Antenatal depression, also known as Prenatal depression, is a form of clinical depression that can affect a woman during pregnancy, and can be a precursor to postpartum depression if not properly treated. It is estimated that 7% to 20% percent of pregnant women are affected by this condition. Any form of prenatal stress felt by the mother can have negative effects on various aspects of fetal development, which can cause harm to the mother and child. Even after birth, a child born from a depressed/ stressed mother feels the affects. The child is less active and can also suffer from emotional distress. Antenatal depression can be caused by the stress and worry that pregnancy can bring, only at a more severe level. Other triggers include unplanned pregnancy, difficulty becoming pregnant, history of abuse, and economic or family situations.
Commonly, symptoms involve how the patient views herself, how she feels about going through such a life changing event, the restrictions on the mother's lifestyle that motherhood will place, or how the partner or family feel about the baby. Pregnancy places significant strain on a woman's body, so stress, mood swings, sadness, irritability, pain, and memory changes are to be expected. Antenatal depression can be extremely dangerous for the health of the mother, and the baby, if not properly treated. If you feel you might be suffering from antenatal depression, it is highly recommended to speak with your health care provider about it. Together you can discuss ways to help treat and cope with this mental illness.
Signs & symptoms
Antenatal depression is classified based on a woman's symptoms. During pregnancy, a lot of changes to mood, memory, eating habits, and sleep is common. When these common traits become severe, and begin to alter one's day-to-day life, that is when it is considered to be antenatal depression. Symptoms of Antenatal depression are:
- Inability to concentrate.
- Difficulty remembering.
- Feeling emotionally numb.
- Extreme irritability.
- Sleeping too much or not enough, or restless sleep.
- Extreme or unending fatigue.
- Desire to over eat, or not eat at all.
- Weight loss/gain unrelated to pregnancy.
- Loss of interest in sex.
- A sense of dread about everything, including the pregnancy.
- Feelings of failure, or guilt.
- Persistent sadness.
- Thoughts of suicide, or death.
Other symptoms can include the inability to get excited about the pregnancy, and/or baby, a feeling of disconnection with the baby, and an inability to form/feel a bond with the developing baby. This can drastically affect the relationship between the mother and the baby, and can drastically affect the mother's capacity for self care. Such inadequacies can lead to even greater risk factors for the mother. Antenatal depression can be triggered by various causes, including relationship problems, family or personal history of depression, infertility, previous pregnancy loss, complications in pregnancy, and a history of abuse or trauma.
Onset & duration of symptoms
Antenatal depression can be caused by many factors. Often it is associated with the fear and stress of the pregnancy. Other factors include unintended pregnancy, financial issues, living arrangements and relationships with the father & family. Typically, depression symptoms associated with pregnancy are categorized as postnatal depression, due to the onset of symptoms occurring after childbirth has occurred. The following is a breakdown of when a group of various women began to feel the onset of symptoms associated with depression:
- 11.8 percent at 18 weeks
- 13.5 percent at 32 weeks
- 9.1 percent 8 weeks after the birth
- 8.1 percent 8 months after the birth
In a recent article posted by The BabyCenter, the authors stated that "For years, experts mistakenly believed that pregnancy hormones protected against depression, leaving women more vulnerable to the illness only after the baby was born and their hormone levels plunged." This is a possible explanation as to why antenatal depression has just recently been identified.
Antenatal depression affects about one in every eight women. It's becoming more prevalent as more medical studies are being done. Antenatal depression was once thought to simply be the normal stress associated with any pregnancy, and was waved off as a common ailment. It can be caused by many factors, usually though involving aspects of the mothers personal life such as, family, economic standing, relationship status, etc. It can also be caused by hormonal and physical changes that are associated with pregnancy.
Treatment for Antenatal depression poses many challenges because the baby is also affected by any treatments given to the mother. It is suggested that the emotional aspects are handled first which includes:
- Taking it easy by relaxing when possible.
- Spending time with your partner.
- Talk about your fears & anxieties involving the pregnancy.
- Manage your stress.
Counseling is highly recommended to any woman suffering from antenatal depression. It is a very effective way for the mother to express her feelings and explain in her own words what she is feeling. This is very effective in that it gives the doctors a better insight into the symptoms and their severity. In severe cases Medication can be prescribed. This is usually only done if the symptoms have proven so severe that they interfere with day-to-day life, self care, and ability to sleep. During pregnancy, there are two main kinds of antidepressants used during pregnancy; Tricyclic antidepressants (TCAs)and Selective serotonin reuptake inhibitors (SSRIs).Once prescribed, anti-depressant medication has been found to be extremely effective in treating antenatal depression. Patients can expect to feel an improvement in mood in roughly 2 to 3 weeks on average, and can begin to feel themselves truly connect with their baby. Reported benefits of medication include returned appetite, feeling of connect, increased mood, increased energy, and better concentration. Side effects are minor, though they are reported in some cases. Currently, no abnormalities of the baby have been associated with the use of antidepressants during pregnancy.
It may be true that maternal SSRI use during pregnancy can lead to difficulty for their newborn adjusting to conditions outside of the womb immediately following birth. Some studies indicate that infants with exposure to SSRIs in the second and third trimester were more likely to be admitted to intensive care following their birth for respiratory, cardiac, low weight and other reasons, and that infants with prenatal SSRI exposure exhibited less motor control upon delivery than infants who were not exposed to SSRIs. Newborns who were exposed to SSRIs for five months or more prior to birth were at a greater risk for lower Apgar scores 1 and 5 minutes after delivery, indicating they were of lesser health than newborns who were not exposed to SSRIs before birth. However, prenatal SSRI exposure was not found to have a significant impact the long-term mental and physical health of the children. These results are not independent of any effects of prenatal depression on infants.
Connection to postpartum depression and parenting stress
Studies have found a strong link between antenatal depression and postpartum depression in women. In other words, women who are suffering from antenatal depression are very likely to also suffer from postpartum depression. The cause of this is based on the continuation of the antenatal depression into postpartum. In a logistical light, it makes sense that women who are depressed during their pregnancy will also be depressed following the birth of their child. This being said there are some factors that determine exclusively the presence of postpartum depression that are not necessarily linked with antenatal depression. These examples include variables like socioeconomic class, if a pregnancy was planned or not, and the parents' relationship prior to conception and delivery of the child.
In reference to a recent study by Coburn et al., the authors found that in addition to prenatal effects, higher maternal depressive symptoms during the postpartum period (12 weeks) were associated with more infant health concerns. This is consistent with other findings among low-SES Mexican-American women and their infants. Women with prenatal depressive symptoms are more likely to develop postpartum depression, which can also have negative consequences on children, such as emotional and behavior problems, attachment difficulties, cognitive deficits, physical growth and development, and feeding habits and attitudes. Related, maternal depression affects parenting behaviors, which in turn could affect child outcomes. Thus, women’s mental health throughout the perinatal period should be a priority, not only to support women, but also to promote optimal functioning for their infants.
Prenatal Depression and Infant Health
Depressive symptoms in pregnant women are linked with poor health outcomes in infants. The rates of hospitalization are found increased for infants who are born to women with high depression levels during pregnancy. Reduced breastfeeding, poor physical growth, lower birth weight, early gestational age and high rates of diarrheal infection are some of the reported outcomes of poor health among infants born to depressed pregnant women. Studies also report that the environmental effects of maternal depression effect the developing fetus to such an extent that the impact can be seen during adulthood of the offspring. The effects are worse for women from low socio-economic backgrounds. In a recent study by Coburn et al, maternal prenatal depressive symptoms predicted significantly higher number of infant health concerns at 12-weeks (3 months) of age. The health outcomes included rash, colic, cold, fever, cough, diarrhea, ear infections, vomiting.
An interesting and informative area of research has been done to see the role of confounding variables in relationship of maternal prenatal depression with infant health concerns. Age of mother, romantic partner, education, household income, immigrant status, and number of other children, breastfeeding, gestational age, birth weight are some of the mediating or moderating factors which are found correlated with infant health concerns. The studies of post-partum depressive symptoms are relatively more than those of prenatal depression and the studies should look into the role of various factors during pregnancy that may impact the health of infants, even continuing into adulthood.
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