Motivation and emotion/Book/2016/Prenatal depression

Prenatal depression:
What is it, what are the risk factors and how is it managed?

Multimedia presentation (3 min)

Overview

Depression is an illness that does not target one specific section of a person but targets the individual entirely, their body, mind and thoughts. Depression is a mental illness that with correct medical treatment is able to be minimised and treated (Gong, Ni, Shen, Wu, & Jiang, 2015).

Prenatal Depression, also known as antenatal depression is an episode of clinical depression that affects mothers-to-be during pregnancy. Prenatal depression is also known to have ties to being a precursor to postpartum depression if correct medical treatment is not sought after (Gong, Ni, Shen, Wu, & Jiang, 2015).

Depression in the general public is seen as a major health problem, in women particularly, as it is twice as common for them to be diagnosed with it during childbearing years in comparison to men (Stewart et al., 2003). Depression that is prevalent during childbearing years can affect between 10 and 49% of women, depending on which study if used, although all studies agree that it is a significant percentage that are at risk. Prenatal depression (PD) is more likely to cause women who have it to deliver premature babies and babies of lower birth weight than those who do not suffer the condition (Field et al., 2012, Fellenzer & Cibula, 2014, Field, Diego, & Hernandez-Reif, 2010).

Though it is clear that prenatal depression is a prevalent and major concern for health professionals, only around 18% of women who meet the criteria to be diagnosed seek treatment during their pregnancies and through to their postpartum depression if it carries. It is regarded as being modifiable and helping both mother and fetus if identified early on in the pregnancy and help is sort out by the correct bodies (Fellenzer & Cibula, 2014).

Definitions

• Emotion: any relatively brief conscious experience characterized by intense mental activity and a high degree of pleasure or displeasure (Cabanac, 2002)
• Perinatal: Relating to time, generally a number of weeks before or after birth is given
• Prenatal: Before birth, during, or related to pregnancy
• Depression: The feelings of severe despondency and dejection, a consistent and persistent feeling of sadness and loss of interest

Psychological Theories

The psychosocial theory approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their mental and physical health along with their ability to correctly function in society. This approach is used in a broad range of health professions including medical and social science setting for researchers and health and social care settings (Woodward, 2015) the use if a psychosocial intervention is to reduce the complaints and improve the functioning of people relating to mental disorders and/or their social problems. These could be problems with their school, personal relationships or work. This is done by addressing the different psychological and social factors influencing that individual (Cummings & Kropf, 2013).

A branch into the psychosocial approach is Cognitive Behaviour Therapy (CBT) and Interpersonal Psychotherapy (IPT). Both of these approaches has been seen to have positive effects for women who are diagnosed with prenatal depression, or who have a prior diagnosis prior to conceiving. For areas outside of urban environments where it may be impractical or hard to locate a behavioural therapist or if there are monetary limitations, web and computer-based cognitive behavioural therapy options have become available (Yonkers et al., 2009).

The cognitive behaviour therapy model is based on the principles from the behavioural and cognitive sides of psychology. CBT is approach based, it is "problem focused" and "action-oriented". It is used to treat specific problems relating to a diagnosis of a mental disorder with the therapist’s role assisting in finding and practicing effective strategies to help manage and address the identified goals of the client with decreasing the symptoms of the diagnosis (Schacter, Gilbert, & Wegner, 2010).

Risk Factors of Prenatal Depression

Prenatal depression risk factors have both the common or well-known factors that are considered to be of high risk with any pregnancy as well as those less known about or individual to certain situations or races. A personal or familial history of depression increases chances of developing PD and is seen as a consistent risk factor for all women. Prenatal anxiety is a part of this consistent risk factor list with both conditions being of concern to the health professionals charged with helping women safely navigate their way through pregnancy (Milgrom et al., 2008, Lara, Navarrete, & Nieto, 2016).

Developmental Risks

Depression developed during pregnancy is a leading form of obstetric morbidity. The risks associated with this is elevated poor pregnancy outcomes, such as; slower foetal growth rates, lower birth weights and premature delivery (Fellenzer & Cibula, 2014). Those children born from mothers who suffered PD continue to feel the effects even after they have been delivered and no longer rely on their mothers for everything. The extended risks for infants included increased risk in development delays, an elevated resting heart rate and a higher likelihood to developing behavioral issues compared to those born to non-depressed mothers (Gong, Ni, Shen, Wu, & Jiang, 2015). Of those mothers with PD, 13% had a greater incidence of premature delivery and 15% of those had a baby that was considered to of low birth weight (Fellenzer & Cibula, 2014). The low level birth weights of infants within the US is one of the leading cause of child mortality (Orr & Miller, 1995). 

Those that face an unintended and/or mistimed pregnancies are more likely to develop or display symptoms of PD than those whose pregnancies were expected and well-timed (Fellenzer & Cibula, 2014). Sociodemographic factors play a part in determining risk factors with women who have low educational attainment, young mothers compared to older mothers and those of minority ethnicity having a higher percentage displaying symptoms (Fellenzer & Cibula, 2014). 

Chemistry Levels

Cortisol levels within the human body stay relatively stable when the human body is not stressed. When it is stressed cortisol levels are raised and shuts down immediately unnecessary functions, such as your immune system. Prenatal depression has been seen to increase the levels of cortisol and cause other changes to the chemistry of the maternal and infant bodies (Fellenzer & Cibula, 2014). Those who have shown higher levels of cortisol levels have also shown to have decreased levels of dopamine and serotonin. The lower levels of each can contribute to depression and may result in contributing to further complications such as low birth weight for newborns and a premature delivery. Infants born to mothers who have low levels of each or both have, as they have aged, mimicked those lower levels and higher levels of cortisol leading towards a never ending cycle of potentially preventable risk factors for each new baby born (Field, Diego, & Hernandez-Reif, 2010). 

Mothers-to-be, that are classed as PD show particular signs of the chronically depressed, these include having a greater relative right frontal EEG (electroencephalogram) activation and lower vagal activity (Field, Diego, & Hernandez-Reif, 2010). It is one of the major precursors to postnatal depression and is a mediator between risk factors and developing postnatal depression. This compounds the potential future risks for both mother and child (Gong, Ni, Shen, Wu, & Jiang, 2015, Fellenzer & Cibula, 2014). In some cases, uterine artery resistance is can be a by-product of the PD which limits the uterine blood flow, this then limits the supply of oxygen and nutrients to the foetus while still in utero which can result in growth deprivation and a shorter gestation period (Field, Diego, & Hernandez-Reif, 2010).  

Everyday behaviours from women may have an impact on their chances of developing prenatal depression, some of these behaviours may be second nature or may be due to their socioeconomic status. The use of tobacco, alcohol and illicit or prescription medication drugs mixed incorrectly has a negative impact on the mothers-to-be and are associated with the development of PD (Fellenzer & Cibula, 2014). Inadequate medical and health care for both the mother and foetus is another factor that can lead to PD, harming the physical and mental health of both (Gong, Ni, Shen, Wu, & Jiang, 2015). The level of social support a mother receives has been noted to carry significant risk if these levels are of the lower portion or not in existence at all (Milgrom et al., 2008).  

Management Options

Each factor that contributes to prenatal depression (PD) and the risks associated have specific and different ways of dealing with them for each individual. The following management options are generalised and are a guide only. If you feel you are suffering symptoms of prenatal depression, please seek help from a licenced health professional who will be able to custom fit a treatment plan for you.

Antidepressant medication for pregnant women is a controversial issue. Their safety use with pregnancy has been thoroughly discussed and continues to instigate further research into the area, though it has been noted to decrease symptoms of PD when used correctly in specific cases. Antidepressants have been attributed to affecting a mothers' postpartum healing, their likelihood of haemorrhaging is increased along with increased negative effects on their unborn child if used incorrectly or misdiagnosed to be suitable for a mother (Gong, Ni, Shen, Wu, & Jiang, 2015). Another medication trialed for use by pregnant women to help reduce and treat PD is psychotropic . This medication has been met with mixed results however, as they skew more towards the inefficiency and negative affects with foetus’ have been put on this medication scoring lower on their Apgar and Bayley developmental tests scoring ladder (Field, Diego, & Hernandez-Reif, 2010).

Alternative Management Methods

Some mothers feel that they do not want to be put on medications for their pregnancy or that it would increase the risks for some mothers if medication were used. For these situations, massage therapy has seen to be a widely used mechanism to help both the mother and foetus reduce the symptoms of PD and prematurity rates (Field et al., 2012 ). Stress reduction therapy is another positive influence on mother with results from research backing it by showing a reduction in depression scores. Stress reduction assists the mothers by lowering their overall negative effects and lowering their cortisol levels back towards normal levels (Field, Diego, & Hernandez-Reif, 2010). Acupuncture is another therapy that has gained positive results from mothers who feel better within themselves and showing their depression levels decreasing once a treatment had been finished. Massage therapy is well used treatment, but not everyone is able to afford to be getting massages. For those on low income, or those that are unable to travel or other factors that make going out to receive a massage impractical there is the significant-other-massage. This particular massage therapy enables the significant to provide an outlet for their partner and reduces their anxiety levels, their depression levels and as an added bonus helps alleviate some of the common pregnancy pain felt, such as leg and back pain (Field, Diego, & Hernandez-Reif, 2010).

Other forms of antidepressant medication free management options include psychotherapy and complementary and alternative medicines (CAMs). The effects of psychological treatments on mothers have been extensively used by mothers and the benefits have been numerous (Gong, Ni, Shen, Wu, & Jiang, 2015). CAMs is a broad range of alternative methods, from herbal teas through to using yoga to relieve stress. Most women have found themselves to be comfortable using a CAM method during their pregnancy. Their benefits include both psychological improvement during pregnancy but also physical improvement (Gong, Ni, Shen, Wu, & Jiang, 2015).

Decreasing the percentage of women who suffer from prenatal depression is of major concern to the health world. By identifying risk factors early on in pregnancy they have the best chance of decreasing the symptoms and avoiding permanent damage to both mother and child. Additional research identifying risk factors, and an increased span of attention on the modifiable factors of PD with a preventative approach for early identification of those women at risk for developing PD by health professionals could lead with additional funding and studies conducted to a reduced number of morbidity attributed to the development of the mostly treatable and preventable condition of prenatal depression.

Conclusion

Prenatal depression is a serious mental condition that can effect upwards of 10% of the female population during childbearing years. It affects their mind, body and thoughts. Though there are many factors associated with developing prenatal depression, such as prior diagnosis and living standards with planned pregnancy compared to unplanned pregnancy. There are, however, many options for relieving the symptoms of prenatal depression with a lot of alternatives including massage therapies not just medications and behaviour therapies.

The most prominent management options including using cognitive behaviour therapy to target specific behaviours decreasing the overall effect. For many women this has enabled them to continue on as normal and enjoy their pregnancy. Other prominent options included massage therapy by their significant other or by a professional to help relieve body stress and acupuncture to help decrease depression symptoms. All management options have their benefits and drawbacks but each case needs to be assessed individually and a treatment plan drawn up to best suit each mother.

Further research into this area is needed as most of the focus is on postpartum depression. Though in the last few years more research has been instigated as the science community has realised the importance of preventing and decreasing the symptoms of prenatal depression for both the mother and foetus’ health and development.

See also

• Depression
• Postpartum Depression
• Antenatal Depression
• Postpartum Return to Work (Book Chapter, 2016)
• Psychological Resilence Development in Children (Book Chapter, 2016)

References

Bledsoe, S. (2006). Treating Depression During Pregnancy and the Postpartum: A Preliminary Meta-Analysis. Research On Social Work Practice, 16(2), 109-120. http://dx.doi.org/10.1177/1049731505282202

Cabanac, M. (2002). What is emotion?. Behavioural Processes, 60(2), 69-83. http://dx.doi.org/10.1016/s0376-6357(02)00078-5

Cummings, S. & Kropf, N. (2013). Handbook of Psychosocial Interventions with Older Adults: Evidence-Based Approaches (pp. 5-9). New York: Routledge Taylor and Francis Group

Fellenzer, J. & Cibula, D. (2014). Intendedness of Pregnancy and Other Predictive Factors for Symptoms of Prenatal Depression in a Population-Based Study. Maternal And Child Health Journal, 18(10), 2426-2436. http://dx.doi.org/10.1007/s10995-014-1481-4

Field, T., Diego, M., & Hernandez-Reif, M. (2010). Prenatal Depression Effects and Interventions: A Review. Infant Behavior And Development, 33(1), 409-418.

Field, T., Diego, M., Hernandez-Reif, M., Medina, L., Delgado, J., & Hernandez, A. (2012). Yoga and massage therapy reduce prenatal depression and prematurity. Journal Of Bodywork And Movement Therapies, 16(2), 204-209. http://dx.doi.org/10.1016/j.jbmt.2011.08.002

Gong, H., Ni, C., Shen, X., Wu, T., & Jiang, C. (2015). Yoga for prenatal depression: a systematic review and meta-analysis. BMC Psychiatry, 15(1). http://dx.doi.org/10.1186/s12888-015-0393-1

Lara, M., Navarrete, L., & Nieto, L. (2016). Prenatal predictors of postpartum depression and postpartum depressive symptoms in Mexican mothers: a longitudinal study. Archives Of Women's Mental Health, 19(5), 825-834. http://dx.doi.org/10.1007/s00737-016-0623-7

Leigh, B. & Milgrom, J. (2008). Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry, 8(1). http://dx.doi.org/10.1186/1471-244x-8-24

Milgrom, J., Gemmill, A., Bilszta, J., Hayes, B., Barnett, B., & Brooks, J. et al. (2008). Antenatal risk factors for postnatal depression: A large prospective study. Journal Of Affective Disorders, 108(1-2), 147-157. http://dx.doi.org/10.1016/j.jad.2007.10.014

Orr, S. & Miller, C. (1995). Maternal Depressive Symptoms and the Risk of Poor Pregnancy Outcomes. Oxford Journals, 17(1), 165-171.

Schacter, D., Gilbert, D., & Wegner, D. (2010). Psychology (2nd ed., p. 600). New York: Worth Pub.

Shivakumar, G., Brandon, A., Snell, P., Santiago-Muñoz, P., Johnson, N., Trivedi, M., & Freeman, M. (2010). Antenatal depression: a rationale for studying exercise. Depression And Anxiety, 28(3), 234-242. http://dx.doi.org/10.1002/da.20777

Sockol, L., Epperson, C., & Barber, J. (2011). A meta-analysis of treatments for perinatal depression. Clinical Psychology Review, 31(5), 839-849. http://dx.doi.org/10.1016/j.cpr.2011.03.009

Stewart, D.E., Robertson, E., Dennis, C-L., Grace, S.L., & Wallington, T. (2003). Postpartum depression: Literature review of risk factors and interventions.

Woodward, K. (2015). Psychosocial Studies: An introduction (pp. 3-8). New York: Routledge

Yonkers, K., Wisner, K., Stewart, D., Oberlander, T., Dell, D., & Stotland, N. et al. (2009). The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. General Hospital Psychiatry, 31(5), 403-413. http://dx.doi.org/10.1016/j.genhosppsych.2009.04.003

External links

AACBT - https://www.aacbt.org.au/resources/what-is-cbt/

Beyond Blue - https://www.beyondblue.org.au/

Black Dog Institute

Headspace