Depression and Anxiety
Depression and mood fluctuations, relatively common among people who have experienced interpersonal trauma can certainly become more pronounced during pregnancy. It may be surprising to learn that 85% of women, regardless of their histories, experience emotional distress during or after pregnancy. About 10%-20% of women have pre-partum depression; generally the greatest risk factor for symptoms while pregnant is a prior history of depression. Other factors, such as lack of social support and life stressors are also risk factors.
About 15-20% of women experience a “PMAD” – or Perinatal Mood or Anxiety Disorder which may begin shortly after giving birth. Many women are reluctant to seek treatment, fearing they may seem less than capable or are not willing to explore medication due to the lack of definitive data on short or long term effects on the fetus and on breastfeeding a newborm, but depression and anxiety during and after pregnancy require treatment. It not only causes mothers to suffer, but can negatively affect relationships with partners and other family members, and the outcomes of pregnancy. Recent research has shown that pre-partum depression can cause expectant mothers to neglect themselves and their fetuses by avoiding prenatal care, or not getting proper nutrition, exercise and rest. Pre-partum depression is also associated with low birth weight.
A considerable amount of research has been conducted to determine whether taking antidepressants during pregnancy is safe for mother and fetus, but the general consensus is that it is better to take medication if the depression is severe. A combination of medication and psychotherapy, as in cases of depression generally, is recommended. See the links below to find out more about depression during pregnancy and taking antidepressants, as some are safer than others, and it is of course imperative to discuss this with your obstetrician.
Another long term effect of trauma which can affect pregnancy is stress. Women with abuse or neglect histories, who are experiencing a current domestic crisis or violence, who find being pregnant and frequent medical intervention retraumatizing, or, who have low social support and feel isolated may have generally high baseline stress levels.
High stress and symptoms of complex trauma may co-occur along with depressed mood, and both can produce high levels of stress hormones, particularly cortisol. Stress hormones during pregnancy can be beneficial for fetal development at normal levels. However they can affect pregnancy health and birth outcomes when persistently above normal levels, or, when a pregnant woman’s response to stressors is accompanied by a spike in cortisol, which can happen in women with PTSD. As psychologist Paula Thomson states, maternal stress during pregnancy can be seen in the fetus as increased heart rate, greater activity, and disrupted sleep-wake cycles. Moreover, it is associated with preterm birth and low birth weight. This brief article by Drs. Christine Dunkel Schetter and Lynlee Tanner explains how this works: Click Here for link.