Mental conditions associated with pregnancy

Pregnancy is a significant life event, and it is expected to feel various emotions. There are many mental health problems a woman could experience before, during, and after this remarkable period. They can happen at any time, even if this is not the first pregnancy. 


Making a decision on whether to have a baby is a crucial and very individual choice. It is common to have some anxiety about bearing. However, some women are so scared of giving birth that they do not want to go through it, even if they really want to become mothers. This condition is called tokophobia, and it can happen in any pregnancy. However, worry is more intense in women having no previous pregnancy experience than in parous women[1]. Tokophobia may affect women from puberty to elderly age. Reasons for this state may vary too: a lack of confidence in the obstetric team, fear of death[2], or dread of child congenital anomalies[3].

This pathological fair has been classified as primary – nulliparous and secondary – after previous traumatic deliveries[4]. Primarily, tokophobia can occur in case of experienced sexual abuse or violence, after horror stories of childbirth heard from other people, in women with panic disorder or problems with the female reproductive system[5]; be inherited from mother. 

A secondary phobia is directly associated with post-traumatic stress disorder (PTSD).

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is an anxiety disorder induced by very stressful, scary, or damaging situations. PTSD can develop rapidly after an accident or appear weeks, months, or even years later. PTSD is frequently identified as a following outcome of childbirth and is related to a pathological fear and delay of further pregnancy adventures. It may be caused by having a traumatic birth experience (emergency cesarean section)[6], miscarriage, or stillbirth.

The most common symptoms of PTSD include flashbacks, nightmares, physical pain, sweating, nausea or trembling, headaches, insomnia, irritability, and avoiding thoughts about what happened. Sometimes women face difficulties in bonding with their babies.

Prenatal depression

Although pregnancy is one of the happiest times in a woman’s life, hormone shifts can create many dangerous conditions. It is evaluated that between 10 and 20 percent of women develop pregnancy-related mood disorders, and approximately 13% of pregnant moms experience depression[7]. Prenatal depression may occur during pregnancy (before childbirth). 

If a female has the following symptoms, it is worth discussing them with a doctor: 

  • Frequent crying or weepiness
  • Sleeping disorders
  • Changes in appetite
  • Lost of interest to earlier pleasurable things 
  • Fatigue
  • Feeling disconnection to developing fetal (poor fetal attachment)
  • Feeling hopeless and overwhelmed
  • Harmful habits (alcohol, smoking)
  • Withdrawing from friends and family

The intensity of symptoms may vary from mild to severe. If a woman had depression before pregnancy, her symptoms might become more intense. 

A confluence of different genetic and environmental factors can contribute to prenatal depression. Life stressors, lack of social support, the physical and emotional demands of childbearing, hormone changes, a personal or family history of depression may be triggers of the depressive disorder. 

This state requires extensive attention from the doctorʼs and familyʼs sides. Depression that appeared during the prenatal period may harm the babyʼs development. Mothers with depressive symptomatology and their infants tend to have elevated cortisol, decreased dopamine, and serotonin. The consequences for infants include some negative behavioral indicators such as irritability, reduced activity, and attentiveness, inadequate emotional expressions[8]. Women with a history of prenatal depression are more likely to experience postpartum depression after childbirth. 

“Baby blues” and postpartum depression (PPD) 

Mood swings in mothers after their child is born are not uncommon too.

Within 24 hours after the baby’s arrival, the levels of estrogen and progesterone (hormones also influencing mood) fall drastically to pre-pregnancy levels[9]. It is called “postpartum hormonal crash,” which causes “baby blues”.

For about 1 or 2 weeks after delivery, a woman may have typical symptoms such as irritability, sadness, overwhelming, frustration, exhaustion, hypersomnia, or insomnia.

Commonly, the symptoms last from 3 to 5 days. If they do not disappear longer than two weeks, the woman may have postpartum depression (PPD). 

In the beginning, postpartum depression may be mistaken for baby blues. However, the signs are more severe and persist more prolonged. Furthermore, they may eventually impede caring for a baby and managing other daily duties. PPD can affect any woman regardless of age, race, and nationality. 

Postpartum depression can be suspected if a woman experience:

  • Severe mood swings
  • Excessive crying
  • Difficulties in bonding with the baby
  • Attendance to isolation from family
  • Loss of appetite or overeating 
  • Loss of energy
  • Intense irritability and anger
  • Fear that she is not a perfect mother
  • Inability to think clearly, in making decisions
  • Severe anxiety and panic attacks

Women are more at risk of PPD if they have a family or personal history of depression, unwanted pregnancy, or a baby with special needs[10]. A more severe form of postpartum depression is called postpartum psychosis. The ill woman may suffer from paranoia, auditory or visual hallucinations, thoughts of harming herself or her baby, recurrent thoughts of suicide. 

Women with developing postpartum depression need medical care immediately. Do not wait and hope for improvement!

Anxiety disorders

It is almost expected to feel anxious while pregnant. However, this sporadic feeling of anxiety can intensify and turn into a disorder. 

The research reports that anxiety is three to four times more common than depression during gestation and early maternity[11], ranging from 13 to 21% of pregnant women experiencing dangerous anxiety during pregnancy[12].

Physical and mental symptoms may include:

  • Persistent concerns
  • Complicated keeping calm and balance 
  • Being constantly “on edge”
  • Flying thoughts
  • Snappy or moody behavior
  • Paralyzing feelings that something terrible will occur to the unborn kid
  • The imagination of the “worst-case scenario”
  • Rapid heart rate
  • Shortness of breath
  • Nausea
  • Hot flashes
  • Dizziness

 Panic attacks can be caused by other disorders such as obsessive-compulsive disorder (OCD). 

Perinatal obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by obsessions and rituals (compulsions) that are not under control. Obsessions are recurring thoughts, urges, or imaginations that cause anxiety. Compulsions are repetitive actions that a person needs to do in response to obsessive thinking. People with OCD repeat some rituals expecting that their obsessive worries will end. 

Obsessive-compulsive disorder can occur with specific symptoms during the pregnancy or postpartum period. The last trimester of pregnancy and the postpartum period are the most likely for this disorder. There is no relationship between age, educational grade, profession, number of pregnancies, history of abortion, gestational complications, and OCD in pregnant women. OCD characteristics are similar in nonpregnant women and those waiting for a child[13].

From a clinical point of view, obsessions and compulsions are mainly related to the fetus or newborn babyʼs health[14]. Some individuals with obsessive-compulsive disorder also have a tic disorder. Motor spasms are sudden, brief, repetitive (eye blinking, facial grimacing, head or shoulder jerking). Traditional vocal tics include repeated throat-clearing, snuffing, or nagging noises. 

If untreated, OCD may interfere with any aspect of life and make it impossible.

Women with severe mental illnesses

Very frequently, severe mental diseases coincide with the period when women experience pregnancy and childbirth. Bipolar disorder is a real example. This psychiatric disease is usually diagnosed between 18 and 30 years of age[15].

Many women with BD and other mental illnesses may have healthy pregnancy outcomes. However, there are some risks around having a child. The complex view of difficulties that ill pregnant women face includes health-related threats for the mother and her baby, taking medications during pregnancy.

Firstly, women with severe mental diseases are more likely to develop postpartum psychosis, postnatal depression, and other conditions associated with pregnancy. Besides, their symptoms are more critical, and women may even harm themselves or their babies. 

Secondly, there is always a question regarding the use of psychotropic medications during pregnancy. Very crucial is to understand the dangers connected with fetal exposure to a specific drug and consider the risks associated with untreated psychiatric illness in the mother. 

Women must not decide before talking to the doctor whether to stop taking medication for mental health problems. A sudden stop may cause withdrawal symptoms and threaten the female mental state. A doctor should explain and weigh all the risks and help future mothers make the best decision. 


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