• Untreated prenatal stress is highly correlated with low birth weight and/or premature delivery
• Prenatal stress is highly treatable
• Negative responses to stress include increased use of alcohol, smoking and drugs. Check all of which have a negative impact on fetal development, delivery and parenting ^1,2,3.
• Prenatal depression is one of the best predictors of postpartum depression.

Psychological Issues During Pregnancy

Depression

Prevalence: ^5,6,7

• 7.4% first trimester
• 12.8% second semester
• 12.0% third semester

Symptoms:

• Depressed mood, tearfulness, despondency
• Lack of pleasure/interest
• Sleep disturbance (insomnia or hypersomnia)*
• Weight loss, loss of appetite*
• Loss of energy*
• Psychomotor agitation or retardation*
• Mood instability/irritability; inability to cope
• Increased feelings of vulnerability
• Lack of confidence/overwhelmed
• Anxiety/nervousness
• Poor concentration/indecisiveness memory problems*
• Frequent thoughts of death/suicide

* Symptoms that are frequently considered normal sequelae of pregnancy

Stress:

• One of the most significant predictors of low-birth weight and premature delivery
• Also associated with increased incidence of complications and malformations
• Multiple stressors
• Changes in body, relationships, career, financial status and responsibilities
• Unplanned pregnancies
• The level of commitment in the couple
• Age of the woman
• Ambivalence about the pregnancy
• Issues of control
• Socioeconomic factors, financial stress, unemployment
• Issues of when to tell people at work/family
• Concerns about other children
• Lack of emotional support
• Previous history of depression
• Physical stressors such as morning sickness, back pain, urinary tract infections, chronic illnesses
• Life events, bereavement, miscarriage, relocation

Psychological Issues - Postpartum

• Postpartum Blues
• Postpartum Depression
• Postpartum Psychosis Why it’s important to diagnose and treat: 

These conditions have detrimental effects on the newborn in terms of cognitive, emotional, social and behavioral development v both long and short term (including language skills and IQ)

• The baby's cognitive development is often impaired if the mother has difficulty staying actively engaged.
• Maternal suicide is higher in this group.
• Father’s have an increased incidence of depression if the mother becomes depressed.
• There is an increased likelihood of using alcohol, tobacco or illicit drugs as part of negative coping styles.
• Having a depressed parent can have a negative impact for children in the family.
• The child is at increased risk for depression later in life.
• The child is more likely to have difficulty forming relationships.
• The child is more likely to lack a sense of mastery.
• The child often exhibits difficulties managing emotions (anger, frustration, etc.).
• Chronic depression has the greatest negative impact.

Only 20 percent of women suffering from postpartum depression receive treatment. The rest are either undiagnosed, misdiagnosed or do not seek medical assistance. ⁴

footnotes

1. Wadhwa, Culhane, Rauh, Barve, Hogan, Sandman, Hobel, Chicz-De Met, Dunkel Schetter, Garite,Glynn Pediatr. Perinat Epidemiol 2001.
2. Dole, Herz-Picciotto, Siega-Riz, McMahon, and Buekens American Journal of Epidemiology. 2003.
3. Rondo, Ferreira, Nogueira, Ribeiro, Lobert and Artes European Journal of Clinical Nutrition 2003.
4. Walther, V.N., Depression: A review for perinatal social workers. 1997; 24 (3-4) 99-111.
5. Bennett, H.A., Einarson A., Taddio, A., Koren, G., Einarson, T.R., Prevalence of Depression During Pregnancy: Systematic Review; Obstetric Gynecology 2004; April 103 (4): 698-709.
6. Evans, J., Heron J., Francomb, H., Oke, S., et. al. British Medical Journal 2004; 323: 257-260.
7. Hediger, M.L., Fischer, R.L., Journal of Clinical Epidemiology, 1992: 1093-1099.