treatment of GAD during pregnancy

Presented by Allison Loftus MA

My Story

healthy moms = happy babies

1 in 7 momsexperience depression or anxiety during pregnancy or postpartum

A new mother might not recognize depression or anxiety because she is tired, overwhelmed, or simply adjusting

to life with a baby

How can I differentiate between normal pregnancy symptoms and a mental health concern?

Britton, J. R. (2008). Maternal anxiety: course and antecedents during the early postpartum period.Carmen, R. B., Primeau, L. A., Levine, R. E., Olson, G, L., Wu, Z. H., and Berenson, A.B. (2006). Anxiety symptoms during pregnancy and postpartum. gynecologists’ screening patterns for anxiety during pregnancy. Cox J. L., Holden J.M., Sagovsky R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale

Adverse obstetric and neonatal outcomes

BABYpreterm labor/delivery ( ≤ 37 weeks)premature rupture of membranesmeconium staininglower Apgar scoresneonatal congenital abnormalitiesuterine artery resistance (cortisol restricts blood flow to the placenta)lower birth weightspossible impaired cognitive and language developmental childhood psychiatric/behavioral problems

MOMcesarean section, preeclampsia, postpartum depression (50%-80%)suicide (accounts for the most maternal deaths one year postpartum) inferences with maternal bonding

A study of ninety-four pregnant women (Misri et al., 2010) found a correlation between increased symptoms of anxiety and an increase in parenting stress. And higher level of parenting stress has been shown to contribute to insecure attachment between baby and caregiver (Gefland, Teti, and Fox, 1992; Reck, Noe, Gerstenlauer, and Stehle, 2012) as well as developmental difficulties in children (Atwood, 2013).

Avin-Barron and Wiegart, 2011; Carmen, Primeau, Levine, and Olson et al., 2006.; Misri et al., 2010; Uguz et al., 2013

how do I tell the difference?PREGNANCY ANXIETY/DEPRESSION

Mood up and down, teary Mood consistently down, hopeless

Self-esteem unchanged Low self-esteem/ guilt

Can fall asleep and can fall back to sleep if waken by physical problems (bladder/heartburn)

May have trouble falling asleep, may have early morning waking and difficulties falling back to sleep

Tires easily, rest refreshes and energies Rest does not help to reduce fatigue

Feels pleasure, joy, and anticipation Lack of joy/pleasurefearful anticipation or lack of anticipation

Appetite increases Appetite may decease

Worries in proportion to anticipate events Excessive worries/fears

Able to cope with pregnancy changes Overwhelmed and unable to cope

Bennet, S., Indman, P., (2011) Beyond the blues

mother yourself as you would mother your baby

NutritionUnderstandingRelaxation and restSpirituality Exercise Beck, C.T., Driscoll, J.W. (2006). Postpartum mood disorder and anxiety disorders a clinician’s guide. Sudbury, MA: Jones and Bartlett Publishers.

building resilience shame empathy

fear courage

blame connection

disconnection compassion

self, partner, friends, family, teachers, membership groups, colleagues, faith community, community members, mentors, educators, media, advertising, books, film, tv, marketing

Describe the perfect mom….Brown, B., (2007) I thought it was just me making the journey from “what will people think” to “i am enough”

mom’s mantra I will recover

I am not aloneThis is not my faultI am a good mom

It is essential I take care of myselfI am doing the best I can

Bennet, S., Indman, P., (2011) Beyond the blues

let’s talk meds (aka a mother’s best friend)

Prenatal Concerns 2009 Mayo Clinic Study1st trimester: birth defects, increase risk of miscarriage (3 out of 10 in controlled studies)

2nd trimester: growth and development

3rd trimester: nervous symptom development

End of pregnancy: fetal withdrawal, preterm deliveries

Long term: motor/speech/language development

Case review of 25,000 deliveries

800 women on antidepressants

All women ≤ 1/% birth defects

Women on antidepressants had lower rates of birth defects (0.4 % heart defects) than women not on meds.

Med moms: None of the babies had pulmonary hypertension (PH)

Non med moms: 16 babies had PHWichman, et al., Mayo Clin Proc. January 2009;84(1):23-27

help! I’m a mom…now what?