Depression during pregnancy affects approximately one in five women,1 which may be an underestimation due to the lack of consistent screening and identification of those struggling.2 This mental health issue, known as perinatal depression, can be an especially difficult topic to navigate when culturally, pregnant mothers are expected to present as happy and glowing parents-to-be.
“Education and awareness can help identify those struggling earlier so that treatment options can be implemented sooner.”
Perinatal depression does not have a single cause. Research suggests that it’s caused by a combination of genetic and environmental factors. Life stress, the physical and emotional demands of childbearing, and changes in hormones that occur during pregnancy may contribute to the development of perinatal depression. Some of the most prominent risk factors for depression in pregnancy include a history of depression, lack of social support, lack of a partner, unplanned pregnancy, unemployment, experience of violence, and smoking before or during pregnancy.1 It’s important to recognize individual factors that may predispose someone to a higher risk of mood disorders in pregnancy.
SYMPTOMS
Symptoms of depression in pregnancy can be insidious and can often mimic common symptoms of pregnancy, such as low energy and reduced sleep quality. Mood changes can occur in any trimester, but are most common in the second and third.3 A sad mood, difficulty enjoying activities that you usually like to do, feelings of worthlessness or guilt, unexpected fatigue or lack of energy, or unexpected changes in your sleep patterns are important to discuss with your healthcare provider. Education and awareness can help identify those struggling earlier so that treatment options can be implemented sooner.
SUPPORT STRATEGIES
The following strategies are helpful for reducing the risk of perinatal depression and supporting mild to moderate depression. These tools are also helpful as adjunct treatments for moderate to severe depression in pregnancy; however, Cognitive Behavioural Therapy (CBT) and pharmaceutical antidepressant medications are considered the standard of care in more serious cases of depression, especially when thoughts of self-harm are present. It’s important to work together with a healthcare practitioner for guidance, regardless of the severity of mental health concerns.
Nutrition
Maternal nutrition during pregnancy significantly affects the health of both mom and baby. Several studies have shown that a nutrient-dense diet may help to reduce the risk of depression during pregnancy. Diets with more green vegetables, fruits, legumes, and fish—and less processed fats and sugars—have been linked to lower levels of prenatal depression. 4,5
Iron
Iron deficiency anemia is significantly associated with an increased risk of maternal depression both during pregnancy and the postpartum period.6 Advocating for testing and following up with the indicated treatment is a key preventative strategy in supporting mental health through the perinatal period. Not only does iron status in pregnancy affect maternal mental health, but we also see it has many links to the baby’s mental and cognitive function for at least the first decade of its life.7
Vitamin D
Low levels of vitamin D have been linked to depression in pregnancy. Research shows that testing for vitamin D levels in early pregnancy, and treating appropriately to correct the deficiency, is the best strategy to ensure appropriate dosing and the best outcomes.8,9
Omega-3s
Fish oil supplementation has shown positive benefits for depression in the general population, and there are many safety studies for its use in pregnancy. Taking fish oil supplements with a combined EPA and DHA omega-3 content during pregnancy has been shown to improve symptoms of depression, and prevent the risk of postpartum depression. Omega-3s are also critical for fetal brain development and cognitive function.10,11
Exercise
Prenatal exercise has been shown to reduce the onset and severity of depression in pregnancy. Aiming for 150 minutes of moderate-intensity activity weekly (such as brisk walking, water aerobics, stationary cycling, or resistance training) has been linked to a significant improvement in mood symptoms. Prenatal yoga has also shown benefits for improving depression and anxiety in pregnant mothers.12,13
Sleep
Poor sleep quality and less than six hours of sleep nightly are associated with an increased risk of depression during pregnancy.14 Recognizing the importance of sleep and prioritizing rest, as well as putting sleep supports in place, may help to modify this risk. Evidence-based tools to improve sleep for pregnant women include massages, yoga and mindfulness, regular exercise, progressive muscle relaxation, and CBT.15
Cognitive Behavioural Therapy
CBT is considered a first-line treatment for depression and anxiety during the perinatal period.16 CBT is a type of psychotherapy that teaches people different ways of thinking, behaving, and reacting to situations. It helps people learn to challenge and change unhelpful patterns of thinking and behaviour as a way of improving their depressive and anxious feelings and emotions. CBT can be conducted individually or with a group of people who have similar concerns.
Bright Light Therapy
This is a first-line therapy for Seasonal Affective Disorder (SAD), and newer research is showing its promise for the treatment of other types of depression, including perinatal depression. One study showed that exposure to bright light therapy of 10'000 lux for 30 minutes daily over the course of six weeks during pregnancy, reduced symptoms of depression in 73 percent of pregnant mothers; improvements in mood were sustained nine months postpartum.17 This is a safe and effective tool that is easily accessible for home use during pregnancy.
One of the most important strategies for maternal mental health is to set up a support system of family, friends, and care providers to help during the perinatal period. This huge life transition truly requires a caring and understanding community. Opening up conversations in advance around mental health, signs and symptoms, as well as identifying individual maternal risk factors, can help mothers get the support they need earlier to prevent negative outcomes. Supporting maternal mental health through pregnancy improves birth outcomes, relationships with the newborn, and family dynamics as a whole.
For references visit ecoparent.ca/TWF/LATEWINTER23
You May Also Like: Tips for Postpartum Depression Prevention, The First 48 Hours After Baby is Born, A Healthy Dose of Postpartum Truth.
