It is generally thought that pregnancy is a time of happiness and well-being for women. However, for many women, pregnancy and motherhood increase their vulnerability to psychiatric conditions such as depression, anxiety, eating disorders and psychosis. The symptoms of these conditions may go unnoticed because they are attributed to temperamental or physiological changes suffered during pregnancy. In addition to this, disorders are often undertreated due to concerns about the harmful effects that medications could have.
Depression in pregnant women
During pregnancy, it is difficult to distinguish some symptoms of this condition from the normal pregnancy experience, think for example of changes in sleep, appetite or energy. Although 70% of women report some symptoms of negative mood during pregnancy, the prevalence of women meeting the criteria for a diagnosis of depression has been shown to be around 13.6% at 32 weeks of gestation and 17 % at 35 to 36 weeks of gestation. The course of depression varies during pregnancy: most report a peak in symptoms during the first and third trimesters and improvements during the second. In one study, it was observed that more women became depressed between 18 and 32 weeks of gestation than between 32 weeks of gestation and 8 weeks postpartum.
Depression is the psychiatric disorder most commonly associated with pregnancy.
Many risk factors and psychosocial correlates have been identified as contributors to depression in pregnancy. The clearest risk factors that have been identified are history of depression, discontinuation of medication in a woman with a history of depression, previous history of postpartum depression, and family history of depression. On the other hand, the psychosocial correlates that usually contribute are: negative attitude towards pregnancy, lack of social support, stress associated with negative events and a partner or family member for whom pregnancy causes unhappiness (studies and ).
Depression left untreated during pregnancy, either because symptoms were not recognized or because of concerns related to the effects of medication, can lead to a multitude of negative consequences, including lack of commitment to prenatal care recommendations. , poor nutrition and self-care, self-medication, use of alcohol and other drugs, suicidal thoughts and thoughts of harming the fetus, and the development of postpartum depression after the baby is born.
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It is difficult to distinguish some symptoms of this condition from the normal pregnancy experience.
One study of 1,123 mother-infant pairs reported that children of mothers who were depressed during pregnancy showed fewer positive facial expressions and vocalizations, and were also more difficult to comfort. Consequently, the relationship between maternal depression and early childhood problems could be part of a continuum that begins with depressive symptoms during pregnancy.
Treatment for depression in pregnancy is based on the same type of therapies used for depression at any time in life, with the additional need to ensure the safety of the fetus. Psychotherapies that have been recognized as effective for the treatment of depression include . Education and support are also important, as pregnancy is a unique experience for women, and some may not know what to expect. If a pharmacological treatment is chosen, it must be clear with the patient and, if possible, her partner regarding the risks and benefits of said treatment.
Anxiety disorders during pregnancy
There is data on some disorders of this type, such as panic attacks or obsessive-compulsive disorder. However, there is very little information about others (for example, social phobia and generalized anxiety disorder).
Panic attacks
The course of anxiety disorders during pregnancy is variable and unclear. Although there are pregnant women who suffered from panic attacks before pregnancy, in which it is suggested that the symptoms decrease during pregnancy, others found that this decrease does not occur in women who suffered from pre-pregnancy panic attacks.
Additionally, a subset of women may experience first onsets of panic attacks during pregnancy. Professionals should check these patients for possible thyroid disorders. The possible effects of anxiety and panic attacks on the course of pregnancy and the health of the fetus are not well understood. A showed a correlation between increased anxiety and increased blood flow resistance in the uterine artery. The difference between plasma cortisol levels in the mother and in the fetus could have implications for the developing brain of the latter. Treatment of panic attacks in pregnancy may include pharmacological therapies, particularly benzodiazepines as sedatives at night and symptomatic relief and antidepressants. They can also be treated with non-pharmacological therapies, such as CBT, relaxation techniques, sleep hygiene, and dietary counseling.
Obsessive-Compulsive Disorder
OCD is characterized by thoughts that cannot be controlled (obsessions) and repetitive or ritualistic behaviors in response to these thoughts (compulsions) that cannot be controlled. Some research suggests that women may be at greater risk for the onset of OCD during pregnancy and the postpartum period. In a study of women diagnosed with OCD, 39% of participants reported that the disorder began during pregnancy. The treatments available are the same as for non-pregnant people, CBT and pharmacotherapy.
Generalized anxiety disorder
A study involving 2,793 participants found that 9.5% suffered from Generalized Anxiety Disorder at some point during pregnancy. Anxiety symptoms were greatest in the first trimester and decreased as the pregnancy progressed. Risk factors in this case were: previous episodes of GAD, education, social support and history of childhood abuse. These patients may benefit from including mindfulness techniques, acceptance, and behavioral activation strategies.
Eating disorders during pregnancy have been linked to higher rates of miscarriages and low birth weight.
Social phobia
There are no data on social phobia with onset during pregnancy or pre-existing social phobia in pregnant people. A small number of women experience fear of pregnancy and childbirth. These patients are more likely to experience postpartum depression if they are denied the birth of their choice.
Eating disorders in pregnancy
The rate of these disorders in pregnant women is approximately 4.9%. Although some suggest that the severity of symptoms may decrease during pregnancy, there are many negative consequences for both mother and child. For example, one found that pregnant women with active eating disorders appeared to be at greater risk of having a cesarean delivery and suffering from postpartum depression. Added to this, eating disorders during pregnancy have been with higher rates of miscarriages and low birth weight.
Psychosis in pregnancy
Although episodes of psychosis during pregnancy are rare, women with a history of this condition have a higher risk of recurrence.
One found that pregnancy appears to worsen the mental health of the mother with schizophrenia. Some women present psychotic denial of pregnancy, a symptom that, if not addressed, can represent a risk factor. Postpartum, these women may be especially susceptible to acute exacerbations of schizophrenia.
On the other hand, a study that included data from 12 studies that included 700 subjects with schizophrenia and 835 subjects in the control group found significant associations between the disorder and premature rupture of the membrane, gestational age less than 37 weeks, and use of incubator and resuscitation. Another also found that they had a higher risk of premature birth and, in addition, schizophrenia during pregnancy was associated with low birth weight.
Regarding treatment, psychoeducation could reduce the risk of pregnancy complications. Brief focused therapies may also be useful for some patients with this psychological condition. Regarding pharmacological treatment, one of two cases of women medicated with clozapine for schizophrenia during pregnancy did not observe risks to pregnancy, childbirth, the health of the mother or the baby.
Bipolar disorder
One noted that mood stabilizer discontinuation, especially suddenly, during pregnancy carries a high risk of new morbidity in women with bipolar disorder, especially for early depression and dysphoric states.
It is recommended that, in women with a history of Bipolar Disorder, the decision to use or not use mood stabilizers is made after an evaluation of risks and benefits, also considering factors such as: number and severity of episodes, level of insight, support family and the person’s wishes. Careful psychological monitoring of symptoms during pregnancy is very important.
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