How Pregnancy Can Affect Your Mental Health

Most of us have heard of the “baby blues,” but did you know that many moms-to-be face mental health challenges that start while they’re expecting?

Anxiety and depression are the two most common psychological disorders that arise during pregnancy, says UNC Health psychiatrist Mary Kimmel, MD.

She shares how pregnant women can be vigilant about prioritizing their mental health before the baby arrives, and how to know when it’s time to seek help.

Mental Health Challenges During Pregnancy Are Common

If you’ve experienced anxiety during pregnancy, you’re not alone. Research shows that 1 in 5 women have an anxiety disorder during pregnancy.

It is normal to worry about things like money, health and family problems. But someone with an anxiety disorder will have persistent worry that can get worse over time, according to the National Institute of Mental Health.

“There are many different types of anxiety disorders, including generalized anxiety disorder, panic attacks, obsessive-compulsive disorder and social anxiety. It’s possible those conditions were there before and become amplified in pregnancy,” Dr. Kimmel says.

Many mothers-to-be also experience depression, a feeling of deep sadness or hopelessness that can impair their quality of life.

Symptoms of anxiety and depression during pregnancy often develop as a result of the following factors:

  • Biological changes. Pregnancy brings hormonal changes, including an increase in estrogen and progesterone until delivery. Some people are sensitive to these hormonal shifts and the way they interact with other systems in the body, which can lead to symptoms of depression or anxiety, Dr. Kimmel says.

Also during pregnancy, the immune system adapts to find a balance between protecting mom and the growing baby while also tolerating the necessary changes. Levels of cortisol, the body’s stress hormone, increase to support the baby. This change can contribute to symptoms of anxiety and depression.

  • Psychological stress. While pregnancy can cause excitement and happy thoughts, it’s important to create space to process negative feelings and emotions, too. For many, pregnancy can conjure up worry about caring for a newborn, as well as negative memories.

“As you think about what parenting will mean for you, you might think about unpleasant experiences from your childhood, miscarriages or infertility,” Dr. Kimmel says.

  • Logistical concerns. Frequent doctor visits throughout pregnancy can cause stress for pregnant women, especially if they need child care or time off work to attend. For working moms, trying to line up child care when maternity leave ends can also cause tension. And the COVID-19 pandemic has added a layer of concern for pregnant women as they try to keep themselves healthy and plan for who can be in the delivery room when the baby comes.

Keep an Eye Out for Symptoms That Stick Around

It’s normal to experience a wide range of emotions during pregnancy, but pay attention to how long any negative emotions last.

“Be kind to yourself and honor your feelings—they don’t have to always be positive,” Dr. Kimmel says. “However, if you feel like you are getting stuck in emotions like sadness or irritability, it might be beneficial to talk with a mental health professional who can help you move through those and assess if treatment would be right for you.”

Other signs to look for include not engaging in activities you used to enjoy, loss of appetite and trouble sleeping.

How to Prioritize Mental Health During Pregnancy

Mental health should be a priority for everyone, regardless of their psychological history. However, it’s especially important for pregnant women as they prepare for such a significant life change.

Here are some practical ways to prioritize your mental health during pregnancy:

  • Make time for things you enjoy. Try to do one thing for yourself every day—work out, read a book, spend time with friends or watch your favorite show.
  • Ensure that you have a strong support system. Whether you lean on your partner, close friends or family, or a therapist, your support system should be committed to encouraging you throughout the pregnancy and ready to listen when you need help processing your emotions.
  • Frequently check in with yourself. Pay attention to whether you are getting enough sleep, eating well and engaging in activities you enjoy. Be ready to adjust if you identify an area that needs more attention.
  • Be honest on mental health screening questionnaires. It can be embarrassing to write down how you really feel, but remember that the questionnaires you fill out at the doctor’s office are designed to get you thinking about your needs and how to meet them. The surveys are a tool to help you advocate for yourself, Dr. Kimmel says.

What if You Had a Psychological Diagnosis Before Your Pregnancy?

If you have a psychological diagnosis and are considering becoming pregnant or are pregnant now, tell your obstetric provider. There are many treatment options that are safe for pregnant women.

“If you are being treated with medicine that has worked well for you, it’s likely that you could continue that treatment,” Dr. Kimmel says.

If you don’t feel comfortable taking medicine, many types of therapy, mindfulness techniques and wellness plans could help. Talk to your medical team about which route might be best for you.

Be Vigilant After Delivery

A study led by UNC School of Medicine researchers found that women who experienced depression during pregnancy may be at risk for more severe postpartum depression than those whose symptoms begin after birth.

If you had symptoms during pregnancy, check in with yourself often to make sure your needs are being met. Ask your partner and support system to check on you, too. If you start experiencing new or worsening symptoms of depression or anxiety, reach out to your care team.

Looking for an obstetric provider or a mental health professional? Find one near you.