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Mental Health During Pregnancy

During pregnancy there is a tendency to focus on a person’s physical health rather than mental health. But in reality there is no separating the connection between the well-being of our bodies and our minds. During pregnancy, the physiological changes in a pregnant body can contribute to overall stress and directly impact your biochemistry – thereby having a large impact on your mental health. In fact, new research highlighting the importance of mental health during pregnancy indicates that about7% of pregnant persons experience clinical depression and nearly 20% of pregnant persons experience at least one of many anxiety disorders during pregnancy. Together these are often referred to as Perinatal Mood and Anxiety Disorders (PMAD).

How does biochemistry impact my pregnancy?

Any kind of stress stimulates the production of the hormone cortisol. Of course some intermittent levels of cortisol throughout your pregnancy as a natural response to stresses you may encounter are perfectly normal. However, sustained high levels of cortisol may suppress other hormones essential for pregnancy and infant development and constrict veins and blood vessels, restricting blood flow. These changes can impact mood and physiological functioning.

Research has indicated that persons with sustained high stress levels are at a 25%-60% higher risk for preterm delivery, preeclampsia, intrauterine growth restriction (chronic anxiety may cause changes in the blood flow to the baby, making it difficult to carry oxygen and other important nutrients to the baby’s developing organs – interfering with infant growth), decreased growth of the placenta, high risk of a low birth weight baby, and other impacts on infant brain development and neurobehavioral disorders. If left unaddressed, PMAD could extend into the postpartum period, impacting your health and your newborn’s health and long term development.

Am I at risk?

Although pregnancy is normally portrayed as a time of joy, for some it is marked with chronic anxiety, persistent sadness and loss of interest. These symptoms of PMAD can sometimes go unrecognized because there are so many other changes happening in your body. A health provider might attribute mental health symptoms to pregnancy instead of depression since changes in sleep, energy level, appetite, and libido are similar to common side-effects of early pregnancy. The following are some of the most common signs of depression and anxiety:

  • Depressed mood, often accompanied by severe anxiety

  • Markedly diminished interest or pleasure in activities

  • Appetite disturbance

  • Sleep disturbance

  • Physical agitation or psychomotor slowing

  • Fatigue, decreased energy

  • Feelings of worthlessness or inappropriate guilt

  • Decreased concentration or inability to make decisions

  • Recurrent thoughts of death or suicidal ideation

  • Symptoms present most of the day, nearly every day for at least 2 weeks

Something else that can help you reduce your risk for perinatal depression or anxiety is to address any of the following risk factors before you get pregnant or as early in your pregnancy as you can. According to the World Health Organization (WHO) the following factors may increase your risk of mental health challenges:

  • Anxiety

  • Life stress

  • History of depression

  • Poor social support

  • Unintended pregnancy

  • Intimate partner violence

  • Financial/housing/food insecurity

The American College of Obstetricians and Gynecologists recommends that health care providers screen for PMAD using a standardized tool at least once during pregnancy. However, you do not need to wait for a screening. If you think you might be struggling with your mental health during your pregnancy, talk to your emotional support team or your health care provider to determine the next steps. This early help can help avoid added strain as your pregnancy progresses, and once your baby arrives.

Enlist support for self-care

If you or someone you know is exhibiting signs of PMAD they will need extra support from those around them. A person struggling with their mental health may not eat in a healthy manner, bathe, or care for themself – exacerbating mental health challenges. The following are somethings you can do to optimize your perinatal mental health.

Mental Health Self Care Tips

  1. Connect with yourself and your baby. Find one moment each day to connect. This moment can be as simple and quick as rubbing your belly in the shower and saying “Hello Baby, I am excited to meet you.”

  2. Connect with people around you. Check in emotionally with someone you trust during your pregnancy at least once a week – this could be your partner, a friend, or a family member. Share your feelings and experiences with someone who won’t judge you, someone who is a good listener, someone who cares about you.

  3. Journal. Keep a journal by your bedside and write down whatever comes to your mind, without judgment, right before you go to bed and in the morning. Sometimes processing feelings and experiences on paper can be more effective than trying to process verbally.

  4. Rest. Make time to rest and relax. You are growing a human being. It’s ok to lower your productivity expectations, take a nap, and slow down.

  5. Eat well. Micronutrients, including iron, zinc, folate, vitamin B6, B12, calcium, selenium, choline, vitamin D, and omega-3 fats (DHA) affect maternal mental health and well-being. Eat a wide variety of real food that has been processed as little as possible. Listen to your body. You’ll feel good when you eat well, and you’ll feel rotten when you eat rotten. Listen to your body.

  6. Breathe. Intentional and mindful breath helps you relax, release tension, and improve your biochemistry. In addition to stimulating the parasympathetic nervous system and the right side of your brain, deep breathing helps to lower your heart rate. Deep belly breathing activates specific neurons that detect blood pressure. These neurons signal to the vagus nerve that blood pressure is becoming too high, and the vagus nerve in turn responds by lowering your heart rate. If you need some help slowing down and focusing on your breath, try some guided mindfulness.

  7. Move your body. People who move and remain active during pregnancy decrease their risk for perinatal mood disorders and other pregnancy diseases, such as gestational diabetes or preeclampsia. They also recover faster from childbirth. Movement also helps your baby. When you get your blood moving and increase your own circulation your movement brings new blood, nutrients, and oxygen to your baby – enhancing fetal development. Babies born to parents who moved regularly during pregnancy are born with more mature brains and show better oral skills and academic performance later in childhood. In addition to benefits to brain development, babies of active parents have a decreased risk of obesity, type 2 diabetes, and metabolic syndrome. Start out with 30 minutes of movement a day – and you’ll soon find that you’ll want more because it feels so good to move!

  8. Find support amongst your peers and professionals. Try talking to a therapist, hypnotherapist, or psychologist, or try acupuncture, massage, tapping/EFT, or energy work. You can also join a circle of other folks who are going through similar experiences through a local support group.

  9. Nourish your soul. Music, dance, laughter, nature, water…find ways to engage with your different senses and nourish yourself. What brings you peace? What brings you joy? What makes you smile and take a deep breath? Do more of that!

Nichols, L. (2018). Real food for pregnancy: The science and wisdom of optimal prenatal nutrition.

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