Pregnancy should be a time of joy, but for women with mental illness it can be a complex period with layers of anxiety, fear and guilt overshadowing the excitement and anticipation.
Up to 3 million women suffer from depression while pregnant and after giving birth, according to Art Guerra, APRN, director of the Peripartum and Adult Outpatient programs at the Institute of Living. Of those, he said 50 percent to 75 percent can be considered the more temporary “baby blues,” but up to 80 percent of women can experience perinatal mood and anxiety concerns that are considered moderate to severe.
“Many of these women are undiagnosed,” he said. “Others might be taken off their medications during pregnancy, which can be a problem.”
Untreated perinatal depression, for example, poses risks to the unborn baby, including:
- Preterm delivery.
- Lower birth weight.
- Fetal distress.
- Increased admission to a neonatal intensive care unit.
- Increased incidence of cesarean section birth.
The pregnant woman is also at risk as a result. She can experience:
- Poor prenatal care.
- Substance use.
- Inadequate pregnancy weight gain.
- Preeclampsia, or high blood pressure.
“The mother-baby relationship can also suffer,” Guerra said. “There can be attachment issues, cognitive delays, behavioral problems and developmental delays in the child. Untreated depression in mothers has also been shown to lead to depressive, anxiety or disruptive disorders in about half of school-aged children.”
IOL’s Peripartum Program was started five years ago to fill a gap in the community and medically manage pregnant women and new mothers with moderate or severe mental health issues.
Besides depression, the program works with pregnant women and new mothers with anxiety and obsessive compulsive disorder and postpartum psychosis, which occurs in one or two out of every 1,000 births.
“Eighty percent of all new mothers report intrusive thoughts about deliberately or accidentally harming their babies,” Guerra said. “It impacts their ability to connect with their child and their quality of life.”
Even with the risks posed by mental illness, many women are reluctant to take medications during pregnancy for fear of harming their unborn baby. The Peripartum Program team works with women individually to outline the risk-benefit scenario of treatment.
“We help them understand the benefit of treatment,” Guerra said. “They can’t function as a mom if their mental health is severely impacted. Moms need decisional support.”
Dr. Karina Weiss, Peripartum Program psychiatrist and medical director of the Adult Resident Outpatient Clinic, said any treatment begins with behavioral therapy and may progress to medication if necessary. She said research indicates that the risks of taking SSRI medications such as Zoloft “are the same as not treating the depression at all.”
“Taking psychiatric medications pose risks to the mom and baby, including preterm birth, a risk of postnatal adaptation syndrome, possibly lower APGAR scores,” Dr. Weiss said. “But there are also risks to both mom and baby if the mom doesn’t take medication and leaves the depression or other mental health condition untreated. We will help mom weigh those risks and get the treatment she feels comfortable with.
“There is no ‘right’ answer and the literature is ambiguous, so it can be hard for parents and mental health providers to feel comfortable with their choice.”
For more information on the Mood Disorders Program at the Institute of Living, click here.