The word pregnancy can conjure up images of celebrities like Demi Moore smiling and glowing with a baby bump. Society perceives and depicts pregnancy as a time of emotional joy. However, celebrity photo ops aside, the perinatal time period — including pregnancy and being postpartum — is more complicated and variable, especially for women who navigate mental health conditions before or during pregnancy.
The cultural myth is that rising hormones protect emotional health during pregnancy and afterward. This is simply untrue. In addition to the nearly 10% of Americans experiencing mood disorders at any given time, recent studies have found that another 20% of perinatal women are vulnerable to their first experiences of anxiety and mood symptoms. In short, this means you are not alone if you are navigating mental health challenges during or after pregnancy.
Should I stop taking my mood medications during pregnancy?
The short answer: maybe.
For many pregnant people, the first thought is to stop all medications to protect the unborn baby, also called a fetus. Taking medication can carry risks and uncertainty during pregnancy, including exposing your baby to the effects of the medications. Even though stopping your medication is a natural first impulse, try to pause and consider the decision carefully.
First, your previous mood symptoms, such as those of major depression or bipolar disorder, are at much greater risk of recurrence or worsening if you abruptly stop your medication. So make sure you are in a stable place and that stopping the medication is recommended by your healthcare team before abruptly discontinuing.
Second, taking mood medications during pregnancy is not the only way that mental health can affect your baby. Research has repeatedly shown that there are risks of untreated depression during pregnancy. Untreated mental illness affects fetal growth and development, leading to lower birth weight and a higher risk of preterm birth.
How will stopping my mental health medications affect me during pregnancy?
If you stop your mood medications, your symptoms of depression, anxiety or bipolar disorder may increase. Impacts of worsening mood symptoms include:
- Increased isolation.
- Worsened irritability.
- Reduced energy.
- Decreased interest in things that were previously enjoyable.
- Lower motivation.
In addition, untreated mental health conditions make you more likely to miss perinatal appointments. Studies show that pregnant people also can be at higher risk of making poor dietary choices, having malnutrition, and turning to alcohol or other substances. The risk of untreated bipolar disorder can lead to high-risk behaviors, poor decisions and impaired judgment, placing both you and your baby at risk.
What if I continue my mental health medication during pregnancy?
Similarly, the decision to keep taking a medication during pregnancy comes with concern and worry about a healthy baby and safe delivery. Some mood disorders can be treated with nonmedication approaches such as coaching, psychotherapy and counseling.
If your mental health is better managed with medication, here are some considerations.
All medications cross the placenta, exposing your baby to their effects. In the U.S., there are no psychiatric medications yet approved by the Food and Drug Administration (FDA) for use during pregnancy.
When considering medications in pregnancy, there are three main areas of concern:
- Is there risk of medications affecting organ development during the first 12 weeks in pregnancy? This is when organs are forming and maturing, so your baby is most susceptible to the medications’ effects.
- Is there risk immediately after delivery? Exposure during pregnancy may lead to neonatal withdrawal, causing physical or behavioral symptoms for your newborn baby at the time of delivery.
- Are there long-term effects for the baby? Some effects of medications won’t manifest until much later, such as developmental delay after prenatal exposure to opioids.
These decisions are never easy. However, repeated studies have clearly shown that the emotional stability of you, the pregnant person, is of the utmost importance. This means you must weigh your overall health against how staying on your medication to manage depression and anxiety symptoms could affect your baby.
Ideally, decisions involving medications should be made in conjunction with your healthcare team or a knowledgeable mental health professional.
It is important to know that your mental health during pregnancy matters. The best choice for you and your baby is one that keeps both of you healthy.
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