Antenatal depression

Antenatal depression is classified based on a woman's symptoms. During pregnancy, a lot of changes to mood, memory, eating habits, and sleep are common. When these common traits become severe, and begin to alter one's day-to-day life, that is when it is considered to be antenatal depression. Symptoms of antenatal depression are:

• Inability to concentrate
• Overwhelming anxiety and fear
• Difficulty remembering
• Feeling emotionally numb
• Extreme irritability
• Sleeping too much or not enough, or restless sleep
• Extreme or unending fatigue
• Desire to over eat, or not eat at all
• Weight loss/gain unrelated to pregnancy
• Loss of interest in sex
• A sense of dread about everything, including the pregnancy
• Feelings of failure, or guilt
• Persistent sadness
• Thoughts of suicide or death{{cite web|title=Antenatal Depression|url=http://www.panda.org.au/practical-information/about-postnatal-depression/27-antenatal-depression|work=www.panda.org.asu|access-date=4 April 2013|archive-url=https://web.archive.org/web/20110218022349/http://www.panda.org.au/practical-information/about-postnatal-depression/27-antenatal-depression|archive-date=18 February 2011|url-status=dead}}

Other symptoms can include the inability to get excited about the pregnancy, and/or baby, a feeling of disconnection with the baby, and an inability to form/feel a bond with the developing baby.{{cite web|title=Antenatal Depression|url=http://www.babiesonline.com/articles/health/antenataldepression.asp|work=www.babiesonline.com|access-date=4 April 2013|archive-date=20 April 2019|archive-url=https://web.archive.org/web/20190420162814/https://www.babiesonline.com/articles/health/antenataldepression.asp|url-status=dead}} This can drastically affect the relationship between the mother and the baby, and can drastically affect the mother's capacity for self-care. Such inadequacies can lead to even greater risk factors for the mother.{{cite journal | vauthors = Leigh B, Milgrom J | title = Risk factors for antenatal depression, postnatal depression and parenting stress | journal = BMC Psychiatry | volume = 8 | pages = 24 | date = April 2008 | pmid = 18412979 | pmc = 2375874 | doi = 10.1186/1471-244X-8-24 | doi-access = free }} Antenatal depression can be triggered by various causes, including relationship problems, family or personal history of depression, infertility, previous pregnancy loss, complications in pregnancy, and a history of abuse or trauma.{{cite journal | vauthors = Mukherjee S, Trepka MJ, Pierre-Victor D, Bahelah R, Avent T | title = Racial/Ethnic Disparities in Antenatal Depression in the United States: A Systematic Review | journal = Maternal and Child Health Journal | volume = 20 | issue = 9 | pages = 1780–97 | date = September 2016 | pmid = 27016352 | doi = 10.1007/s10995-016-1989-x | s2cid = 32334253 }}

Antenatal depression can be caused by many factors. Often it is associated with the fear and stress of the pregnancy. Other factors include unintended pregnancy, hyperemesis gravidarum, financial issues, living arrangements and relationships with the father and family.{{Cite web |date=2022-06-02 |title=Mom's Mental Health Matters: Moms-to-be and Moms - NCMHEP {{!}} NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development |url=https://www.nichd.nih.gov/ncmhep/initiatives/moms-mental-health-matters/moms |access-date=2023-10-30 |website=www.nichd.nih.gov |language=en}}{{Cite journal |last1=Boelig |first1=Rupsa C |last2=Barton |first2=Samantha J |last3=Saccone |first3=Gabriele |last4=Kelly |first4=Anthony J |last5=Edwards |first5=Steve J |last6=Berghella |first6=Vincenzo |date=2016-05-11 |editor-last=Cochrane Pregnancy and Childbirth Group |title=Interventions for treating hyperemesis gravidarum |journal=Cochrane Database of Systematic Reviews |language=en |volume=2016 |issue=5 |pages=CD010607 |doi=10.1002/14651858.CD010607.pub2 |pmc=10421833 |pmid=27168518}} Typically, depression symptoms associated with pregnancy are categorized as postnatal depression, due to the onset of symptoms occurring after childbirth has occurred. The following is a breakdown of when a group of various women began to feel the onset of symptoms associated with depression:

• 11.8 percent at 18 weeks
• 13.5 percent at 32 weeks
• 9.1 percent 8 weeks after the birth
• 8.1 percent 8 months after the birth{{cite news|last=Sharps|first=Linda| name-list-style = vanc |title=Prenatal Depression Warning Signs: Here's What to Look For|url=http://www.huffingtonpost.com/the-stir/prenatal-depression_b_1967991.html|access-date=2013-04-21|newspaper=The Huffington Post|date=2012-10-18}}

In a recent article posted by The BabyCenter, the authors stated that "For years, experts mistakenly believed that pregnancy hormones protected against depression, leaving women more vulnerable to the illness only after the baby was born and their hormone levels plunged."{{cite web|title=Is it common to suffer from depression or anxiety during pregnancy?|url=http://www.babycenter.com/0_depression-during-pregnancy_9179.bc|archive-url=https://web.archive.org/web/20071012022118/http://www.babycenter.com/0_depression-during-pregnancy_9179.bc|url-status=usurped|archive-date=October 12, 2007|work=The Baby Center|access-date=2013-04-21}} This is a possible explanation as to why antenatal depression has just recently been identified.

The prevalence of antenatal depression differs slightly by region of world. In the United States, antenatal depression is experienced in as many as 16% of pregnant women, while in South Asia it is experienced in as many as 24% of pregnant women.{{cite journal | vauthors = Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T | title = Perinatal depression: a systematic review of prevalence and incidence | language = en | journal = Obstetrics and Gynecology | volume = 106 | issue = 5 Pt 1 | pages = 1071–83 | date = November 2005 | pmid = 16260528 | doi = 10.1097/01.AOG.0000183597.31630.db | s2cid = 1616729 | url = http://insights.ovid.com/ | url-access = subscription }}{{cite journal | vauthors = Mahendran R, Puthussery S, Amalan M | title = Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis | journal = Journal of Epidemiology and Community Health | volume = 73 | issue = 8 | pages = 768–777 | date = August 2019 | pmid = 31010821 | doi = 10.1136/jech-2018-211819 | url = https://jech.bmj.com/content/73/8/768 | hdl = 10547/623278 | s2cid = 128363186 | hdl-access = free }}{{cite journal | vauthors = Ashley JM, Harper BD, Arms-Chavez CJ, LoBello SG | title = Estimated prevalence of antenatal depression in the US population | journal = Archives of Women's Mental Health | volume = 19 | issue = 2 | pages = 395–400 | date = April 2016 | pmid = 26687691 | doi = 10.1007/s00737-015-0593-1 | s2cid = 9272059 }} It's becoming more prevalent as more medical studies are being done. Antenatal depression was once thought to simply be the normal stress associated with any pregnancy, and was waved off as a common ailment. It can be caused by many factors, usually though involving aspects of the mothers personal life, such as family, economic standing, relationship status, etc. It can also be caused by hormonal and physical changes that are associated with pregnancy.{{cite web|title=Prenatal (Antenatal) Depression|url=http://www.pandasfoundation.org.uk/help-and-information/pre-ante-and-postnatal-illnesses/pre-antenatal-depression.html|work=www.pandasfoundation.org.u|publisher=Pandas Foundation|access-date=2013-05-13|archive-url=https://web.archive.org/web/20130521141455/http://www.pandasfoundation.org.uk/help-and-information/pre-ante-and-postnatal-illnesses/pre-antenatal-depression.html#.UZKT8rWkpa8|archive-date=2013-05-21|url-status=dead}} Additional risk factors include lack of social support, marital dissatisfaction, discriminatory work environments, history of domestic abuse, and unplanned or unwanted pregnancy.{{Cite journal|last1=Biaggi|first1=Alessandra|last2=Conroy|first2=Susan|last3=Pawlby|first3=Susan|last4=Pariante|first4=Carmine M.|date=February 2016|title=Identifying the women at risk of antenatal anxiety and depression: A systematic review|journal=Journal of Affective Disorders|volume=191|pages=62–77|doi=10.1016/j.jad.2015.11.014|issn=0165-0327|pmc=4879174|pmid=26650969}} Studies have determined that there may be a connection between antenatal and postpartum depression in women with lower vitamin D levels.{{Cite journal|last1=Aghajafari|first1=Fariba|last2=Letourneau|first2=Nicole|last3=Mahinpey|first3=Newsha|last4=Cosic|first4=Nela|last5=Giesbrecht|first5=Gerald|date=2018-04-12|title=Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review|journal=Nutrients|volume=10|issue=4|page=478|doi=10.3390/nu10040478|issn=2072-6643|pmc=5946263|pmid=29649128|doi-access=free}} There is a higher risk of antenatal depression in woman living in low-income countries who deal with less access to quality healthcare, have economic issues, and don't have a good support system.{{Cite journal|last1=Fekadu Dadi|first1=Abel|last2=Miller|first2=Emma R.|last3=Mwanri|first3=Lillian|date=2020-01-10|title=Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis|journal=PLOS ONE|volume=15|issue=1|pages=e0227323|doi=10.1371/journal.pone.0227323|issn=1932-6203|pmc=6953869|pmid=31923245|bibcode=2020PLoSO..1527323F|doi-access=free}}

Antenatal depression is also experienced by parents who identify as part of the LGBTQ+ community. Literature on the experiences of pregnancy amongst transgender men reveals that sources of antenatal depression amongst pregnant transgender men arise from gender dysphoria.{{Cite journal |last=MacLean |first=Lori Rebecca-Diane |date=April 2021 |title=Preconception, Pregnancy, Birthing, and Lactation Needs of Transgender Men |url=https://linkinghub.elsevier.com/retrieve/pii/S1751485121000313 |journal=Nursing for Women's Health |language=en |volume=25 |issue=2 |pages=129–138 |doi=10.1016/j.nwh.2021.01.006|pmid=33651985 |s2cid=232101013 |url-access=subscription }} Where feelings of isolation and loneliness are already reported high amongst this particular group, the experiences they commonly face during their pregnancy exacerbate those feelings.

Perinatal mental health screenings are important in detecting and diagnosing antenatal and postpartum depression early. The American College of Obstetricians and Gynecologists is one of the many maternal health organizations that strongly encourage universal screening for expectant and postpartum women for depression as part of routine obstetric care.{{cite journal | vauthors = Kendig S, Keats JP, Hoffman MC, Kay LB, Miller ES, Moore Simas TA, Frieder A, Hackley B, Indman P, Raines C, Semenuk K, Wisner KL, Lemieux LA | display-authors = 6 | title = Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety | journal = Journal of Obstetric, Gynecologic, and Neonatal Nursing | volume = 46 | issue = 2 | pages = 272–281 | date = 2017-03-01 | pmid = 28190757 | pmc = 5957550 | doi = 10.1016/j.jogn.2017.01.001 }} In fact, many states, including California have already legislated laws that require providers to screen patients during visits because they recognize that early screenings can expedite the process in receiving effective treatment. The Patient Health Questionnaire 9 (PHQ-9) is a screening tool typically used to detect depression.{{Cite web|url=http://www.nationalperinatal.org/mental_health|title=National Perinatal Association - Perinatal Mental Health|website=www.nationalperinatal.org|access-date=2019-10-24|archive-date=2020-05-16|archive-url=https://web.archive.org/web/20200516180100/http://www.nationalperinatal.org/mental_health|url-status=dead}} Another tool, the Edinburgh Postnatal Depression Scale, was developed for the postnatal period, but has also been validated for use during pregnancy.{{Cite journal |last1=Bergink |first1=Veerle |last2=Kooistra |first2=Libbe |last3=Lambregtse-van den Berg |first3=Mijke P. |last4=Wijnen |first4=Henny |last5=Bunevicius |first5=Robertas |last6=van Baar |first6=Anneloes |last7=Pop |first7=Victor |date=April 2011 |title=Validation of the Edinburgh Depression Scale during pregnancy |url=https://linkinghub.elsevier.com/retrieve/pii/S0022399910002837 |journal=Journal of Psychosomatic Research |language=en |volume=70 |issue=4 |pages=385–389 |doi=10.1016/j.jpsychores.2010.07.008|pmid=21414460 |url-access=subscription }}

PHQ-9 is a reliable depression severity scale that was formulated in accordance with DSM-IV criteria for depression, consisting of 9 items correlating to the 9 criteria listed in DSM-IV.{{cite journal | vauthors = Kroenke K, Spitzer RL, Williams JB | title = The PHQ-9: validity of a brief depression severity measure | journal = Journal of General Internal Medicine | volume = 16 | issue = 9 | pages = 606–13 | date = September 2001 | pmid = 11556941 | pmc = 1495268 | doi = 10.1046/j.1525-1497.2001.016009606.x }} It is a shortened version of the PHQ and has been assessed for comparable sensitivity and specificity. The screening test is self-administered to patients and are usually performed at the primary care clinic.

However, it is not enough to just provide mental health screenings to at risk patients. Interventions such as referrals to treatment and mental health monitoring should be implemented in health care systems in order to ensure these women are helped consistently throughout their recovery journey.

Studies suggest that obese woman tend to develop mental health issues more frequently and should discuss any symptoms with their doctor at the first prenatal appointment.{{Cite journal|last1=Petursdottir Maack|first1=Heidrun|last2=Skalkidou|first2=Alkistis|last3=Sjöholm|first3=Anna|last4=Eurenius-Orre|first4=Karin|last5=Mulic-Lutvica|first5=Ajlana|last6=Wikström|first6=Anna-Karin|last7=Sundström Poromaa|first7=Inger|date=2019-04-17|title=Maternal body mass index moderates antenatal depression effects on infant birthweight|journal=Scientific Reports|volume=9|issue=1|page=6213|doi=10.1038/s41598-019-42360-1|issn=2045-2322|pmc=6470129|pmid=30996270|bibcode=2019NatSR...9.6213P}}

Treatment for antenatal depression poses many challenges because the baby is also affected by any treatment given to the mother.{{cite journal | vauthors = Shivakumar G, Brandon AR, Snell PG, Santiago-Muñoz P, Johnson NL, Trivedi MH, Freeman MP | title = Antenatal depression: a rationale for studying exercise | journal = Depression and Anxiety | volume = 28 | issue = 3 | pages = 234–42 | date = March 2011 | pmid = 21394856 | pmc = 3079921 | doi = 10.1002/da.20777 }} There are both non-pharmacological and pharmacological treatment options which can be considered by women with antenatal depression.

Psychotherapy is recommended for any woman with antenatal depression,{{Cite journal|last1=Li|first1=Caixia|last2=Sun|first2=Xiaohua|last3=Li|first3=Qing|last4=Sun|first4=Qian|last5=Wu|first5=Beibei|last6=Duan|first6=Dongyun|date=2020-07-02|title=Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life|journal=Medicine|volume=99|issue=27|pages=e20947|doi=10.1097/MD.0000000000020947|issn=0025-7974|pmc=7337511|pmid=32629701}} as it is an effective way for the mother to express her feelings in her own words. Specifically, cognitive behavioral therapy effectively helps decrease symptoms of antenatal depression.{{Cite journal|date=1997|title=Selective serotonin reuptake inhibitors are tolerated better than tricyclic antidepressants|journal=BMJ|volume=314|issue=7081|doi=10.1136/bmj.314.7081.0e|s2cid=220157751|issn=0959-8138}} In addition to psychotherapy, being seen by a psychiatrist is recommended as they can assess if medications will be beneficial and make specific medication recommendations, if warranted. Familial support may also play a role in helping with the emotional aspects of antenatal depression.{{Cite journal|last1=Hu|first1=Ying|last2=Wang|first2=Ying|last3=Wen|first3=Shu|last4=Guo|first4=Xiujing|last5=Xu|first5=Liangzhi|last6=Chen|first6=Baohong|last7=Chen|first7=Pengfan|last8=Xu|first8=Xiaoxia|last9=Wang|first9=Yuqiong|date=2019-11-19|title=Association between social and family support and antenatal depression: a hospital-based study in Chengdu, China|journal=BMC Pregnancy and Childbirth|volume=19|issue=1|page=420|doi=10.1186/s12884-019-2510-5|issn=1471-2393|pmc=6862749|pmid=31744468 |doi-access=free }}

While mental health specialists are trained in providing counseling interventions, results from a recent systematic review and meta-analysis of the literature found that nonspecialist providers, such as lay counselors, nurses, midwives, and teachers with no formal training in counseling interventions, often fill a gap in providing effective services related to depression and anxiety treatments.{{Cite journal|last1=Singla|first1=Daisy R.|last2=Lawson|first2=Andrea|last3=Kohrt|first3=Brandon A.|last4=Jung|first4=James W.|last5=Meng|first5=Zifeng|last6=Ratjen|first6=Clarissa|last7=Zahedi|first7=Nika|last8=Dennis|first8=Cindy-Lee|last9=Patel|first9=Vikram|date=2021-05-01|title=Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries: A Systematic Review and Meta-analysis|url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2775992|journal=JAMA Psychiatry|language=en|volume=78|issue=5|pages=498–509|doi=10.1001/jamapsychiatry.2020.4556|issn=2168-622X|pmc=7859878|pmid=33533904}}

Studies suggest that forms of exercise can help with depressive symptoms both before and after birth, but not prevent it entirely.{{Cite journal|last1=Daley|first1=A. J.|last2=Foster|first2=L.|last3=Long|first3=G.|last4=Palmer|first4=C.|last5=Robinson|first5=O.|last6=Walmsley|first6=H.|last7=Ward|first7=R.|date=2015|title=The effectiveness of exercise for the prevention and treatment of antenatal depression: systematic review with meta-analysis|journal=BJOG: An International Journal of Obstetrics & Gynaecology|language=en|volume=122|issue=1|pages=57–62|doi=10.1111/1471-0528.12909|pmid=24935560|s2cid=42209084 |issn=1471-0528|doi-access=}}

Exercise options that have been studied to help reduce symptoms:

• Yoga{{Cite journal|last1=Gong|first1=Hong|last2=Ni|first2=Chenxu|last3=Shen|first3=Xiaoliang|last4=Wu|first4=Tengyun|last5=Jiang|first5=Chunlei|date=2015-02-05|title=Yoga for prenatal depression: a systematic review and meta-analysis|journal=BMC Psychiatry|volume=15|page=14|doi=10.1186/s12888-015-0393-1|issn=1471-244X|pmc=4323231|pmid=25652267 |doi-access=free }}
• Walking
• Stretching
• Aerobic exercise{{Cite journal|last1=El-Rafie|first1=Mervat M|last2=Khafagy|first2=Ghada M|last3=Gamal|first3=Marwa G|date=2016-02-24|title=Effect of aerobic exercise during pregnancy on antenatal depression|journal=International Journal of Women's Health|volume=8|pages=53–57|doi=10.2147/IJWH.S94112|issn=1179-1411|pmc=4772941|pmid=26955293 |doi-access=free }}

When discussing medication options for antenatal depression, it is important to ask the prescribing healthcare provider to share more details about all the risks and benefits of the available medications. During pregnancy, there are two main kinds of antidepressants used during pregnancy; tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Once prescribed, anti-depressant medication has been found to be extremely effective in treating antenatal depression. Patients can expect to feel an improvement in mood in roughly 2 to 3 weeks on average, and can begin to feel themselves truly connect with their baby. Reported benefits of medication include returned appetite, increased mood, increased energy, and better concentration. Side effects are minor, though they are reported in some cases. Currently, no abnormalities of the baby have been associated with the use of antidepressants during pregnancy.{{cite web|url=http://www.mhcs.health.nsw.gov.au/publication_pdfs/7570/AHS-7570-ENG.pdf|title=Depression in Pregnancy& Antidepressant Medication Use|work=www.mhcs.health.nsw.gov.au/|publisher=Division of Mental Health St George Hospital and Community Health Services|access-date=13 November 2013|archive-date=22 May 2020|archive-url=https://web.archive.org/web/20200522195539/http://www.mhcs.health.nsw.gov.au/publication_pdfs/7570/AHS-7570-ENG.pdf/|url-status=dead}} It may be true that maternal SSRI use during pregnancy can lead to difficulty for their newborn adjusting to conditions outside of the womb immediately following birth. Some studies indicate that infants with exposure to SSRIs in the second and third trimester were more likely to be admitted to intensive care following their birth for respiratory, cardiac, low weight and other reasons, and that infants with prenatal SSRI exposure exhibited less motor control upon delivery than infants who were not exposed to SSRIs. Newborns who were exposed to SSRIs for five months or more prior to birth were at a greater risk for lower Apgar scores 1 and 5 minutes after delivery, indicating they were of lesser health than newborns who were not exposed to SSRIs before birth. However, prenatal SSRI exposure was not found to have a significant impact the long-term mental and physical health of the children. These results are not independent of any effects of prenatal depression on infants.{{cite journal | vauthors = Casper RC, Gilles AA, Fleisher BE, Baran J, Enns G, Lazzeroni LC | title = Length of prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants: effects on neonatal adaptation and psychomotor development | journal = Psychopharmacology | volume = 217 | issue = 2 | pages = 211–9 | date = September 2011 | pmid = 21499702 | doi = 10.1007/s00213-011-2270-z | s2cid = 24565503 }}

Studies have found a strong link between antenatal depression and postpartum depression in women. In other words, women who have antenatal depression are very likely to also develop postpartum depression. The cause of this is based on the continuation of the antenatal depression into postpartum. In a logistical light, it makes sense that women who are depressed during their pregnancy will also be depressed following the birth of their child.{{cite journal | vauthors = Misri S, Kendrick K, Oberlander TF, Norris S, Tomfohr L, Zhang H, Grunau RE | title = Antenatal depression and anxiety affect postpartum parenting stress: a longitudinal, prospective study | journal = Canadian Journal of Psychiatry | volume = 55 | issue = 4 | pages = 222–8 | date = April 2010 | pmid = 20416145 | doi = 10.1177/070674371005500405 | doi-access = free }} This being said there are some factors that determine exclusively the presence of postpartum depression that are not necessarily linked with antenatal depression. These examples include variables like socioeconomic class and if a pregnancy was planned or not.{{Cite journal |last1=Ghaedrahmati |first1=Maryam |last2=Kazemi |first2=Ashraf |last3=Kheirabadi |first3=Gholamreza |last4=Ebrahimi |first4=Amrollah |last5=Bahrami |first5=Masood |date=2017-08-09 |title=Postpartum depression risk factors: A narrative review |journal=Journal of Education and Health Promotion |volume=6 |pages=60 |doi=10.4103/jehp.jehp_9_16 |doi-access=free |issn=2277-9531 |pmc=5561681 |pmid=28852652}}{{Cite journal |last1=Brito |first1=Cynthia Nunes de Oliveira |last2=Alves |first2=Sandra Valongueiro |last3=Ludermir |first3=Ana Bernarda |last4=Araújo |first4=Thália Velho Barreto de |date=2015 |title=Postpartum depression among women with unintended pregnancy |journal=Revista de Saude Publica |volume=49 |pages=33 |doi=10.1590/s0034-8910.2015049005257 |issn=1518-8787 |pmc=4544504 |pmid=26083941}}

In reference to a recent study by Coburn et al., the authors found that in addition to prenatal effects, higher maternal depressive symptoms during the postpartum period (12 weeks) were associated with more infant health concerns. This is consistent with other findings among low-SES Mexican-American women and their infants.{{cite journal | vauthors = Gress-Smith JL, Luecken LJ, Lemery-Chalfant K, Howe R | title = Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants | journal = Maternal and Child Health Journal | volume = 16 | issue = 4 | pages = 887–93 | date = May 2012 | pmid = 21559774 | doi = 10.1007/s10995-011-0812-y | s2cid = 574162 }} Women with prenatal depressive symptoms are more likely to develop postpartum depression, which can also have negative consequences on children, such as emotional and behavior problems, attachment difficulties, cognitive deficits, physical growth and development, and feeding habits and attitudes.{{cite journal | vauthors = Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM | title = Effects of perinatal mental disorders on the fetus and child | journal = Lancet | volume = 384 | issue = 9956 | pages = 1800–19 | date = November 2014 | pmid = 25455250 | doi = 10.1016/S0140-6736(14)61277-0 | s2cid = 8388539 }} Related, maternal depression affects parenting behaviors,{{cite journal | vauthors = Bornstein MH, Hahn CS, Haynes OM | title = Maternal personality, parenting cognitions, and parenting practices | journal = Developmental Psychology | volume = 47 | issue = 3 | pages = 658–75 | date = May 2011 | pmid = 21443335 | pmc = 3174106 | doi = 10.1037/a0023181 }} which in turn could affect child outcomes. Thus, women's mental health throughout the perinatal period should be a priority, not only to support women, but also to promote optimal functioning for their infants.{{Cite web|date=2018-10-03|title=Mother's depression linked to depression in offspring|url=https://www.nhs.uk/news/pregnancy-and-child/mothers-depression-linked-to-depression-in-offspring/|access-date=2020-10-29|website=nhs.uk|language=en}}

Depression during pregnancy is associated with an increased risk of spontaneous abortion. In a review by Frazier et al., acute and chronic stress during pregnancy can diminish proper immunological activity crucial during pregnancy, and can possibly induce spontaneous abortion.{{Cite journal|last1=Frazier|first1=Tyralynn|last2=Hogue|first2=Carol J. Rowland|last3=Bonney|first3=Elizabeth A.|last4=Yount|first4=Kathryn M.|last5=Pearce|first5=Brad D.|date=2018-06-01|title=Weathering the storm; a review of pre-pregnancy stress and risk of spontaneous abortion|journal=Psychoneuroendocrinology|volume=92|pages=142–154|doi=10.1016/j.psyneuen.2018.03.001|pmid=29628283|s2cid=4712455|issn=0306-4530}} There is still a debate on whether the miscarriage is due to the depressive disease state or the anti-depressant medication. A large study conducted in Denmark observed that there was a higher incidence of first trimester miscarriage in depressed women not exposed to SSRI compared to non-depressed women exposed to SSRI,{{Cite journal|last1=Johansen|first1=Rie Laurine Rosenthal|last2=Mortensen|first2=Laust Hvas|last3=Andersen|first3=Anne-Marie Nybo|last4=Hansen|first4=Anne Vinkel|last5=Strandberg-Larsen|first5=Katrine|date=2015|title=Maternal Use of Selective Serotonin Reuptake Inhibitors and Risk of Miscarriage – Assessing Potential Biases|journal=Paediatric and Perinatal Epidemiology|volume=29|issue=1|pages=72–81|doi=10.1111/ppe.12160|pmid=25382157|issn=1365-3016}} indicating that the miscarriage may be associated with the psychological state of the mother rather than the anti-depressant.

Depressive symptoms in pregnant women are linked with poor health outcomes in infants.{{cite journal | vauthors = Coburn SS, Luecken LJ, Rystad IA, Lin B, Crnic KA, Gonzales NA | title = Prenatal Maternal Depressive Symptoms Predict Early Infant Health Concerns | journal = Maternal and Child Health Journal | volume = 22 | issue = 6 | pages = 786–793 | date = June 2018 | pmid = 29427015 | doi = 10.1007/s10995-018-2448-7 | s2cid = 3276559 | pmc = 7928222 }} The rates of hospitalization are found increased for infants who are born to women with high depression levels during pregnancy. Reduced breastfeeding, poor physical growth, lower birth weight, early gestational age and high rates of diarrheal infection are some of the reported outcomes of poor health among infants born to depressed pregnant women.{{cite journal | vauthors = Chung EK, McCollum KF, Elo IT, Lee HJ, Culhane JF | title = Maternal depressive symptoms and infant health practices among low-income women | journal = Pediatrics | volume = 113 | issue = 6 | pages = e523-9 | date = June 2004 | pmid = 15173532 | doi = 10.1542/peds.113.6.e523 | doi-access = free }} In fact, positive antenatal screenings administered in the first or third trimester are found to be high risk factors for early cessation in breastfeeding.{{cite journal | vauthors = Stark EL, Shim J, Ross CM, Miller ES | title = The Association between Positive Antenatal Depression Screening and Breastfeeding Initiation and Continuation | journal = American Journal of Perinatology | pages = s–0039–1695775 | date = September 2019 | volume = 38 | issue = 2 | pmid = 31480085 | doi = 10.1055/s-0039-1695775 | s2cid = 201830547 }} Studies also report that the environmental effects of maternal depression affect the developing fetus to such an extent that the impact can be seen during adulthood of the offspring. The effects are worse for women from low socio-economic backgrounds. In a recent study by Coburn et al., maternal prenatal depressive symptoms predicted significantly higher number of infant health concerns at 12-weeks (3 months) of age. The health concerns included rash, colic, cold, fever, cough, diarrhea, ear infections, and vomiting. Additional concerns for women in low-income backgrounds includes low birth rate and preterm births.

An interesting and informative area of research has been done to see the role of confounding variables in relationship of maternal prenatal depression with infant health concerns. Age of mother, romantic partner, education, household income, immigrant status, and number of other children, breastfeeding, gestational age, birth weight are some of the mediating or moderating factors which are found correlated with infant health concerns.{{cite journal | vauthors = Verma T | title = Comments on "Prenatal Depression and Infant Health: The Importance of Inadequately Measured, Unmeasured and Unknown Confounds" | journal = Indian Journal of Psychological Medicine | volume = 40 | issue = 6 | pages = 592–594 | year = 2018 | pmid = 30533965 | pmc = 6241178 | doi = 10.4103/IJPSYM.IJPSYM_306_18 | doi-access = free }} The studies of post-partum depressive symptoms are relatively more than those of prenatal depression and the studies should look into the role of various factors during pregnancy that may impact the health of infants, even continuing into adulthood.

More than 10% of father experience paternal perinatal depression (PPND).{{Cite journal |last1=O’Brien |first1=Anthony P. |last2=McNeil |first2=Karen A. |last3=Fletcher |first3=Richard |last4=Conrad |first4=Agatha |last5=Wilson |first5=Amanda J. |last6=Jones |first6=Donovan |last7=Chan |first7=Sally W. |date=July 2017 |title=New Fathers' Perinatal Depression and Anxiety—Treatment Options: An Integrative Review |journal=American Journal of Men's Health |volume=11 |issue=4 |pages=863–876 |doi=10.1177/1557988316669047 |issn=1557-9883 |pmc=5675308 |pmid=27694550}} Symptoms are common displayed as fatigue or changes in sleep and eating patterns.{{Cite web |title=Dads Can Get Depression During and After Pregnancy, Too |url=https://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Dads-Can-Get-Postpartum-Depression-Too.aspx |access-date=2022-10-19 |website=HealthyChildren.org|date=17 December 2018 }} A systematic review done in 2016 also found that 4–16% of men experienced anxiety during the antenatal period.{{Cite journal |last1=Leach |first1=Liana S. |last2=Poyser |first2=Carmel |last3=Cooklin |first3=Amanda R. |last4=Giallo |first4=Rebecca |date=2016-01-15 |title=Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review |url=https://pubmed.ncbi.nlm.nih.gov/26590515/ |journal=Journal of Affective Disorders |volume=190 |pages=675–686 |doi=10.1016/j.jad.2015.09.063 |issn=1573-2517 |pmid=26590515}} Men whose partners are women struggling with antenatal or postnatal depression often find themselves receiving less affection and intimacy from their partners.{{Cite web|url=https://raisingchildren.net.au/grown-ups/looking-after-yourself/depression-before-and-after-birth/antenatal-postnatal-depression-men|title=Antenatal depression and postnatal depression in men|website=Raising Children Network|access-date=2019-10-24}} If symptoms of antenatal depression arise in mothers, it is recommended for fathers to provide encouragement for their partners to discuss their condition with a healthcare provider. It is also important for the father to seek support for themselves. Fathers who experience depression are more likely to spank their children and less likely to interact with them.{{Cite web |title=Dads Can Get Depression During and After Pregnancy, Too |url=https://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Dads-Can-Get-Postpartum-Depression-Too.aspx |access-date=2022-10-19 |website=HealthyChildren.org|date=17 December 2018 }} In a research study performed in Sweden observing 366,499 births, newly diagnosed paternal depression around the time of conception or during pregnancy was associated with an increased risk of preterm birth. However, a preexisting paternal depression did not show any correlation, which may be due to the mother's perception of the changes in their partner's mood.{{Cite journal|last1=Liu|first1=C|last2=Cnattingius|first2=S|last3=Bergström|first3=M|last4=Östberg|first4=V|last5=Hjern|first5=A|date=November 2016|title=Prenatal parental depression and preterm birth: a national cohort study|journal=BJOG|volume=123|issue=12|pages=1973–1982|doi=10.1111/1471-0528.13891|issn=1470-0328|pmc=5096244|pmid=26786413}}

• Depression
• Gender disappointment
• Postpartum psychosis

{{reflist}}

• {{cite journal | vauthors = Andrade C | title = Prenatal Depression and Infant Health: The Importance of Inadequately Measured, Unmeasured, and Unknown Confounds | journal = Indian Journal of Psychological Medicine | volume = 40 | issue = 4 | pages = 395–397 | year = 2018 | pmid = 30093759 | pmc = 6065138 | doi = 10.4103/IJPSYM.IJPSYM_232_18 | doi-access = free }}

Category:Pathology of pregnancy, childbirth and the puerperium

Category:Major depressive disorder

Category:Mental disorders associated with pregnancy, childbirth or the puerperium