Mental health during pregnancy: Everything you need to know

Pregnancy can be an emotionally daunting time. Don’t be surprised if you feel an imbalance in mental health during pregnancy making you feel enthusiastic and happy one day, and exhausted and dejected the next.

In fact, stress and anxiety are even more common if it's your first pregnancy, or you’ve previously suffered a mental illness, and/or if you are about to have a rainbow baby. 

According to the World Health Organisation (WHO), about 10 per cent of all pregnant women worldwide “and 13 per cent of women who have just given birth experience a mental disorder, primarily depression.” 

This, on top of the fact that pregnancy itself can be a challenge. From fluctuating hormones to physical changes, to tests and scans, there is a lot happening in these nine months.

If you’ve suffered a previous mental disorder, chances of a pregnancy becoming a gruelling task more than an enjoyable experience are even higher. 

Unfortunately, many women suffer unnecessarily and ignore their mental health during pregnancy as they continue to focus only on the growing baby.

But an untreated mental disorder at this point can often lead to serious consequences on your wellbeing as well as that of your baby’s.

The good news is that there are many practical treatments to balance mental health during pregnancy and after birth, especially once you are properly diagnosed. 

But for that to work you’ll need to understand what you’re going through. There are five types of common mental health issues that affect most expecting mums globally.

Mental health during pregnancy: 5 common emotional disorders 

Many women who suffer from conditions of mental health during pregnancy may sail through these nine months easily. While those who may have never had any issue might suddenly develop them during their pregnancy.

The fact that each pregnancy is different makes it difficult to generalise.

However, there are some common mental health conditions you should watch out.   

1) Depression 

Depression during pregnancy can often go unnoticed. Unfortunately, it is more common than you think.

According to a study published in the British Journal of Psychiatry and funded by the National Institute for Health Research, about 25 per cent of cases of postpartum depression actually begin during pregnancy. 

It was also observed that depression rating was highest during the eight-month of the pregnancy. While it is difficult to clearly identify depression, if you notice the following symptoms, you must urgently visit a doctor. 

• Feeling down and miserable for the better part of the day or most days of a week.  
• Constantly feeling irritable, anxious, or angry. 
• Lack of interest in activities you normally enjoyed 
• Unable to sleep properly or sleeping more than usual 
• Constant or increased crying, mostly for no apparent reason
• Considerably reduced appetite or overeating 
• Excessive tiredness or fatigue 
• Lack of concentration
• Feeling disconnected with your baby and preoccupation with sad thoughts  
• Disinterested in your partner and/or unable to connect 
• Constantly feeling that you are a ‘bad mother’ 
• Increased thoughts of harming your body 
• Suicidal thoughts 

If you notice any of these symptoms, you must alert your family members and visit your doctor. This may help you identify the primary cause of depression during pregnancy.

It could be because you either have a history of depression within your family or have somebody around you who is going through it.

If it’s an unplanned pregnancy, you may feel burdened by unrealistic expectations of motherhood.

Or, you could be facing difficulties in your marriage or relationship and may not have adequate social support.

Either way, once you are properly diagnosed - and know that this feeling is not due to lack of nutrition any medical illness that mimics depression such as iron deficiency, thyroid, or anaemia - you may be given a tailor-made treatment. 

2) Anxiety 

Another common mental health issue during pregnancy is anxiety. Based on your symptoms, anxiety may further be divided into the following:

• A generalised anxiety disorder 
• Obsessive-compulsive disorder (OCD) 
• Post-traumatic stress disorder (PTSD)
• Agoraphobia (fear of places)  
• A panic disorder

Many women have symptoms based on these types of anxiety disorders before pregnancy. While some women develop symptoms during their pregnancy.

If you notice the following signs, chances are you suffer from some type of anxiety. 

• Stress or worry and feel ‘on edge’ most of the time
• Difficulty staying calm and have muscular tension 
• Have difficulty in sleeping
• Often have recurring worrying thoughts
• Actual physical panic attacks (lack of breathing or constant moving of a body part) 
• Dizziness and shortness of breath

Most of us are commonly predisposed to stress, either genetically or due to our work or in personal relationships.

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But when anxiety is due to pregnancy, it can often give you an anxious temperament and make you worry most of you waking hours. You may worry about your own health, your baby’s health, and societal pressures. 

Women who are victims or survivors of sexual assault may also experience some form of anxiety during pregnancy. Unfortunately, for such women, anxiety can be common even after birth and well into the later years of parenthood. 

On the other hand, women who have always had some form of anxiety can experience more of it during pregnancy. Especially since they are put out of their comfort zones and into new territory.

Some women even feel dizziness, shortness of breath, hot flashes, increased heart rate during the later part of pregnancy, which can be mistaken for panic attacks or can lead to one.

It is crucial to visit a doctor and seek proper treatment. 

These may include therapeutic treatments, Ayurveda, and even some mindfulness exercises. In severe cases, you may be given medication by your doctor. 

3) Bipolar disorder 

This is a form of depression where one may experience extreme types of emotions - high (mania), lows (depression), and hypomania (change of mood, not as severe as mania).

Although it's important to point that it is an uncommon form of mental disorder and may likely be genetic, the depressive symptoms here are similar to actual depression. 

So in case you are suffering from a bipolar disorder during pregnancy, you may experience the following symptoms.

• You have an excessively happy mood 
• May sometimes have an irritable mood rather than a happy mood
• You may have lots of energy and move frantically 
• Find yourself speaking very quickly, almost trying to keep up with your thoughts
• Lack of sleep and excessive energy 
• You may feel overly confident in your talent, looks, and abilities 
• You want to engage in dangerous activities to feel exhilarated.  
• May notice increased libido 
• You may behave rashly and out of character 
• There could be an increased alcohol and drug use
• In extreme cases, one may experience psychotic symptoms and even a loss of touch with reality.

Women who are diagnosed with a bipolar disorder before pregnancy, it's a good idea to plan your pregnancy with the help of a doctor.

That’s because some medications that are often taken for this order cannot be consumed during pregnancy. 

So it's best to always consult your doctor beforehand as these symptoms can make pregnancy a challenging experience.

If you previously had this disorder, you are likely to experience a relapse during the first month after delivery. So be honest and transparent with your GP. 

4) Schizophrenia 

While schizophrenia during pregnancy is quite uncommon, it can occur due to a family history. Women who suffer from this particular mental disorder may typically experience two types of symptoms: Hallucinations and delusions. 

Symptoms of the former force one to think that they are seeing things that may seem real, but are not. It may seem that your eyes, ears, and other senses are playing a game with your mind.

This is as interesting as it is unnerving. 

On the other hand, symptoms of the latter may force one to feel that they are being manipulated or controlled or have a belief about things that may be untrue. 

Some of the other symptoms of this mental disorder include the following:  

• Social withdrawal because of paranoia
• Difficulty in mankind regular decisions 
• Feeling of uncertainty 
• Difficulty in organising normal daily tasks
• Jumbled speech
• Reversal of sleep cycle, where you sleep during the day and stay awake during the night  

If you notice any of these symptoms, it's best to urgently visit your doctor. You may not be put under medication due to pregnancy or during breastfeeding, but this may be weighed against your condition. 

5) Eating disorders (and lack of nutrition)

Some of the common issues of mental health during pregnancy are often attributed to a lack of proper nutrition and eating disorders.

Women who suffer from eating disorders during their teenage years, often carry them during their pregnancy too.

These could include anorexia nervosa, bulimia nervosa, and a general lack of nutrition.  

In the case of the former, you may fear weight gain during pregnancy and end up limiting food intake. While in the case of bulimia nervosa, you may resolve to nervous eating and then purging.

Finally, you may not exactly get the right kind of nutrition your body needs to sustain a healthy pregnancy.

Either due to economic reasons or because you are addicted to harmful substances such as drugs, smoking, or drinking. All of these can lead to stillbirth or miscarriage. 

Women with such eating disorders are often at a higher risk during pregnancy. That's because of the following reasons: 

• At this stage, your body may divert any nutrition you get to your baby. All this, at your expense.
• Women who often purge food or have active symptoms of bulimia nervosa are at an increased risk of miscarriage.
• While women who often limit food intake and have active symptoms of anorexia nervosa have an increased of small babies with smaller heads. They can even give birth to low-weight premature babies. 
• Such women are also more prone to anaemia.
• Lack of nutrition would mean a longer time to recover from caesarean, episiotomy, or tearing.

It goes without saying that during pregnancy, it's important to keep your eating disorder in check. It can be challenging because you cannot control your weight and it may be distressing for women with eating disorders. 

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If you already have an eating disorder, you may need extra monitoring to ensure good health of your baby and yourself.

Consult with a dietician and your GP to create a proper food chart and try to stick with it. It is also common for women to experience a relapse after delivery and you may have unrealistic weight loss goals.  

Speak with your GP and your midwife about the best way to stay fit and healthy pre and post-delivery. Remember, if you are breastfeeding, eating restrictions can have a serious effect on your breastmilk and the health of your baby.

After birth, if you find yourself purging and limiting food, its time to visit your doctor. 

How to improve mental health during pregnancy

In addition to visiting your doctor, there are also some practical ways to look out for your mental health during pregnancy.

These can help you sail through your pregnancy, irrespective of whether or not you suffer from the aforementioned mental health issues. 

1. Talk it out 

Being a mother can be lonely sometimes. However, if you find somebody who you can talk to freely, this can be an easier journey. Whether it's your partner, your parent or your friend, share your daily experiences with them.

If it is a fellow expecting mum, it's even better as you are going through the motions - both emotional and physical together and have a lot in common. 

What's important is that you do not keep your emotions, challenges and even achievements bottled up. You can even enrol in various pregnancy classes and use that as a platform to share your fears and worries.  

2. Make a wellness plan 

If you are quite the planner, it's a good idea to already start talking about a wellbeing plan even before your pregnancy. A wellbeing plan could include a list of activities you need to do during your pregnancy, to stay sane.

But also as an outlet to share your feelings.

You can even enrol in antenatal classes and connect more deeply with your baby.

You can share details of this plan with your family and friends and most importantly with your partner, who is also going this journey with you. 

3. Exercise and meditate 

Keeping your mind, body, and soul active and nourished is crucial for not only your wellbeing but also of your baby.

Post permission from your GP, include physical activities such as swimming, walking, or running into your daily routine.

Give your mind a much-needed break from work or routine life, by meditating and practising deep-breathing exercises.  

4. Treat yourself 

Pregnancy can often take all the attention away from you and onto your baby. So its time to bring the focus back onto the most important person in this journey - you!

Treat yourself to massages or manicures, fancy dinners with your partner, some fun and safe activities, and even travel. 

It's your time, and you must enjoy it.  

5. Ask for support 

Finally, if you see yourself struggling, don't be afraid to ask for support. Whether that means from your family or friends or even from your midwife. Consider counselling if it comes to it.

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And try complementary therapies such as acupuncture, yoga, or even shiatsu. 

Yes, these nine months can be a rollercoaster of emotions. You may feel that things are out of control, but trust yourself and know that mental health during pregnancy should be at the top of your 'to-do list.'

Talk to close family and friends and be mindful and forgiving towards yourself.

After all, with a positive attitude, and focus on positive mental health during pregnancy, this can be the most joyful experience of your life.

This article was first published in theAsianparent.