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Pregnancy is portrayed as a time of happiness and emotional well-being, and for many that is their experience, but evidence shows mental illness can affect women in pregnancy.\u00a0 Pregnancy impacts women from many angles with regards to their physical and mental health and also the baby\u2019s health. There is much debate over whether you are more or less likely to have ill mental health during pregnancy. Statistically, if a woman has had mental ill health in the past or at the time she falls pregnant, then she is more likely to have mental ill health during pregnancy or in the year after giving birth (postpartum) than at other times in her life. Overall, however, mental health admissions and completed suicide are less common in pregnancy than at other times. Indeed, some women who have had mental ill health in the past remain well during pregnancy, everyone is different and have varying triggers for becoming unwell.<\/p>\n
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Normal Pregnancy<\/h2>\n
There is usually an increase in symptoms of anxiety and depression during pregnancy, but these are quite normal.\u00a0 In the first trimester they are related to \u2018adjustment\u2019 to being pregnant and in the third trimester they are related to \u2018fear\u2019.\u00a0 Risk factors for experiencing a mental health condition during pregnancy include:<\/p>\n
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- Personal and family history of depression<\/li>\n
- Ambivalence about the pregnancy<\/li>\n
- Lack of marital, family and social support<\/li>\n<\/ul>\n
Mental Illness during Pregnancy<\/h2>\n
It is common for women to experience mental ill health for the first time during pregnancy. Women may feel more vulnerable, anxious and some may develop depression.\u00a0 If a woman on prescribed medication discontinues her antidepressants during pregnancy, then it can precipitate a relapse of depressive symptoms.<\/p>\n
Conditions which can impact mental health during pregnancy include:<\/p>\n
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- Prenatal depression (depression during pregnancy)<\/strong> \u2013 The American College of Obstetricians and Gynecologists (ACOG) and The American Psychiatric Association (APA) sate that between 14-23% of women will experience symptoms of depression during pregnancy.\u00a0 Symptoms of prenatal depression include frequent crying, trouble sleeping, fatigue, change in appetite, loss of enjoyment of pleasurable activities, heightened anxiety, trouble feeling connected to the developing baby.\u00a0 Prenatal depression is the most common mental illness experienced by pregnant women and yet it is often under detected and under treated by health care providers.<\/li>\n
- Bipolar disorder (BD)<\/strong> \u2013 Pregnant women with bipolar disorder have seven times the risk of being admitted to hospital compared to a pregnant woman who does not have bipolar disorder.\u00a0 BD can worsen during pregnancy and symptoms are characterized by mood swing cycles between mania (feelings of high energy) and depression (feelings of sadness and hopelessness).\u00a0 For this reason, a thorough review of medications the patient is taking for their condition should be conducted. It was found that women who stopped taking bipolar medications during pregnancy had twice the risk of relapse, a 50% recurrence of symptoms within two weeks of ceasing medication if stopped suddenly and bipolar symptoms existed throughout 40% of their pregnancy or more than four times that of women who continued their bipolar medications.<\/li>\n
- Schizophrenia <\/strong>\u2013 As with BD symptoms of Schizophrenia can worsen during pregnancy and a medication review should be conducted with the patient.\u00a0 Symptoms of Schizophrenia include hallucinations, delusions, confused thoughts and speech, and trouble concentrating.<\/li>\n
- Panic disorder<\/strong> \u2013 This tends\u00a0to be a pre-existing condition and may result in increased symptoms during pregnancy, although some people have reported a reduction of symptoms when pregnant. Emotional symptoms include sudden feelings of fear, anxiety, nervousness and apprehension.\u00a0 Physical symptoms may include accelerated heart rate, chest pain, light headedness, shaking, nausea and numbness.\u00a0 A referral to a psychotherapist will help the patient cope with their symptoms and fears whilst pregnant.<\/li>\n
- Eating disorder <\/strong>\u2013 Although the chances of pregnancy tend to decrease in a patient who has an eating disorder the chance of pregnancy can still occur.\u00a0 As good nutrition and hydration are important to both mother and child for a successful pregnancy and delivery then good team work between care provider and patient is essential with extra appointments, consultation with a dietician and support groups for pregnancy, childbirth, child development and groups who support eating disorders.<\/li>\n
- Obsessive-compulsive disorder (OCD)<\/strong> \u2013 This can be a pre-existing condition or pregnancy can be a trigger for it to occur. Symptoms include thoughts or images which keep entering their mind (obsessions), anxiety, and actions or thoughts they keep repeating to reduce their anxiety (compulsions).\u00a0 In pregnancy, this could involve excessive washing as the woman has an intense fear the developing baby will be contaminated by germs or dirt, or repeatedly asking people that everything is alright with the pregnancy. Women with prenatal OCD often realize their symptoms are unreasonable and excessive but may not seek help for fear of feeling ashamed. Health care providers should enquire about prenatal OCD when discussing other psychiatric conditions in pregnancy. If not discussed and detected, then symptoms could worsen leading to other conditions including depression.\u00a0<\/li>\n
- Generalized anxiety disorder (GAD)<\/strong> \u2013 8.5-10.5% of women who are pregnant will experience GAD. The disorder tends to be under-diagnosed and it may be difficult to distinguish from normal worrying. Untreated GAD may lead to pregnancy complications including low birth weight, preterm delivery, high blood pressure and failure to progress during labor.\u00a0 Symptoms of GAD include persistent worrying and anxiety out of proportion to the impact of events, overthinking plans and solutions, difficulty concentrating, difficulty handling uncertainty, inability to relax, restlessness, fatigue, trouble sleeping and muscle aches.\u00a0 Treatment options include psychoeducation, cognitive-behavioral therapy (CBT), support groups and medication may be necessary after careful evaluation.<\/li>\n
- Pseudocyesis<\/strong> \u2013 A woman believes herself to be pregnant and develops objective signs of pregnancy such as abdominal enlargement, menstrual disturbance, apparent fetal movements, nausea, breast changes, labor pains, uterine enlargement, urinary frequency, cervical softening and a positive pregnancy test.\u00a0 On examination and after being examined and other conditions excluded (including ectopic pregnancy, corpus luteal cyst, placenta previa, pituitary tumor and pelvic tumor) it is found the patient is not pregnant.\u00a0 Pseudocyesis is regarded as a somatoform disorder or a variant of depression. It may present as psychosis with amenorrhea.\u00a0 Treatment includes psychotherapy and a trial of an antidepressant.<\/li>\n<\/ul>\n
- Bipolar disorder (BD)<\/strong> \u2013 Pregnant women with bipolar disorder have seven times the risk of being admitted to hospital compared to a pregnant woman who does not have bipolar disorder.\u00a0 BD can worsen during pregnancy and symptoms are characterized by mood swing cycles between mania (feelings of high energy) and depression (feelings of sadness and hopelessness).\u00a0 For this reason, a thorough review of medications the patient is taking for their condition should be conducted. It was found that women who stopped taking bipolar medications during pregnancy had twice the risk of relapse, a 50% recurrence of symptoms within two weeks of ceasing medication if stopped suddenly and bipolar symptoms existed throughout 40% of their pregnancy or more than four times that of women who continued their bipolar medications.<\/li>\n
- Prenatal depression (depression during pregnancy)<\/strong> \u2013 The American College of Obstetricians and Gynecologists (ACOG) and The American Psychiatric Association (APA) sate that between 14-23% of women will experience symptoms of depression during pregnancy.\u00a0 Symptoms of prenatal depression include frequent crying, trouble sleeping, fatigue, change in appetite, loss of enjoyment of pleasurable activities, heightened anxiety, trouble feeling connected to the developing baby.\u00a0 Prenatal depression is the most common mental illness experienced by pregnant women and yet it is often under detected and under treated by health care providers.<\/li>\n
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\u00a0Isabel PRO differential for psychological symptoms during pregnancy<\/em><\/h4>\n![\"download-the-patient-engagment-white-paper\"](\"https:\/\/no-cache.hubspot.com\/cta\/default\/133692\/9e14314e-52a7-4921-9140-b56f09cceb58.png\")
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