Preconception Planning to Reduce the Risk of Perinatal Depression and Anxiety Disorders

Orit Avni-Barron; Kelly Hoagland; Christina Ford; Laura J Miller


Expert Rev of Obstet Gynecol. 2010;5(4):421-435. 

In This Article

Risks of Untreated Symptoms

Depressive and anxiety symptoms may increase the risk of adverse outcomes affecting mother and child both during and after pregnancy. Understanding these risks clarifies the importance of planning preventive strategies in advance.

Some adverse effects are directly linked to the symptoms of depression or anxiety. For example, anhedonia (the inability to experience interest or pleasure) can reduce a woman's emotional involvement with her fetus, and loss of appetite can interfere with adequate nutrition. Other adverse effects stem indirectly from the effects of depression or anxiety on health practices.[8] For example, antenatal depression has been associated with increased use of alcohol and tobacco during pregnancy.[9]

Other obstetric problems associated with antenatal depression and anxiety include increased frequency of nausea and vomiting, epidural analgesia and cesarean sections.[10] In addition, several studies have shown associations between maternal antenatal stress and/or depression with preterm birth and low birth weight.[11–13] High levels of cortisol are posited to mediate this effect.[14]

Sustained cortisol elevation may also account for the adverse effects of antenatal maternal depression and anxiety on obstetric complications and on offspring, a phenomenon known as 'fetal programming'. Infants of depressed mothers tend to show more inconsolability and excessive crying.[15] Children of women who experienced antenatal depression are more prone to negative emotions and behavioral problems.[16] Similarly, sustained high levels of maternal anxiety during the third trimester of pregnancy significantly predict anxiety, sleep disturbance and other emotional problems in children.[17,18]

Postpartum anxiety and/or depression may interfere with maternal self-care and mother–infant bonding, increasing the risk of infant neglect.[19] In addition, compared with nondepressed mothers, depressed mothers have decreased breastfeeding duration and self-efficacy, and more breastfeeding difficulties.[20]

In summary, untreated perinatal depression and anxiety symptoms pose significant short- and long-term risks to women and their offspring.


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