Antenatal depression

Antenatal depression is classified based on a woman's symptoms. During pregnancy, a lot of changes to mood, memory, eating habits, and sleep are 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.[4]

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.[5] 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.[6] 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.[7]

The prevalence of antenatal depression differs slightly by region of world. In the United States, antenatal depression is experienced in as many as 16% of pregnant women, while in South Asia it is experienced in as many as 24% of pregnant women.[10][11][12] 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.[13] Additional risk factors include lack of social support, marital dissatisfaction, discriminatory work environments, history of domestic abuse, and unplanned or unwanted pregnancy.[14]

Perinatal mental health screenings are important in detecting and diagnosing antenatal and postpartum depression early. The American College of Obstetricians and Gynecologists is one of the many maternal health organizations that strongly encourage universal screening for expectant and postpartum women for depression as part of routine obstetric care.[15] In fact, many states, including California have already legislated laws that require providers to screen patients during visits because they recognize that early screenings can expedite the process in receiving effective treatment. The Patient Health Questionnaire 9 (PHQ-9) is a screening tool typically used to detect depression.[16]

PHQ-9 is a reliable depression severity scale that was formulated in accordance with DSM-IV criteria for depression, consisting of 9 items correlating to the 9 criteria listed in DSM-IV.[17] It is a shortened version of the PHQ and has been assessed for comparable sensitivity and specificity.[17] The screening test is self-administered to patients and are usually performed at the primary care clinic.[17]

However, it is not enough to just provide mental health screenings to at risk patients. Interventions such as referrals to treatment and mental health monitoring should be implemented in health care systems in order to ensure these women are helped consistently throughout their recovery journey.[15]

Treatment for antenatal depression poses many challenges because the baby is also affected by any treatment given to the mother.[18] There are both non-pharmacological and pharmacological treatment options which can be considered by women with antenatal depression.

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.[23] 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.[24] 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.[25] Related, maternal depression affects parenting behaviors,[26] 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.

Depression during pregnancy is associated with an increased risk of spontaneous abortion. In a review by Frazier et al., acute and chronic stress during pregnancy can diminish proper immunological activity crucial during pregnancy, and can possibly induce spontaneous abortion.[27] There is still a debate on whether the miscarriage is due to the depressive disease state or the anti-depressant medication. A large study conducted in Denmark observed that there was a higher incidence of first trimester miscarriage in depressed women not exposed to SSRI compared to non-depressed women exposed to SSRI,[28] indicating that the miscarriage may be associated with the psychological state of the mother rather than the anti-depressant.

Depressive symptoms in pregnant women are linked with poor health outcomes in infants.[29] 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.[30] In fact, positive antenatal screenings administered in the first or third trimester are found to be high risk factors for early cessation in breastfeeding.[31] Studies also report that the environmental effects of maternal depression affect 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.,[29] maternal prenatal depressive symptoms predicted significantly higher number of infant health concerns at 12-weeks (3 months) of age. The health concerns included rash, colic, cold, fever, cough, diarrhea, ear infections, and vomiting.[29]

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.[32] 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.[32]

Fathers can also experience depression during their partner's pregnancy, commonly displayed as fatigue or changes in sleep and eating patterns.[33] Men whose partners are women struggling with antenatal or postnatal depression often find themselves receiving less affection and intimacy from their partners.[34] If symptoms of antenatal depression arise, it is recommended for fathers to provide encouragement for their partners to discuss their condition with a healthcare provider.[34] It is also important for the father to also seek support for himself. In a research performed in Sweden observing 366,499 births, newly diagnosed paternal depression around the time of conception or during pregnancy was associated with an increased risk of preterm birth. However, a preexisting paternal depression did not show any correlation, which may be due to the mother's perception of the changes in her partner's mood.[35]

• Depression
• Mood swings
• Postpartum depression
• Pregnancy
• Postpartum psychosis

• Andrade C (2018). "Prenatal Depression and Infant Health: The Importance of Inadequately Measured, Unmeasured, and Unknown Confounds". Indian Journal of Psychological Medicine. 40 (4): 395–397. doi:10.4103/IJPSYM.IJPSYM_232_18. PMC 6065138. PMID 30093759.