Mental health conditions including anxiety and depression are amongst essentially the most common disorders affecting women while pregnant and after birth.
Evidence shows mental health conditions in pregnancy increase the danger of complications for the mother and baby.
However, there’s some stigma around taking antidepressants while pregnant or breastfeeding. So how should women determine whether or to not take antidepressants during these periods?
Mental health in pregnancy and after birth
Untreated anxiety and depression in pregnancy have been linked to an increased risk of stillbirth, premature birth, low birth weight and low APGAR scores (a test done at birth to ascertain the child’s health in various domains).
In addition, anxiety or depression while pregnant may result in increased maternal weight gain, substance use or smoking. These lifestyle aspects can even result in complications for the child.
Anxiety and depression during and after pregnancy can affect bonding between mother and baby, and hinder the kid’s behavioural and emotional development.
Meanwhile, complications within the pregnancy may worsen mental health symptoms for the mother.
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Not coping while pregnant and particularly after giving birth is demoralising and puts women liable to self-harm. Suicide is a leading cause of maternal death in Australia within the yr after giving birth.
Treatment options
Depending on the severity of symptoms, treatment options for ladies during and after pregnancy range from social and emotional support (for instance, support groups) to psychological interventions (corresponding to cognitive behavioural therapy) to medical treatments (for instance, antidepressants).
Understandably, many ladies are reluctant to take medications while pregnant and while breastfeeding as a result of concerns the drugs may cross over to the child and cause complications. Historical instances corresponding to using thalidomide for morning sickness, which resulted in severe structural abnormalities in hundreds of youngsters, naturally make pregnant women frightened.
Robust evidence about medication use in pregnancy is lacking. This could also be as a result of ethical limitations around trialling medications in pregnant women. The limited data available, mainly from observational studies on selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), the mostly prescribed antidepressants while pregnant, has mixed results.
While some studies have reported no noticeable increase in the danger of congenital malformationsevidence has shown a marginal rise in abnormalities corresponding to heart defects (an additional two cases per 1,000 babies with SSRIs).
Collaborative decisions
There is a fragile balance to strike between treating the mother and stopping harm to the child. To make well-informed decisions, an open discussion between the patient and specialised mental health care providers on the advantages and risks of starting or continuing antidepressants is crucial.
Given the mother’s poor mental health increases the danger of opposed outcomes for the child, it could be that taking antidepressants is the perfect technique to protect the child.
For women already taking antidepressants, it’s not normally mandatory to stop using them while pregnant. Sudden cessation of antidepressants increases the danger of relapse.
Continuing breastfeeding on antidepressants is probably going the perfect decision due to the low levels of medicine infants are exposed to in breast milk, the benefits of breastfeeding for the child, and the risks of not taking antidepressants when indicated.
Recently revised guidelines on mental health care within the perinatal period (while pregnant and after birth) warn health professionals against the risks of failing to prescribe mandatory medication:
Be aware that failure to make use of medication where indicated for depression and/or anxiety in pregnancy or postnatally may affect mother-infant interaction, parenting, mental health and wellbeing and infant outcomes.
These guidelines also recommend repeated screening for symptoms of depression and anxiety for all women through the perinatal period. This is crucial to providing women with an early referral to perinatal mental health services if needed.
At present, mental health conditions while pregnant and after birth often go undetected and untreated.
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Supporting perinatal mental health
Mental illness in pregnancy is a big public health problem. Screening is just not at all times delivered effectively, and currently, there’s no national data regarding perinatal mental health screening service use or outcomes.
Mine and my colleagues’ research on pregnant women’s engagement with perinatal mental health services indicated only one-third of eligible women accepted a referral, and lower than half attended their appointment. Women could also be reluctant to interact as a result of stigma, time restraints, and lack of childcare or social support.
To address this, we must always create strategies and resources in collaboration with pregnant women to discover solutions that work best for them. This might include assistance with childcare, access to telehealth, visits from a perinatal mental health skilled, or written information on medications.
Care have to be holistic and include partners who could also be best placed to support pregnant women in making complex decisions. Health-care providers should be respectful of individual needs and supply compassionate care to interact vulnerable moms who may understandably feel uncertain regarding their options.