Unipolar Depression During Pregnancy: Nonpharmacologic Treatment Options

Christopher Tjoa; Emmanuelle Pare; Deborah R Kim

Disclosures

Women's Health. 2010;6(4):565-576. 

In This Article

Depression During Pregnancy

Depressive symptoms occur in approximately 20% of pregnant women,[5] with major depressive episodes (MDEs) occurring in 13% of pregnant women.[6–8] With approximately 4 million live births each year in the USA, this translates to approximately half a million pregnancies being exposed to depression per year. The risk is higher in women who have a history of recurrent MDD prior to pregnancy with a relapse rate of almost 70% in women who discontinue antidepressants for pregnancy.[6] Unfortunately, pregnant women with mental illness are less likely to access care. A recent study reported that only 6% of women needing referral for perinatal mental illness remained in treatment at 6 months, with pregnant women being less likely to follow-up than postpartum women.[9]

Maternal health is a key component of child health. Depressed women may have difficulty caring for themselves in ways necessary to ensure the health of their developing fetus. Women who are depressed during pregnancy are less likely to get prenatal care and more likely to abuse drugs and alcohol.[3,4,10–13] Common symptoms of depression, such as poor sleep and decreased appetite, may also have an adverse impact on pregnancy. Suicidal ideation during pregnancy is unexpectedly high.[14] In addition, depression during pregnancy is associated with poorer obstetrical outcomes such as preterm birth,[15,16] pre-eclampsia,[17] decreased birth weight[18,19] and increased admission to neonatal care units.[20] Importantly, depression during pregnancy usually continues into the postnatal period[21] when maternal depression is known to have adverse effects on mother–infant bonding as well as child development and behavior.[22–27]

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