May 3, 2023

Mental Health Awareness Month: Maternal Mental Health Facts by Dr. Holly Puritz

While almost 450 million people in the world have some type of mental illness, only about a third of those people sought treatment for their condition. In order to promote education and awareness of the importance of mental health and to fight stigma around mental illness, Mental Health Awareness Month is observed each year in May. 

Pregnancy is a time of great physical, mental and environmental change, and many people experience mental illness such as anxiety, depression and substance use disorders while pregnant. In fact, maternal mental health conditions are some of the most common yet underdiagnosed issues of pregnancy and childbirth. About 20 percent of women experience a mental health condition while pregnant or in the year following pregnancy.

Lucina board member and board-certified OB/Gyn Dr. Holly Puritz explains that people who are not often feeling well continue with work and other responsibilities. This can be especially difficult, for example, in the first trimester when many pregnant women experience nausea and vomiting or excessive sleepiness. Or in the last trimester, when many women deal with swelling and shortness of breath from carrying a pregnancy.

“These physical changes can be stressors for people while managing their normal activities and the demands that are placed on them, even when they were not pregnant,” she says.

Some women are at higher risk than others for mental health complications during pregnancy. The Maternal Mental Health Leadership Alliance (MMHLA) reports that women of color and those who live in poverty are more likely to have mental health conditions and less likely to receive treatment.

Women with existing mental illness may find that pregnancy can exacerbate their condition. Dr. Puritz explains that women with existing mental health challenges may not reach out for care in a timely fashion, may not be able to understand the care that they need, or may not be able to carry through on advice that has been given to them. In addition, many patients who are on medication feel that it is best to discontinue taking that medication when they become pregnant.

While many patients do not want to talk about their mental health because they are embarrassed or concerned, Dr. Puritz says it is important for women to attend a counseling session prior to pregnancy to discuss their medication, find out whether their mental health treatment needs to be changed, and learn how to best manage mental health while pregnant.

“Being aware of mental health concerns at the beginning of a pregnancy really helps a clinician to deal with and expect or anticipate any problems,” she said.

Questions that are important to consider are:

  • Do we need to increase therapy?
  • Are there lower doses that can be taken?
  • How real are the risks?
  • Do the benefits outweigh the risks?

“Try to get preconceptual counseling,” Dr. Puritz says. “It’s important to make women aware that there is help both through therapy and medication and that there are medicines that are safe to take during pregnancy. Speaking with your obstetrician at any time during the pregnancy is expected and encouraged so we can work as a team to help that person get through any of the stressors that they’re experiencing.”

During pregnancy, stress needs to be addressed when it affects behavior like eating well, sleeping enough and exercising. Signs of a problem can include poor or excessive weight gain, taking on physical symptoms of stress, and not coping well at work, school or with family life.

Other serious red flags include tearfulness, high anxiety, feeling out of control, and talking about ending one’s life.

“If anyone is speaking about suicide or ending their life, they need to be taken seriously,” Dr. Puritz says, emphasizing that it is important to seek help immediately when someone talks about suicide.

MMHLA found that 75 percent of mothers with mood and anxiety disorder symptoms do not receive treatment. This comes with a serious price tag. Maternal mental illness is associated with obstetric, neonatal and long-term health complications. At a cost of $32,000 per mom and baby, mental illness left untreated in the two years from conception to the infant’s first birthday cost the United States around $14.2 billion in 2017.

The good news is new modalities with artificial intelligence and digital health tools are enabling healthcare providers to become more aware of potential mental health problems so they can broach the subject without the patient having to bring it up.

Lucina’s technology can identify at-risk moms as early as the first trimester. Accessing this information early in pregnancy translates to better care for mom and baby during current and future pregnancies. And Lucina can continue to provide important risk assessment data 90 days post-delivery. This is vital for mothers and infants after they’ve left the hospital.

“This can be truly helpful so that we can get the right professionals and support in place to help patients during pregnancy,” Dr. Puritz explains.

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