Picture this, during your first trimester, you are getting the progesterone equivalent of 400 birth control pills a day. This could cause anyone to feel unhinged. And by the time you give birth, you are ingesting the equivalent of 1,000 pills a day. Lauren Slater, author of the memoir Love Works Like This, writes about her bout with prenatal depression and seeing a specialist who informed her of the correlation between women who react badly to the birth control pill and women who become depressed during pregnancy. These hormonal changes which occur during pregnancy are a contributing factor to a woman’s depressive state.
In many countries, 1 in 5 new mothers experience perinatal mood and anxiety disorder, including prenatal and postpartum anxiety, depression and psychosis. Unfortunately, these illnesses go unnoticed and untreated, often with tragic and long-term consequences to both mother and child. Probably owing to the stigma associated with mental health issues, 7 in 10 women hide or downplay their symptoms. This could be the result of a widespread assumption that pregnant women should be happy, and if they are not, they are often reluctant to talk about their feelings, or even seek help.
Dr. Catherine Monk, professor of medical psychology at Columbia University in New York has for 20 years studied the correlation between pregnant women’s mental health and its effects on their offspring in utero. She has proved with her research that a woman’s mental state is an intrinsic part of her fetus’ environment. In a review that she coauthored in 2019, in the Annual Review of Clinical Psychology, they found that high maternal anxiety is associated with a twofold increase in the risk of probable mental and behavioral disorder in children.
Among the more startling effects of stress on pregnant mothers is the study presented in the Proceedings of the National Academy of Sciences (PNAS) journal, also coauthored by Dr. Monk; apparently, pregnant women experiencing physical and psychological stress are less likely to have a boy. The reason being that males are more vulnerable to adverse prenatal environments. Increasingly robust evidence also suggests long-lasting effects of prenatal stress, depression or anxiety on pregnancy outcome, including low birth weight and pre-term birth.
Maternal anxiety is also associated with placenta functioning. For more anxious women, the fetus is exposed to cortisol — a steroid hormone that helps the body to respond to stress or danger among other functions, via the placenta and amniotic fluid. There is a protective enzyme in the placenta whose role is to deactivate cortisol as it crosses the placenta. However, it’s functioning varies based on a woman’s anxiety levels. Maternal anxiety has been associated with ‘turning off’ of the gene that controls this protective enzyme so that more cortisol reaches the developing fetus, causing decreased nerve cell formation and differences in how neurons migrate and form connections, which increases the risk of anxiety to the fetus.
In mothers with prenatal depression, the reactive heart rate of fetuses was associated with less connectivity between two regions in the brain known as amygdala — a part of brain cells involved in regulating emotion, detecting and experiencing stress responses, and prefrontal cortex — which is involved in the control of behavior, speech, and reasoning, and can dampen the amygdala’s reactivity to stimuli, which could be an early sign of less cognitive control over emotion.
There is some conflicting research around this issue. Researchers from the University of California-Irvine studied how the mother’s psychological state affects a developing fetus. Interestingly, consistency of the child’s environment before and after birth showed favorable outcomes. So, babies who did best were those who either had mothers who were healthy both before and after birth or those whose mothers were depressed before birth and stayed depressed afterward. Apparently, the babies’ development was slowed down by changing conditions — a mother who went from healthy before birth to depressed after or one who went from depressed before birth to healthy after.
While it is not uncommon for women to experience mental health issues for the first time in pregnancy, those with severe mental ill health in the past are more susceptible during pregnancy or in the year after giving birth. However, some women with a history of severe mental illness will not experience it during pregnancy. Everyone is different. Increasingly, routine screening for depression and anxiety are becoming part of prenatal practice.
Whilst treatment varies from person to person and depends on the severity of the mother’s mental state, milder episodes respond well to a better diet, more exercise, and talking therapies. However, more severe attacks may require medication which is a risk-risk situation, as research still has not clarified whether antidepressants are harmful to the fetus or not. Either way, your healthcare provider should provide the best course of action, as the environment of the fetus in the womb of a depressive woman will also affect the baby’s development.