Pregnancy is a complicated time for all women: It’s often equal parts challenging, exciting, and rewarding, with multiple highs and lows. For the 1 in 5 women who experience a mental illness, however, pregnancy comes with its own unique set of concerns. New moms living with anxiety, depression, bipolar disorder, or another mental health condition must carefully balance their own need to stay healthy with the well-being of their unborn child. Though women with mental health concerns can – and do – have enjoyable, healthy pregnancies, their journey to motherhood often requires careful preparation and specific support. Below, we’ll discuss what women experiencing mental illness should expect during pregnancy and how to navigate issues like pregnancy planning, medication use, and postpartum mental health.
How is Pregnancy Different for Women with Mental Health Issues?
Pregnancy brings about a host of physical and mental changes, including hormonal shifts, altered sleep patterns, and psychosocial considerations, such as what it means to become a parent. For women with a history of mental ill health, the biological and social upheaval associated with pregnancy can increase the likelihood of suffering a relapse. Making sudden changes in treatment after becoming pregnant, like abruptly discontinuing medication use, can further increase the risk of relapse. Medication cessation is associated with a 68% higher risk of depression relapse and an 85.5% higher risk of bipolar relapse, for example. Women who continue medication use, on the other hand, have a 26% chance of depression relapse and a 37% chance of bipolar relapse.
Women with a history of depression should also be aware that they have an increased risk of postpartum depression, even if they haven’t experienced a depressive episode recently. Women with depression (and those with a family history of mood disorders) may be uniquely sensitive to the abrupt drop in estrogen levels that occurs after child delivery. Other physiological processes, such as changes in the immune system after pregnancy, might also play a role in susceptibility to postpartum depression. (Research suggests that depression is linked to inflammatory immune-mediated processes in the brain.)
Should Women Continue Using Psychotropic Medication While Pregnant?
There is no “one size fits all” approach to pharmacologic treatment during pregnancy. Women must seek advice from their care team and carefully assess their individual risk factors before making any decisions about medication. Some women can safely discontinue their medication for the duration of their pregnancy, while for others, medication use remains necessary for the health of both mother and child.
Women should also be aware that stopping medication use isn’t the only way to reduce their risk of pregnancy complications. In many cases, switching medications, reducing the dosage taken, or limiting medication use during the first trimester is sufficient to protect developing infants. Certain antidepressants and bipolar medications, such as fluoxetine and lamotrigine, do not appear to be associated with an increased risk of natal complications, for example. Women are encouraged to carefully consider all of their treatment options and remember that using psychotropic medication during pregnancy is no different than continuing treatment for any other medical condition. Many women with heart disease, hypertension, and other chronic conditions cannot stop taking medication when they become pregnant, and that generally isn’t considered a barrier to motherhood – Mental illness should be viewed in a similar context.
Regardless of whether a woman decides to continue or discontinue medication use, managing mental health symptoms is key to having a healthy pregnancy. Depression itself is a risk factor for natal complications, including preterm delivery and the need for C-sections, so women should never ignore or minimize their mental health needs. Experts also believe that maternal depression increases the risk of a child developing certain disorders later in life, such as depression, psychosis, and attention-deficit hyperactivity disorder. Women should take these risks into account and avoid shaming themselves if medication use proves necessary for their health.
How Should Women Living With Mental Illness Prepare for Pregnancy?
Women with a history of mental health problems are strongly encouraged to attend preconception counselling. This type of counselling can help women plan out medication changes and determine if they’re mentally ready for parenthood. Women may wish to explore new treatment options and different therapeutic modalities, to determine whether there any medication alternatives that work for them. According to psychologist Dr. Joe Accardi, many pregnant women choose the most common therapeutic modality such as cognitive behavior therapy (CBT) just because it is widely available. However, emotion focused therapy (EMT) or psychodynamic therapy may work much better when preparing for childbirth.
A therapist can also answer questions about the advantages and disadvantages of having children biologically, adopting a child, or trying a third option, such as a surrogate. Many women living with mental illness are worried about the possibility of “passing on” their condition to their children, so it’s important to address these concerns before choosing to conceive.
Through counselling, women can identify what they need to stay healthy during and after pregnancy, too. No two mental illnesses are alike, and individual patients often have different triggers. For one woman, sleep deprivation during pregnancy may be of particular concern; for another, limitations on physical activity will be the most challenging aspect of carrying a child. A therapist will work with each woman to assess how sensitive she is to the various stressors of pregnancy, then formulate a wellness plan to manage each one. Therapy should continue postpartum as well, so patients can make adjustments to their plans in response to the demands of parenting a new baby.
Ultimately, it’s crucial to dismantle the stigma surrounding mental illness and pregnancy and ensure that all women have a safe space to talk about their reproductive goals. Mothers living with mental illness should have access to a reliable support network consisting of their OB/GYN, regular physician, mental health provider, and other women who share their experiences. Regardless of a woman’s mental health status, having social support in place before pregnancy significantly reduces the risk of postpartum depression and improves maternal and infant well-being. Because women experiencing mental illness have an increased awareness of the need for support during pregnancy, they’re often among the most well-prepared and attentive mothers – In this sense, living with a mental health condition can be a source of strength, knowledge, and empowerment for women hoping to conceive.