Mental health disorders and pregnancy

While pregnancy is often a time of happiness and excitement, for women with medical complications it can also be a time of increased stress. Having a mental health disorder, such as anxiety, depression, bipolar, or obsessive-compulsive disorder (to only name a few), can definitely increase the stress level for a mom-to-be.

Mental health disorders are common. In the United States, it is estimated that 500,000 pregnancies coexist with a mental health diagnosis. This includes those women who have a preexisting mental health disorder as well as those who are diagnosed during their pregnancy.

Pregnancy is often a time of increased awareness when it comes to medication safety. Many pregnant women do not want to take any medications—or as few as possible—out of fear that something they take may harm their baby. While this is often a good rule of thumb, abruptly discontinuing a medication can spell disaster for the woman who has a mental health illness and depends on a drug for treatment.

In a perfect world, all women who are planning to become pregnant would have a preconception visit. This is a visit with an obstetric provider before a woman is pregnant so her health history can be reviewed. This ensures a mom-to-be is in her healthiest state prior to conceiving, and it gives doctors the chance to make sure all health issues are addressed and all medications are safe for pregnancy.

For women with mental health disorders, this visit is important. While many medications are fine to continue in pregnancy, there are some that should definitely be stopped as they can lead to birth defects. Other medicines may require dosage adjustments in pregnancy, and failing to do so can mean a woman is not getting enough of the drug she needs.

This visit is also a time to ensure that a woman feels ready and stable enough to become pregnant, and that she has the supports in place to make sure she feels ready to tackle the emotional and physical changes that pregnancy and a new baby will bring.

If a preconception visit was not possible, there is still plenty of time to help a mom and her baby get off to their best start. As early as possible, it is important that medications are reviewed and the same safety checks that would have occurred at a preconception visit still happen.

For medicines that are safe in pregnancy, or for those where the benefit of taking them outweighs the risks, the usual goal is to have a pregnant woman take as few as possible—if that is achievable. This means rather than taking two medicines at lower doses, if possible a single medicine at a higher dose may be preferable.

The guiding mantra when it comes to psychiatric drugs in pregnancy for obstetric providers is that if it is helping the woman, leave her on it! For example, while some antidepressants are considered safer in pregnancy, if a pregnant woman is doing great on a different drug and it is reasonably safe, it is usually better to leave her on that drug rather than make a switch mid-pregnancy.

Treating mental health disorders is more than just taking pills, however, and it is important that obstetric providers realize this. Preparing a woman for the emotional rollercoaster of childbirth, the sleep deprivation that comes with having a new baby, and the hormonal fluctuations that can lead to worsening depression and anxiety symptoms is so important. The prenatal time is a perfect chance to establish a relationship with a trusted therapist (and one who is experienced with new moms is best), get involved with new parent groups so a safety net is already waiting for you, and plan to have help if and when you need it. Getting family members on board to help watch out for mom, and even hiring a postpartum doula to pitch in during those early weeks, can mean the difference between a happy homecoming and a stressful one.

It is possible to have a happy, healthy pregnancy and manage a mental health disorder successfully. If you are in this scenario, make sure your obstetric provider knows your medical history so he or she can be available to you and be on your side. Never stop a medicine without checking in first, and if at some point you feel that you might harm yourself or someone else, be sure to call 911 or go to the nearest emergency department so you can get the help you deserve and need.