Skip to main content

Risk of Untreated Symptoms of PMADs in Pregnancy and Lactation

  • Chapter
  • First Online:
Women's Mood Disorders
  • 1081 Accesses

Abstract

When left untreated, perinatal mood and anxiety disorders (PMADs) are associated with increased risk for numerous adverse effects for the mother, the infant, and the mother-infant dyad. The significant risks of untreated symptoms must be weighed against the risks of treatment options in pregnancy and lactation. It is paramount that providers and patients understand the risk of not treating during pregnancy, as the symptoms themselves can lead to great harm. This chapter will review the correlated risks of untreated symptoms in detail, as well as the impact on lactation and breastfeeding. Lastly, the economic impact of untreated PMADs will be addressed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Cohen LS, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499–507.

    Article  CAS  PubMed  Google Scholar 

  2. Llewellyn AM, Stowe ZN, Nemeroff CB. Depression during pregnancy and the puerperium. J Clin Psychiatry. 1997;58(Suppl 15):26–32.

    PubMed  Google Scholar 

  3. O'Hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry. 1996;8(1):37–54.

    Article  Google Scholar 

  4. Yonkers KA, et al. Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry. 2001;158(11):1856–63.

    Article  CAS  PubMed  Google Scholar 

  5. Gaynes BN, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ). 2005;119:1–8.

    Google Scholar 

  6. Elisei S, et al. Perinatal depression: a study of prevalence and of risk and protective factors. Psychiatr Danub. 2013;25(Suppl 2):S258–62.

    PubMed  Google Scholar 

  7. Earls MF. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032–9.

    Article  PubMed  Google Scholar 

  8. Isaacs M. Community care networks for depression in low-income communities and communities of color: a review of the literature. Washington, DC: Howard University School of Social Work and National Alliance of Multiethnic Behavioral Health Associations; 2004.

    Google Scholar 

  9. Figueiredo B, Pacheco A, Costa R. Depression during pregnancy and the postpartum period in adolescent and adult Portuguese mothers. Arch Womens Ment Health. 2007;10(3):103–9.

    Article  CAS  PubMed  Google Scholar 

  10. Milgrom J, et al. Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord. 2008;108(1–2):147–57.

    Article  PubMed  Google Scholar 

  11. Borri C, et al. Axis I psychopathology and functional impairment at the third month of pregnancy: results from the Perinatal Depression-Research and Screening Unit (PND-ReScU) study. J Clin Psychiatry. 2008;69(10):1617–24.

    Article  PubMed  Google Scholar 

  12. Giardinelli L, et al. Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health. 2012;15(1):21–30.

    Article  CAS  PubMed  Google Scholar 

  13. Mota N, et al. The relationship between mental disorders, quality of life, and pregnancy: findings from a nationally representative sample. J Affect Disord. 2008;109(3):300–4.

    Article  PubMed  Google Scholar 

  14. Reck C, et al. Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatr Scand. 2008;118(6):459–68.

    Article  CAS  PubMed  Google Scholar 

  15. Uguz F, et al. Is pregnancy associated with mood and anxiety disorders? a cross-sectional study. Gen Hosp Psychiatry. 2010;32(2):213–5.

    Article  PubMed  Google Scholar 

  16. Wenzel A, et al. Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord. 2005;19(3):295–311.

    Article  PubMed  Google Scholar 

  17. Wynter K, Rowe H, Fisher J. Common mental disorders in women and men in the first six months after the birth of their first infant: a community study in Victoria, Australia. J Affect Disord. 2013;151(3):980–5.

    Article  PubMed  Google Scholar 

  18. Fairbrother N, et al. Perinatal anxiety disorder prevalence and incidence. J Affect Disord. 2016;200:148–55.

    Article  PubMed  Google Scholar 

  19. Cox EQ, et al. The perinatal depression treatment cascade: baby steps toward improving outcomes. J Clin Psychiatry. 2016;77(9):1189–200.

    Article  PubMed  Google Scholar 

  20. Davalos DB, Yadon CA, Tregellas HC. Untreated prenatal maternal depression and the potential risks to offspring: a review. Arch Womens Ment Health. 2012;15(1):1–14.

    Article  PubMed  Google Scholar 

  21. Ogunyemi D, et al. The contribution of untreated and treated anxiety and depression to prenatal, intrapartum, and neonatal outcomes. Am J Perinatol Rep. 2018;8(3):e146–57.

    Article  Google Scholar 

  22. Grigoriadis S, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013;74(4):e321–41.

    Article  PubMed  Google Scholar 

  23. Herring SJ, et al. Association of postpartum depression with weight retention 1 year after childbirth. Obesity (Silver Spring). 2008;16(6):1296–301.

    Article  Google Scholar 

  24. Qiu C, et al. Preeclampsia risk in relation to maternal mood and anxiety disorders diagnosed before or during early pregnancy. Am J Hypertens. 2009;22(4):397–402.

    Article  PubMed  Google Scholar 

  25. Meltzer-Brody S, et al. A prospective study of perinatal depression and trauma history in pregnant minority adolescents. Am J Obstet Gynecol. 2013;208(3):211.e1–7.

    Article  Google Scholar 

  26. Woolhouse H, et al. Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG. 2015;122(3):312–21.

    Article  CAS  PubMed  Google Scholar 

  27. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health. 2005;8(2):77–87.

    Article  CAS  PubMed  Google Scholar 

  28. Austin MP, Kildea S, Sullivan E. Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting. Med J Aust. 2007;186(7):364–7.

    Article  PubMed  Google Scholar 

  29. Esscher A, et al. Suicides during pregnancy and 1 year postpartum in Sweden, 1980–2007. Br J Psychiatry. 2016;208(5):462–9.

    Article  PubMed  Google Scholar 

  30. Esscher A, et al. Maternal mortality in Sweden 1988-2007: more deaths than officially reported. Acta Obstet Gynecol Scand. 2013;92(1):40–6.

    Article  PubMed  Google Scholar 

  31. Högberg U, Innala E, Sandström A. Maternal mortality in Sweden, 1980-1988. Obstet Gynecol. 1994;84(2):240–4.

    PubMed  Google Scholar 

  32. Do T, et al. Depression and suicidality during the postpartum period after first time deliveries, active component service women and dependent spouses, U.S. Armed Forces, 2007-2012. MSMR. 2013;20(9):2–7.

    PubMed  Google Scholar 

  33. Zuckerman B, et al. Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J Obstet Gynecol. 1989;160(5 Pt 1):1107–11.

    Article  CAS  PubMed  Google Scholar 

  34. Cui Y, et al. Smoking during pregnancy: findings from the 2009–2010 Canadian Community Health Survey. PLoS One. 2014;9(1):e84640.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Zhu S-H, Valbø A. Depression and smoking during pregnancy. Addict Behav. 2002;27(4):649–58.

    Article  PubMed  Google Scholar 

  36. Smedberg J, et al. The relationship between maternal depression and smoking cessation during pregnancy—a cross-sectional study of pregnant women from 15 European countries. Arch Womens Ment Health. 2015;18(1):73–84.

    Article  PubMed  Google Scholar 

  37. Goodwin RD, et al. Smoking during pregnancy in the United States, 2005–2014: the role of depression. Drug Alcohol Depend. 2017;179:159–66.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Brown RA, et al. Predictors of drug use during pregnancy: the relative effects of socioeconomic, demographic, and mental health risk factors. J Neonatal Perinatal Med. 2019;12(2):179–87.

    Article  CAS  PubMed  Google Scholar 

  39. Lange S, et al. Alcohol use and self-perceived mental health status among pregnant and breastfeeding women in Canada: a secondary data analysis. BJOG. 2016;123(6):900–9.

    Article  CAS  PubMed  Google Scholar 

  40. Howard LM, et al. Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Med. 2013;10(5):e1001452.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Boy A, Salihu H. Intimate partner violence and birth outcomes: a systematic review. Int J Fertil Womens Med. 2004;49:159–64.

    PubMed  Google Scholar 

  42. Murphy CC, et al. Abuse: a risk factor for low birth weight? a systematic review and meta-analysis. CMAJ. 2001;164(11):1567–72.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Venturella R, et al. Non-obstetrical indications for cesarean section: a state-of-the-art review. Arch Gynecol Obstet. 2018;298(1):9–16.

    Article  CAS  PubMed  Google Scholar 

  44. Olieman RM, et al. The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):195–8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Betrán AP, et al. The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One. 2016;11(2):e0148343.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. Sydsjö G, et al. Psychiatric illness in women requesting caesarean section. BJOG Int J Obstet Gynaecol. 2015;122(3):351–8.

    Article  Google Scholar 

  47. Grote NK, et al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Stein A, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800–19.

    Article  PubMed  Google Scholar 

  49. Berle JØ, et al. Neonatal outcomes in offspring of women with anxiety and depression during pregnancy: a linkage study from The Nord-Trøndelag Health Study (HUNT) and Medical Birth Registry of Norway. Arch Womens Ment Health. 2005;8(3):181–9.

    Article  CAS  PubMed  Google Scholar 

  50. Goedhart G, et al. Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a large multiethnic cohort study. Psychosom Med. 2010;72(8):769–76.

    Article  PubMed  Google Scholar 

  51. Field T, Diego M, Hernandez-Reif M. Prenatal depression effects on the fetus and newborn: a review. Infant Behav Dev. 2006;29(3):445–55.

    Article  PubMed  Google Scholar 

  52. Lahti M, et al. Maternal depressive symptoms during and after pregnancy and psychiatric problems in children. J Am Acad Child Adolescent Psychiatry. 2017;56(1):30–39.e7.

    Article  Google Scholar 

  53. Essex MJ, et al. Maternal stress beginning in infancy may sensitize children to later stress exposure: effects on cortisol and behavior. Biol Psychiatry. 2002;52(8):776–84.

    Article  CAS  PubMed  Google Scholar 

  54. Health, C.o.P.A.o.C.a.F. et al. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2011.

    Google Scholar 

  55. Shonkoff JP, et al. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2011;129(1):e232–46.

    Article  PubMed  Google Scholar 

  56. Flaherty EG, et al. Effect of early childhood adversity on child health. Arch Pediatr Adolesc Med. 2006;160(12):1232–8.

    Article  PubMed  Google Scholar 

  57. Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry. 2012;25(2):141–8.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Ding X-X, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Disord. 2014;159:103–10.

    Article  PubMed  Google Scholar 

  59. Yonkers KA, et al. Association of panic disorder, generalized anxiety disorder, and benzodiazepine treatment during pregnancy with risk of adverse birth outcomes. JAMA Psychiat. 2017;74(11):1145–52.

    Article  Google Scholar 

  60. Winston R, Chicot R. The importance of early bonding on the long-term mental health and resilience of children. London J Prim Care. 2016;8(1):12–4.

    Article  Google Scholar 

  61. Ashman SB, et al. Stress hormone levels of children of depressed mothers. Dev Psychopathol. 2002;14(2):333–49.

    Article  PubMed  Google Scholar 

  62. Cohn JF, et al. Face-to-face interactions of depressed mothers and their infants. New Dir Child Dev. 1986;(34):31–45.

    Google Scholar 

  63. Field T, et al. Infants of depressed mothers show “depressed” behavior even with nondepressed adults. Child Dev. 1988;59(6):1569–79.

    Article  CAS  PubMed  Google Scholar 

  64. Ohoka H, et al. Effects of maternal depressive symptomatology during pregnancy and the postpartum period on infant–mother attachment. Psychiatry Clin Neurosci. 2014;68(8):631–9.

    Article  PubMed  Google Scholar 

  65. Dawson G, Ashman SB, Carver LJ. The role of early experience in shaping behavioral and brain development and its implications for social policy. Dev Psychopathol. 2000;12(4):695–712.

    Article  CAS  PubMed  Google Scholar 

  66. Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 months. NICHD Early Child Care Research Network. Dev Psychol. 1999;35(5):1297–310.

    Google Scholar 

  67. Warnock FF, et al. The relationship of prenatal maternal depression or anxiety to maternal caregiving behavior and infant behavior self-regulation during infant heel lance: an ethological time-based study of behavior. BMC Pregnancy Childbirth. 2016;16:264.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Moehler E, et al. Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother–child bonding. Arch Womens Ment Health. 2006;9(5):273–8.

    Article  CAS  PubMed  Google Scholar 

  69. Eidelman AI, et al. Breastfeeding and the use of human milk. Pediatrics (Evanston). 2012;129(3):e827–41.

    Article  Google Scholar 

  70. Stuebe A, et al. Failed lactation and perinatal depression: common problems with shared neuroendocrine mechanisms? J Women’s Health. 2012;21(3):265–72.

    Article  Google Scholar 

  71. EQ Cox AS, B Pearson K, Grewen D, Rubinow S. Meltzer-brody, oxytocin and hpa stress axis reactivity in postpartum women. Psychoneuroendocrinology. 2015;55:164–72.

    Article  CAS  Google Scholar 

  72. Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. J Affect Disord. 2015;171:142–54.

    Article  PubMed  Google Scholar 

  73. Luca DL, et al. Financial toll of untreated perinatal mood and anxiety disorders among 2017 births in the United States. Am J Public Health. 2020;110(6):888–96.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elizabeth Cox .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Brooks, E., Cox, E., Kimmel, M., Ruminjo, A. (2021). Risk of Untreated Symptoms of PMADs in Pregnancy and Lactation. In: Cox, E. (eds) Women's Mood Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-71497-0_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-71497-0_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-71496-3

  • Online ISBN: 978-3-030-71497-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics