Indeed maternal mood changes and maternal health disorders before and after childbirth are not uncommon, Dr Lavinia Lumu, a psychiatrist at Akeso Crescent Clinic, points out.
According to her the prevalence of postnatal depression is 20% worldwide, while postnatal depression in South Africa is as high as 34,5%. “Research on antenatal depression during pregnancy is limited, but studies suggest that antenatal depression is as high as 39%. Alas, research on bipolar disorder in pregnancy is also limited in South Africa.
According to the World Health Organisation, 10% of pregnant women and 13% of women who have just given birth, have a risk of developing a mood disorder.
“Maternal mood disorders may occur during pregnancy (antenatal) or in the postnatal period, up to 12 months after delivery. Mood disorders that are likely to occur in the peripartum period include depression and bipolar disorder, which may present with either a manic or a depressive episode”
“Pregnancy is a vulnerable time. There is a surge in reproductive hormones during pregnancy. The increase in reproductive hormones can precipitate or worsen an underlying mood disorder. Childbirth is an intensely physiologically stressful period. After birth, there is a drop reproductive hormones and this becomes a very high-risk time for the development of postnatal depression and bipolar disorder - which could also present as a postpartum psychosis,” she goes on to explain.
There are numerous psychological stressors that can predispose a mother to a mood disorder. “Stressors such as financial problems, intimate-partner violence and a lack of social support can all predispose a mother to a mood disorder. The diathesis-stress theory hypothesises that certain vulnerable individuals who are exposed to stress, are more susceptible to the development of depression. In bipolar disorder, psychosocial stressors may precipitate an episode of either mania or depression.
The mother may have symptoms of depression such as lack of enjoyment in activities, severe anxiety or excessive worry, severe insomnia, poor appetite and concentration, negative ruminations, excessive guilt and suicidal preoccupation can impair a mother's ability to care for her new-born. Data suggests that mothers with antenatal depression may have a small increased risk of pre-eclampsia and a moderately increased risk of giving birth to a baby with low birth weight.
“Manic episodes in bipolar disorder may be associated with an increase in risky behaviours such as promiscuity or substance use, which could affect the unborn foetus during pregnancy. Bipolar disorder has been associated with placental abnormalities and antepartum haemorrhages, foetal abnormalities, restricted birth-weight or gestational age.
Moreover, when a mother has a severe mood disorder, it may result in her inability to fulfill her maternal role in the family, Dr Lumu adds. “Her mood may become unpredictable and this may cause distress to the children. In severe depression, mothers may feel fatigued and lack energy; this may result in the children’s needs being neglected. Mothers with severe mood disorders need support and assistance with the care and nurturing of children in the family,” she advises.
Mood disorders do not resolve spontaneously and tend to get worse if left untreated, Dr Lumu cautions.“Untreated depression, for example, can result in severe symptoms such as suicidal thoughts, thoughts of infanticide or psychosis. It is therefore essential that depressed mothers or mothers with a suspected mood disorder are identified and assisted by seeking professional help so that they can receive effective treatment. This will ensure that they are able to continue to care for their babies,” says Dr Lumu stresses.
“If a mother has been diagnosed with mild depression, she can be managed with psychotherapy. In moderate to severe cases of depression, the mother may need to be treated with medication. Bipolar disorder in pregnancy and the postnatal period requires medication and close monitoring by a trained health professional.
This said, having a mood disorder does not mean that one cannot be a good mother, Dr Lumu adds. “However, if the mood disorder is untreated, the neonatal outcomes are poor. Depressed mothers are more likely to not want to nurture or spend time with their babies. This may result in a neglected baby,” says Dr Lumu.
According to her mood disorders during pregnancy and after delivery may worsen if left untreated. “In severe cases, mothers may become suicidal or psychotic and thoughts of infanticide can also occur in severe cases. Mothers who are manic, may engage in impulsive behaviours that may be dangerous for the unborn foetus. Untreated mania may also result in the mother engaging in high-risk behaviours such as hyper- sexuality and substance use,” she points out.
“An untreated mood disorder can carry on for months. Depressive symptoms that may occur during the perinatal period include a low or depressed mood for at least two weeks, associated changes in sleep, appetite and energy levels, associated symptoms such as impaired concentration and memory, feelings of guilt and hopelessness and social isolation.
“Mothers who have had postnatal depression in past pregnancies are at risk of having postnatal depression in their next pregnancies. Mothers with bipolar disorder are at high-risk of relapse during pregnancy or after delivery. If a mother has had a previous history of depression or bipolar disorder, it is essential that they inform their healthcare provider. This will ensure close monitoring and early intervention in the next pregnancy,” according to Dr Lumu.
On the other hand, professional care and appropriate treatment, as well as family support can go a long way in helping mothers with mood disorders on the way to recovery so that they, along with their families, can enjoy happy, fulfilled lives.