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Can Depression Affect my Pregnancy?

July 07, 2013

Everyone faces times of sadness that may result in depression. Sometimes, the sadness may be a lifelong struggle, but sometimes, the feelings may come suddenly from an unexpected tragic event. Unfortunately, pregnant women are not immune to those feelings or uncontrollable events. Recently, I had a lovely pregnant patient face something incredibly challenging in her pregnancy. I’ll change the names and exact details so it doesn’t identify the person, but it’s a situation that may strike a chord with you.

Melissa is a 37-year-old woman followed in my office with her first pregnancy. The pregnancy was planned; she and her significant other were ecstatic! She likes her job and her husband is supportive of her both personally and professionally. They have never had serious marital problems. She was raised in a traditional nuclear family and was extremely close to her grandmother Ann who watched Melissa grow up until she went to college at 18. Whenever Melissa had exciting news, her grandmother was one of the first to know it. Also, to demonstrate their closeness, whenever Melissa encountered difficulties in her life, she would routinely discuss it with Ann, as she deemed her grandmother to be such a wise woman with unconditional love.

At 24 weeks gestation her mother called and informed her that her grandmother, Ann, had suddenly and unexpectedly passed away from a stroke. Melissa felt empty, sad and lost and made plans to fly home to attend the funeral. Because of work circumstances, however, she could not get permission to leave and became angry.

Before getting into what happened next, I’ll share a little of Melissa’s family and social history. Her brother had been treated for panic disorder since adolescence and her mother who suffered from postpartum depression. Melissa did not smoke, drink or use drugs. She graduated from a liberal arts college and met her husband on a blind date. She was Christian and went to church intermittently. Melissa did not have any known medical problems or psychiatric history up to this point. She had never been treated for depression and had never lost a close family member.

Five days after being notified of her grandmother, Ann’s, death, she came to my office and discussed the loss and her feelings. She said she so wanted her grandmother to see and hold her baby, but felt helpless and hopeless now. She denied any suicidal thoughts, but stated she had not eaten in two days and was crying and sleeping ‘a lot.' She was worried that her stress and depression could be hurting her fetus.

We talked about the grief process and I explained that the way she was feeling was likely temporary since she had never had psychiatric illness in the past. I recommended that she schedule counseling. She already had an appointment with her church assistant pastor for that afternoon. I told her that unless she spent a prolonged time in starvation or dehydration it was very unlikely her fetus would be hurt.  She seemed in better spirits when she left the office.

She returned a week later and had gained two pounds. The visit with her pastor and time were helpful in regaining her perspective and reestablishing equilibrium.  On the advice of her pastor she had written a letter to her grandmother Ann that detailed how much Ann meant to her. At nine months she had an uncomplicated delivery of a 7 lb. 2 oz. baby girl that she and her husband named Ann.

There are many different ways to define depression. Sometimes depression is caused by a situation, as in Melissa’s case, or sometimes there is not trigger, so it’s endogenous. The endogenous form, however, can be chronic, recurrent and associated with other psychiatric disorders. This form may require therapy.

The situational form usually has a trigger event, is self-limited and may not require long-term therapy.

Whether depression directly affects the pregnancy or not is controversial. Clearly, if prolonged nutrition and hydration are compromised the pregnancy could suffer, but whether stress hormones adversely affect the pregnancy is unknown. There is some suggestion, however, that the way one copes with depression can affect pregnancy. For example, some women may not continue with the recommended prenatal care, which could result in missing crucial findings for the pregnancy that need to be addressed (fetus is measuring smaller, findings on sonograms, blood pressure readings, etc).  Other women may seek peace in using tobacco, alcohol or drugs, which has proven detrimental effects to the fetus. Sometimes, the maternal-infant bonding can be affected or perhaps the mother may not initiate breastfeeding (which has many proven benefits especially early on).

Furthermore, depression in pregnancy can eventually turn into postpartum depression, which is depression that occurs after the baby is born. Postpartum depression can occur in women who have no history of depression. There are certain risk factors for having it (which we can address at another time in depth) and given that Melissa’s mother suffered from it, that does place Melissa at an increased risk for developing it herself.

In Melissa’s case understanding the important role Ann played in her life allowed her to emotionally accept the loss. The pastor gave Melissa the opportunity to create a transition to life with memories of Ann by writing the letter to her grandmother. She understood that losing her grandmother Ann did not mean she lost the loving memories that influenced her life’s decisions.

Throughout the process, her husband remained supportive and even had an old snapshot of Melissa and Ann on a sliding swing in the backyard when Ann was 7 years old blown up into an 8 X 11 photo and framed it for her.

The loss of her cherished grandmother during her pregnancy resulted in a situational depression that was emotionally painful, but self-limited. No medications or long-term therapy were required to resolve the depression. What was important for Melissa was to recognize her feelings and to seek help. By relying on the help provided by her doctor, pastor, husband, family and friends, she was able to overcome this difficult season in her life and go on to enjoy her baby girl.