Depression and mental health in pregnancy

When can mental health concerns arise?

A large UK study on depression in pregnancy found the peak time for experiencing was at 32 weeks, when 13.5 per cent of women scored highly on tests for depression. Smaller studies echo this finding.

It's also clear many women experience stress, anxiety and other forms of emotional distress and mental illness at this and at other times during pregnancy.

Some women are depressed or anxious already, and this may continue or become more intense when they are pregnant.

Mental health concerns in pregnancy

Researchers have found if a woman is very anxious during pregnancy, it increases the risk of her baby developing behavioural problems later in life. Heightened maternal anxiety can also affect the stress response of the baby because stress hormones cross the placenta.

Depression during and after pregnancy may increase the risk of the mother having problems bonding with her baby. This doesn't mean if you're experiencing such problems your baby's bound to be affected. The differences are in risk levels - they don't predict anything.

But the possible effect on your baby is one of the reasons your mental health during pregnancy should be taken seriously and treatment offered where necessary. You may need extra care and support after the birth, too.

Feelings towards your baby

Pregnancy can be daunting, whether or not you it was planned, and some women have negative thoughts about being a mother.

Having a baby is a massive change in your life and feeling love for someone you've never met is a challenge. But persistently dark thoughts or fears maybe a symptom of depression or anxiety and it will help you if you share them with a midwife or doctor you feel comfortable with.

Diagnosing mental health problems in pregnancy

Your midwife or GP should ask questions about how you're feeling mentally at each antenatal visit, in line with NICE guidelines.

If your midwife or doctor is following this guidance they should ask two questions, using words similar to these:

• During the past month, have you often been bothered by feeling down, depressed or hopeless?
• During the past month, have you often been bothered by having little interest or pleasure in doing things?

If you answer 'yes' to either of these questions, you'll be asked if you want to seek help.

You may find you're also asked to complete a questionnaire that aims to assess whether or not you might be depressed.

Treating mental health problems in pregnancy

Antidepressant medication is sometimes offered to mothers in pregnancy, but not everyone agrees it’s safe or suitable. The research into the effects of medication on the health of the baby, or the effects on labour and birth, just aren’t conclusive.

You and your doctor will need to weigh the risks and benefits carefully, bearing in mind your individual needs and background.

NICE recommends women who are mildly or moderately depressed in pregnancy should be offered self-help or talking therapies, including counselling. If the depression becomes worse or doesn't respond to such treatments, antidepressants might be the next option to consider. If you and your doctor decide you need medication, some drugs appear to be safer in pregnancy than others.Serious mental illness may benefit from further intervention, including a hospital stay.