxiety and depression. Understanding the signs and symptoms and seeking help early can help to prevent the symptoms from becoming worse. As it can often be difficult to recognize early symptoms of depression and anxiety in yourself, your partner, family members and friends can provide vital support and guidance.
If you or someone you know needs help, please call or visit:
WellMama: Pregnancy & Postpartum Depression Hotlines Call: 1.800.896.0410
National Suicide Prevention Lifeline Lifeline Call: 1-800-273-8255
The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.