Doctor and Aldi, how does getting pregnant or having a baby affect a woman's mental health?

Yeah, so that's a great question, doctor O'Neill.

So when women are plannin to become pregnant, especially, you know, preconception during pregnancy and after pregnancy, we encourage them to come up with a plan.

we have things like CBT cognitive behavioral therap and then interpersonal therapy.

And these really help to adjust to the role of being a mother and adjusting their big role shift.

Yeah.

we're thinking about becomin pregnant we have to think about, you know, who our supports are.

What's our preconception plan?

What's our plan?

Who's going to be in the household helping out?

How are you going to get sleep?

those are things that we go over with our patients to see.

How are they going to manage in this postpartum period.

oxytocin is like the bonding hormone.

And we know that stress negatively affects oxytocin with bonding.

stress levels that are related to anxiety depression can affect cortisol which can affect oxytoci and milk letdown with prolactin.

when a mother is trying to latch with baby that can affect maybe her patient when she's trying to breastfeed.

So you're suggesting that a woman think about those things, maybe even before she's gettin pregnant, Yeah, that's a hope.

But as we know, about 50% of pregnancies are unplanned.

Unplanned.

Wow.

Yeah.

So that can lead to a lot of stress itself.

So it's helpful during that period to try and plan what stresses you're expecting, Well, the big things, all the big things, babies change, all of that stuff they do.

Baby changes everything.

What percentage of women have mental health issue during pregnanc or we don't have exact numbers for how many women have menta health issues during pregnancy.

for women that are in the postpartum period, 70 to 80% of women have something called postpartum blues.

Yeah.

Shocking.

So the physiology behind that is that estrogen and progesterone have a precipitous drop.

Yeah.

Yep.

Okay.

Hormones.

Yeah.

So those are elevated throughout pregnancy.

Progesterone to maintain the placenta and estrogen.

And then after giving birth, those drop down.

estrogen is important in serotonin maintenance and production.

when those two kind of drop off you might see some increasing increased depressed mood.

so it's norma for people to have baby blues.

But then about 20% of women in the postpartum period might go into postpartum depression.

so if a woman is having mental health struggles postpartum after she delivers other treatments available.

So for me and depression specifically, we can use something like an Sarai or Senri.

So serotonin norepinephrine.

And then there are unique medications like Zarand alone which is FDA approved for postpartum depression.

It's a one.

And done so for 14 days means you just use it one time for that period.

So you can use it up to 12 months postpartum.

Okay.

And you can use it for each subsequent pregnancy too.

But then again just once.

Okay.

And essentially it helps to just reestablish along alone, which is an offshoot of progesterone So that med reestablishes that level and that affects mood in a positive way?

Yes.

Are there risks and benefits of psychiatric meds for pregnant women?

So I just want to start off by saying that any pregnancy carries a background risk of 3 to 5% for birth defects.

And then from studies, we know maybe there's a 1 to 2% increase in that very slight and very slight.

the other side of that is if you're not treating perinatal mood and anxiety that can affect birth weight.

You can have low birth weight, preterm labor, unplanned C-section.

And then we know one of the leading cause of maternal death is suicide So that is about 25%.

Based on 2017 2019 data from the CDC.

if a woman is considering starting medication or stopping medication, obviously they should talk to their doctor.

Are there other resources available?

Yeah.

So I'd like to plug a resource called Mother to baby.

And they have some fact sheets that include different medications, All the SSRI are pretty much on there.

And they can tell you abou breastfeeding risk birth defect risk what you might be abl to talk about with your doctor I find it to be a very helpful resource to share with my patients.

Doctor, thank you very much for being with us.

Thank you.