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Perinatal anxiety

Anxiety disorders are more common in women than in men, and they are most likely to occur during a woman’s reproductive years. Being pregnant, giving birth, and becoming a new mom can be a highly anxiety-provoking experience. The significant bodily changes can be upsetting for a woman, as can anxiety regarding the upcoming role and identity change. Labour and delivery can be very scary for some women. Some women worry about whether they will be able to tolerate the pain of labour and delivery. Others fear being exposed physically, and/or fear having no sense of control during labour and delivery. After giving birth, many women experience normal anxiety about their ability to care for their baby. They may find themselves being vigilant about the baby’s wellbeing. If the worry becomes excessive and/or interferes with daily functioning, it is important to see someone for help. Signs that suggest your anxiety and concern may be something more serious include:

  • inability to think about anything else
  • checking your baby more than necessary
  • trouble leaving your baby even with a trusted caregiver
  • panic attacks
  • excessive fear that something is wrong with your baby
  • frequent thoughts or images of harming your baby

What are the risks of not seeking help for depression during pregnancy?

There are risks for both the mother and the fetus. The risks for the mother include:

  • poor self care – depression is related to poor self care which can lead to inadequate nutrition, inadequate weight gain, or weight loss
  • use of drugs, alcohol and smoking – all of which negatively impact your health and can seriously harm your baby’s health
  • sleep disturbance
  • anxiety and/or depression can worsen
  • pre-eclampsia

What are the risks of maternal depression for the fetus?

Untreated depression in a mother can lead to:

  • the baby being born earlier than full term
  • baby having lower birth weight (which is related to a number of developmental difficulties)
  • baby having smaller head circumference
  • baby’s APGAR score being lower
    • The APGAR is a test given to newborns to assess their overall health. It looks at the following:
      • appearance – what is the colour of the baby’s skin?
      • pulse – what is the heart rate?
      • grimace – does the baby respond to being stimulated?
      • activity – what is the muscle tone of the baby?
      • respiration – what is the breathing of the baby?
  • Poor neonatal adaptation (for example, feeding, sleeping and other self-regulation difficulties)

Far-reaching effects of maternal depression: the multi-generational impact

During the first years of life, parent-infant interactions influence the development and structure of the infant’s brain. When an infant coos or babbles, and a parent responds appropriately by cooing in return, being attentive, or interested, the connections in the infant’s brain are strengthened. These connections are the architectural foundation of the developing brain, which supports later learning, and physical and mental health. The parent-infant interactions provide the infant with the beginning abilities to manage stress. And, how an infant copes with stress impacts later mental and physical development and health.

Maternal depression can interfere with parent-infant interactions and thus the infant’s development. For example, depressed mothers may be intrusive and hostile, and/or disengaged and withdrawn from their infants.

It is through these parent-infant interactions that infants modulate and cope with stress. This early relationship influences the regulation of stress hormone production. Research shows the infants of depressed mothers show disruptions in their stress response and immune systems. Specifically, infants of depressed mothers tend to have higher levels of stress chemicals in their brains. Studies have also shown that infants of depressed mothers have brain activity that is similar to depressed adults. Again, this increased level of stress chemicals and depressive brain patterns interferes with the child’s ability to learn, impacts later physical health (for example, cardiovascular health), and increases the infant’s risk of developing emotional difficulties later in life.

In short, the first couple of years of life permanently set the stage for the cognitive, mental, and medical health of individuals. And, maternal depression is one of the greatest adversities an infant can face. Other adversities of comparable grave influence include child maltreatment (abuse and neglect) and parental substance abuse.

Research has shown that interventions can help to mediate some of the effects of maternal depression. We know that early and intensive interventions are best. In addition, interventions must address the parent-infant interactions. If they only address the mother’s depression symptoms, they won’t provide enough benefit to the baby’s health.

That’s why maternal depression is a society-level problem: the children affected by maternal depression are, after all, the future generation’s citizens, workers and parents.

What do you do if you are taking medications?

If you are taking any medications, it is important to talk to your doctor. Your doctor will want to weigh out the individual risks and benefits of taking medication in your particular case. There is a significant amount of research on the risks of taking mental health-related medications during pregnancy and during breastfeeding that can be found at www.motherisk.com (a site at based out of the Hospital for Sick Children in Toronto)

Treatment

If you are experiencing the “baby blues” it can be helpful to talk to others who can reassure you that this is normal. Find support from those you trust and continue to monitor yourself. If your symptoms persist or worsen, talk to your doctor.

If you have depression or anxiety, seek out mental health support. Depression and anxiety are highly treatable conditions.

If you have, or someone you know has, postpartum psychosis, it is important to seek medical attention immediately.

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  • A publication of:
  • Women's College Hospital