News Moms Need

We receive a number of questions about the effects of stress and depression on pregnancy. Here is some information that can help you better understand these conditions, how they can affect your pregnancy, and when you should talk to your provider.

Stress

Feeling stress during pregnancy is very common. There are so many changes happening all at once—to your body, your emotions, and your family—it is hard not to feel overwhelmed. But too much stress can make you uncomfortable. Stress can make you have trouble sleeping or have headaches. Regular stress during pregnancy, such as work deadlines and sitting in traffic, probably don’t add to pregnancy problems.

However, more serious types of stress may increase your chances for premature birth. Serious types of stress include:

• Negative life events. Such as divorce, serious illness or death in the family.
• Catastrophic events. Earthquakes, hurricanes or terrorist attacks.
• Long-lasting stress. This type of stress can be caused by having financial problems, being abused, having serious health problems or being depressed.
• Racism. Some women may face stress from racism during their lives. This may help explain why African-American women in the United States are more likely to have premature and low-birthweight babies than women from other racial or ethnic groups.
• Pregnancy-related stress. Some women may feel serious stress about pregnancy. They may be worried about miscarriage, the health of their baby or about how they’ll cope with labor and birth or becoming a parent. If you feel this way, talk to your health care provider.

We don’t completely understand the effects of stress on pregnancy. But stress-related hormones may play a role in causing some pregnancy complications.

Post-traumatic stress disorder (PTSD)

PTSD occurs in some people after they have experienced a shocking, scary, or dangerous event. People with PTSD may have:

• Serious anxiety
• Flashbacks of the event
• Nightmares
• Physical responses (like a racing heartbeat or sweating) when reminded of the event

As many as 8 in 100 women (8 percent) may have PTSD during pregnancy. Women who have PTSD may be more likely than women without it to have a premature or low-birthweight baby. A 2014 study looked at the effects of PTSD on pregnancy. Researchers reviewed over 16,000 births and found that having PTSD in the year before delivery increased a woman’s chance of giving birth early by 35%.

Depression

Depression is a medical condition in which strong feelings of sadness last for a long time and interfere with your daily life. People who have depression need treatment to help them get better. About 1 in 5 women has depression sometime in her life. And 1 in 7 women is treated for depression at some time between the year before pregnancy and the year after pregnancy.

If you’re pregnant and have depression that’s not treated, you’re more likely to have:

• A premature baby.
• A baby born at a low birthweight.
• A baby who is more irritable, less active, less attentive and has fewer facial expressions than babies born to moms who don’t have depression during pregnancy

Being pregnant can make depression worse or make it come back if you’ve been treated and are feeling better. If you have depression that’s not treated, you may have trouble taking care of yourself during pregnancy. And if you have depression during pregnancy that’s not treated, you’re more likely to have postpartum depression (PPD) after pregnancy. PPD can make it hard for you to care for and bond with your baby. Treatment for depression during pregnancy can help prevent these problems.

If you are concerned that you may have one of these conditions, please talk to your health care provider. She can help you to get the appropriate treatment so that you and your baby can be as healthy as possible.

Have questions? Text or email AskUs@marchofdimes.org

A new study suggests that the use of antidepressants during pregnancy, specifically in the second and third trimesters, may increase the risk of autism spectrum disorder (ASD) in children.

While these findings help to add to our understanding of autism, it is important to recognize that this study does not prove that antidepressant use causes autism. It is difficult to determine whether the increased risk of ASD is the result of antidepressants or the result of the underlying depression.

Researchers looked at data from more than 145,000 births between 1998-2009. They found that when mothers took antidepressants during the second and third trimesters, the chance that the child would develop ASD was higher when compared to children whose mothers did not take antidepressants. Keep in mind that the overall risk of having a child with autism is 1%. This study suggests that the risk increases to 1.87% if a woman is taking certain antidepressants.

The increase was seen with a specific type of antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs are the most commonly prescribed antidepressant medicines and include medications like citalopram (Celexa®), escitalopram (Lexapro®), fluoxetine (Prozac®), paroxetine (Paxil®) and sertraline (Zoloft®).

There are a number of causes of ASD but we don’t know all of them. More research is needed. However, there are some factors that we know increase the chance of ASD:

• Having pregnancy complications. Some research shows that there may be a link between ASD and pregnancy complications that lead to low birthweight, premature birth or cesarean birth.
• Taking certain prescription medicines, like valproic acid or thalidomide, during pregnancy. Taking these medicines during pregnancy has been linked with a higher risk of having a child with ASD.
• Having an older parent. Babies born to older parents are more likely to have ASD.
• Having genes linked to ASD. Researchers are studying a number of genes that may be linked to ASD. Children who have a brother or sister with ASD are more likely to have ASD themselves.
• Having a genetic or chromosomal condition. ASD happens more often in children who also have certain genetic or chromosomal conditions, like fragile X syndrome or tuberous sclerosis.

Important:  If you are pregnant or thinking about getting pregnant and are taking antidepressants, you should not stop taking them until you talk to your health care provider. Together you can look at the possible risks of these drugs on your baby as well as the risk of having your depression come back if you stop taking your medicine. Learn as much as you can about the medicines so you can make the best choice for you and your baby.

Have questions? Email us at AskUs@marchofdimes.org.

Depression is more than just feeling sad. It is a medical condition that affects your thoughts, feelings, and even causes changes to your body. You may have depression if you have any of these signs that last for more than 2 weeks:

Changes in your feelings 

• Feeling sad, hopeless or overwhelmed
• Feeling restless or moody
• Crying a lot
• Feeling worthless or guilty

Changes in your everyday life 

• Eating more or less than you usually do
• Having trouble remembering things, concentrating or making decisions
• Not being able to sleep or sleeping too much
• Withdrawing from friends and family
• Losing interest in things you usually like to do

Changes in your body 

• Having no energy and feeling tired all the time
• Having headaches, stomach problems or other aches and pains that don’t go away

If you have any of these symptoms, talk to your health care provider.

Depression during pregnancy

If you’ve had depression before, you’re more likely than other women to experience depression during pregnancy. If left untreated, depression during pregnancy can affect your baby. If you’re pregnant and have depression that’s not treated, you’re more likely to have:

• Premature birth (before 37 weeks of pregnancy).
• A low-birthweight baby (a baby weighing less than 5 pounds, 8 ounces).
• A baby who is more irritable, less active, less attentive and has fewer facial expressions than babies born to moms who don’t have depression during pregnancy.

It’s best if a team of providers treats your depression during pregnancy. These providers can work together to make sure you and your baby get the best care. They may include your prenatal care provider and a professional who treats your depression (such as a psychiatrist, psychologist, therapist, or counselor).

There are several treatment options available for depression during pregnancy including talk therapy, support groups and medicine, such as antidepressants.

Some research shows that taking an antidepressant during pregnancy may put your baby at risk for certain health conditions. But if you’ve been taking an antidepressant, it may be harmful to you to stop taking it. So talk with your provider about the benefits and risks of taking an antidepressant while you’re pregnant. Together you can then decide what you want your treatment to be. If you’re taking an antidepressant and find out you’re pregnant, don’t stop taking the medicine without talking to your provider first. Not taking your medicine may be harmful to your baby, and it may make your depression come back.

If you’re pregnant and you have any signs of depression, talk to your health care provider. There are things you and your provider can do to help you feel better.

Have questions? Text or email us at Askus@marchofdimes.org.

The use of certain antidepressants during pregnancy is associated with a higher risk of birth defects, according to a new study. But other antidepressants do not carry the same risk.

The study looked at a specific group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs are medications used to treat depression and other mental health conditions. Previous studies gave conflicting evidence about potential links between the use of SSRIs during pregnancy and certain birth defects.

In this study, researchers from the CDC analyzed data from 17,952 mothers of infants with birth defects and 9,857 mothers of infants without birth defects, born between 1997 and 2009.

The researchers found that some birth defects occur about two or three times more frequently among babies born to women who took certain SSRI medications, like Prozac (fluoxetine) and Paxil (paroxetine) early in pregnancy. It is important to note that the actual risk for a birth defect among babies born to women taking Prozac or Paxil is still very low. For example, the risks for a specific heart defect could increase from 10 per 10,000 births to about 24 per 10,000 births among babies of women who are treated with Paxil early in pregnancy. Since these specific types of birth defects are rare, even doubling the risk still results in a low overall chance.

Researchers did not find a link between birth defects and other SSRIs such as Zoloft (sertraline).

“A pregnant woman should be reassured that she can choose a safe drug to treat her depression and not have to go off her medication because she is afraid her baby may develop a birth defect,” Dr. Edward McCabe, Chief Medical Officer of the March of Dimes said. “Not treating depression can be unhealthy for both the mom and her baby. It can cause stress, and stress during pregnancy is associated with early births and low-birthweight babies.”

If you are currently taking an antidepressant and are concerned, do not stop taking the medication until you talk to your health care provider. And if you are planning to become pregnant and are taking an antidepressant, schedule a preconception checkup and discuss what medications may be best for you.

Depression is a serious medical condition. It is an illness that involves the body, mood and thought. It affects the way a person feels about themselves and the way they think about their life. So many people were shocked and saddened by the news about Robin Williams. But unfortunately, depression is far more common than many of us realize. And regrettably, many people still feel that depression is a sign of weakness and do not recognize it as the biological illness that it is.

As many as 1 out of 5 women have symptoms of depression during pregnancy. For some women, these symptoms are severe. Women who have been depressed before they conceive are at a higher risk of experiencing depression during pregnancy than other women.

Signs of depression
Depression is more than just feeling sad or “blue.” There are physical signs as well. Other symptoms include:
• Trouble sleeping
• Sleeping too much
• Lack of interest
• Feelings of guilt
• Loss of energy
• Difficulty concentrating
• Changes in appetite
• Restlessness, agitation or slowed movement
• Thoughts or ideas about suicide

It may be hard to diagnose depression during pregnancy. Some of its symptoms are similar to those normally found in pregnancy. For instance, changes in appetite and trouble sleeping are common when you are pregnant. Other medical conditions have symptoms similar to those of depression. A woman who has anemia or a thyroid problem may lack energy but not be depressed. If you have any of the symptoms listed, talk to your health care provider.

Treatment options
Since depression is a serious medical condition, it poses risks for you and your baby. But a range of treatments are available. These include therapy, support groups and medications.

It is usually best to work with a team of health care professionals including:
• Your prenatal care provide
• A mental health professional, such as a social worker, psychotherapist or psychiatrist
• The provider who will take care of your baby after birth

Together, you and your medical team can decide what is best for you and your baby.

If you are on medication and thinking about getting pregnant, talk to your doctor. You will need to discuss whether you should keep taking the medication, change the medication, gradually reduce the dose or stop taking it altogether.

If you are taking an antidepressant and find that you are pregnant, do not stop taking your medication without first talking to your health care provider. Call him or her as soon as you discover that you are expecting. It may be unhealthy to stop taking an antidepressant suddenly.

If you or someone you know is experiencing any signs of depression, please talk to your health care provider or someone you trust. Help is available and you can feel better.

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