A Critical Health Test for Pregnant Women and New Moms

Screening for depression during pregnancy and after helps protect mom and baby—while also strengthening their bond.

A Critical Health Test for Pregnant Women and New Moms

You’ve probably heard of postpartum depression, even if you haven’t experienced it yourself. But mommies-to-be may be just as susceptible to serious bouts of depression and related symptoms as women who’ve recently had a baby. Guidelines from the United States Preventive Services Task Force (USPSTF) make it clear that healthcare providers (HCPs) should be screening women for depression during pregnancy and after their little one is born. 

“Fewer than 20 percent of women with perinatal depression self-report their symptoms,” says Sz-Min Harley, MD.“So this routine screening helps to catch the women who may fall through the cracks.” 

Here’s what you need to know about pregnancy and depression. 

Maternity and mental health 
Maternal mental illness and postpartum depression are more common than you might think, affecting as many as 1 in 7 expectant and new moms. And during the postpartum period, it’s estimated that up to 85 percent of women will experience some type of negative mood. 

Experts believe that women are more susceptible to mental health issues like depression during pregnancy and right after because of rapid shifts in hormones. Estrogen and progesterone levels can fall quickly, leading to potentially severe mood changes. 

And while any woman can experience depression during this time, Dr. Harley says that women with a history of psychiatric disorders—including previous postpartum depression, major depression, bipolar disorder, anxiety or schizophrenia—are at higher risk. 
 
Seeing the signs 
It’s completely normal to feel emotional and overwhelmed after having a baby. That's why many health professionals think of maternal mental health on a continuum—from mild “baby blues,” to postpartum depression, to more severe postpartum psychosis. 

According to Harley, it can be difficult to tell the difference between postpartum depression and a simple case of baby blues, but you should keep an eye out for these signs in the first couple of weeks following delivery: 

  • Sadness 
  • Unexplained crying 
  • Impatience or irritability 
  • Restlessness or lack of concentration 
  • Anxiety 
  • Fatigue 
  • Sleeping too much or too little 

If the symptoms don’t go away after one to two weeks or if, in addition, you start to experience any of these symptoms, it could indicate more serious postpartum depression: 

  • Feelings of anger 
  • Withdrawing from friends, family and your baby 
  • Feeling numb or disconnected from your baby 
  • Fear that you could hurt your baby 
  • Worrying about your ability to take care of your baby 
  • Feelings of apathy about being a mom 
  • Persistent problems with recalling details or making decisions 
  • Overeating or loss of appetite 
  • Aches and pains that don’t go away 
  • Thoughts of hurting yourself or suicide 

Postpartum psychosis is much rarer—affecting only 1 or 2 out of every 1,000 new moms. It presents dramatically and quickly, often within the first 72 hours of giving birth, with symptoms escalating within the first two weeks.  The symptoms may be similar to episodes of bipolar disorder. Although rate, it’s important to be aware of the signs, which include: 

  • Early signs: restlessness, insomnia and irritability
  • Manic episodes of high energy and rapid, muddled thinking that interfere with your ability to sleep, followed by periods of total exhaustion 
  • Hallucinations or delusions—seeing and hearing things that aren’t there 
  • Feelings of suspicion or paranoia—thinking that someone is trying to harm your baby 
  • Confusion
  • Changes in appetite
  • Lack of touch with reality
  • Disorganized and erratic thoughts or behaviors
  • Noticeable change in functioning
  • Suicidal or homicidal ideation

If you’re concerned about any of these symptoms or their potential impact on your new little one, it’s important that you speak to your OBGYN or mental health professional right away. That way you can be screened and provided with the right level of care, says Harley. 

“Women should seek professional help if they’re having persistent or extreme anxiety or guilt, insomnia, feelings of hopelessness, loss of pleasure in doing fun activities more days than not or any thoughts of hurting themselves or their baby,” she adds. 

How depression affects the baby bond 
“Mothers with untreated depression have a harder time bonding with their children,” says Harley. “Women with depression also perform less self-care and have a more difficult time meeting the needs of their newborn. They have a lower threshold for stress, which increases the risk of the mother harming the child.” In extreme cases, it can also lead to maternal suicide. 

But there are steps you can take to make sure both you and your child are happy and healthy. 

First, let go of the need to be perfect. Between physically healing after giving birth and emotionally adjusting to new schedules and routines after your baby arrives, it can take some time to start feeling like yourself again. And that’s okay. 

Here are a few more ways to adjust to your new role: 

  • Talk to close friends and family about how you’re feeling, or vent those feelings in a journal. 
  • Practice self-care. Nourish your body with a healthy diet and HCP-approved exercise. 
  • Ask for help. It’s easy to try and take on the role of Superwoman after your little one arrives but calling on friends and family when you’re overwhelmed can make a huge difference and give you that much-needed break. 
  • Seek treatment. If your symptoms are putting you or your baby at risk or impacting your ability to care for yourself and your child, talk to your OBGYN or mental health professional immediately. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for 24/7 support for people in distress and their loved ones.

Medically reviewed in April 2021. 

Sources:
U.S. Preventative Services Task Force. “Perinatal Depression: Preventive Interventions.” February 12, 2019.
University of Kansas Health System. “Emotional Support During Pregnancy and Postpartum.” My Baby Magazine. 2018.
Bob Carolla. “Postpartum Depression Affects 1 In 7 Mothers; Bipolar Rate Strikingly High, Study Finds.” National Alliance on Mental Illness. March 18, 2013.
Massachusetts General Hospital Center for Women’s Mental Health. “Postpartum Psychiatric Disorders.” Accessed May 24, 2021.
Mayo Clinic. “Depression (major depressive disorder).” February 3, 2018.
Massachusetts General Hospital Center for Women’s Mental Health. “New Study at CWMH: Genetics of Postpartum Psychosis – Massachusetts General Hospital Postpartum Psychosis Project (MGHP3).” October 10, 2018.
Raza SK, Raza S. “Postpartum Psychosis.” StatPearls Publishing. January 2021.

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