One in five new and expecting mothers will experience a Perinatal Mood and Anxiety Disorder (PMAD). This Q&A will review the signs, symptoms, and how to get help.
1. What are PMADS and how common are they?
Becoming a new parent is stressful, and some difficulty adjusting to parenthood is considered normal. Normal postpartum adjustment may involve symptoms similar to “Baby Blues” (feeling sad, irritable, and exhausted), and it’s likely that most new mothers experience some of these symptoms during the first few months after childbirth. However, if these symptoms are interfering with mom’s normal coping abilities, functioning, or parenting, something more serious like a Perinatal Mood and Anxiety Disorder (PMAD) may be happening.
PMADs are a group of symptoms that can affect women during pregnancy and the postpartum period, causing emotional and physical problems that make it hard to enjoy life and function well.
PMADs are a group of symptoms that can affect women during pregnancy and the postpartum period, causing emotional and physical problems that make it hard to enjoy life and function well. Mood disorders, such as depression or bipolar disorder, can include symptoms of sadness, loss of pleasure, irritability, difficulty concentrating, and changes in energy. Anxiety disorders often include symptoms such as worrying too much, panic attacks, irritability, and obsessionality.
Research suggests that one in five new and expecting mothers will experience a PMAD with either mild, moderate, or severe symptoms. Those of us who treat women suffering from a PMAD think that it’s more like one in three due to the stigma and shame that continues to surround mental illness — let alone maternal mental illness.
2. Can someone who has never had mental health issues develop anxiety or depression during pregnancy?
Women that have experienced anxiety and depression prior to becoming pregnant are at a great risk of experiencing a PMAD during pregnancy or postpartum, but those who have no mental health history can also develop symptoms. Often times women have been symptomatic in the past yet never received treatment for their anxiety and/or depression — so when these symptoms evolve again in the perinatal period, it can be the first time she receives an actual diagnosis.
3. How can anxiety and depression affect a pregnancy?
Untreated depression during pregnancy can be risky for both mother and child. Depressed women often take poor care of themselves. They may smoke, drink excessively, or neglect proper diet. And some research suggests that depression in pregnant women can have direct effects on the fetus. Their babies are often irritable and lethargic, with irregular sleep habits. These newborns may grow into infants who are underweight, slow learners, and emotionally unresponsive, with behavior problems such as aggression. Untreated anxiety during pregnancy has been associated with an increased risk of developing preeclampsia, premature birth, and low birth weight. It has been demonstrated that low birth weight in premature infants has been associated with changes in brain morphology.
4. How can someone manage mental health while pregnant?
PMADs are the number one complication affiliated with birth — higher than gestational diabetes and preeclampsia.
Education is key! Know the signs and symptoms affiliated with PMADs — and have your partner and family and friends know what to look for as well. PMADs are the number one complication affiliated with birth — higher than gestational diabetes and preeclampsia. If we all know what PMADs look like, then we can introduce early intervention and support to help new or expecting mom feel better. There are a number of different interventions that can help — support groups, individual therapy, medication, or a combination of these, and in more acute situations, a woman may need to participate in a Partial Hospitalization Program, or be hospitalized. The more we know what PMADs look like — and we share our collective experiences with PMADs — the more we de-stigmatize them and make it easier for women to seek treatment.
5. What do you tell parents who have suffered a miscarriage?
Up to 15 percent of known pregnancies end in miscarriage; pregnancy loss, sadly, is common. Yet the perception is that it’s rare, and we don’t talk enough about just how common it is. This leads women and couples to feel alone and isolated, often times struggling with immense feelings of guilt, shame, and sorrow. With the secrecy and stigma that surround pregnancy loss, many women go on to develop a mental health diagnosis like depression, anxiety, and PTSD. Scientific research, at least, has begun to reveal the extent to which women struggle after such a loss. Estimates suggest that up to 20 percent of women who have a miscarriage develop symptoms of depression and/or anxiety, and these feelings that don’t necessarily just disappear with time or even a subsequent pregnancy. Oftentimes women will experience depression and/or anxiety through a subsequent pregnancy and postpartum period if untreated, and some women may experience a recurrence of symptoms postpartum as they are reminded of their previous loss.
6. Women who experience infertility are at a higher risk to develop a PMAD during pregnancy, and especially, postpartum. Why is this?
Women who experience infertility may have been through a whole host of invasive procedures. They may feel shame or guilt around the fact that it’s difficult to become pregnant without intervention, or they may feel as though their body has failed them somehow by not being able to get pregnant naturally. Due to these thoughts and feelings, they are predisposed to developing depression and/or anxiety leading up to the pregnancy itself. If untreated, this can continue on into pregnancy and intensify, especially if the woman has experienced a pregnancy loss prior. She may be extremely anxious through the pregnancy that something may happen again to the fetus, and in some instances, she may attempt to separate herself from the pregnancy as to not develop strong feelings for the developing baby — attempting to protect herself.
In the postpartum period, women can be at a higher risk for all of these same reasons — and the impact can feel even more intense for a new mom as many around her may be saying things like “Aren’t you so happy considering everything you went through for this baby” or “You must be so in love and thankful for the baby — aren’t you over the moon?” Well, what if mom isn’t over the moon, what if she is experiencing a PMAD, and on top of it, she feels even worse because she “should” be loving every minute of it because she worked so hard to get here?
If you or someone you know is suffering from a PMAD and you live in the New York Tri-State area, please call The Motherhood Center today at 212–335–0034 or visit us at www.themotherhoodcenter.com.
For all areas outside of the New York Tri State area, please call Postpartum Support International at 800–944–4773 or visit them at www.postpartum.net.
Paige S. Bellenbaum, LMSW is chief external relations director and the Founding Director of The Motherhood Center of New York. For the past 20 years, Paige has been committed to the field of social work practice, focusing her efforts on direct service to have a micro impact, and public policy to have a macro impact.
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