What do we mean by PMADs?
Perinatal mood and anxiety disorders, PMADs, is a term that encompasses mental health disorders during pregnancy and / or up to one year postpartum. It includes conditions such as depression, anxiety, bipolar disorders, panic disorders, obsessive-compulsive disorder (OCD) or intrusive thoughts, post-traumatic stress disorder (PTSD) and the rarer, psychosis.
PMADs is one of the commonest complications of childbirth; much higher than for example, gestational diabetes or pregnancy-related high blood pressure. However, it is group of illnesses that still has stigma attached to it. If left untreated, PMADs can significantly impact the holistic wellbeing of the mother, her infant, and the family.
Why do women suffer from PMADs?
Pregnancy and the period following birth brings substantial changes to a woman’s health. There are some hypotheses as to why mental health is significantly affected for women during pregnancy and postpartum:
- Change in hormones, especially after birth with rapid drop in oestrogen and progesterone can decrease serotonin levels, which impacts mood.
- The healthy maternal brain is hard-wired for temporary traits of obsessive-compulsive disorder and anxiety. This is an evolutionary trait, likely to heighten mother’s protection for their infants and one that has been passed on through generations.
- The hormone oxytocin, which promotes attachment, may also overstimulate a mother’s response to protect and keep their baby safe.
Who is at risk?
Although there is no one single cause which may trigger the typical hormonal and behavioural changes in pregnancy and postpartum to developing mental health disorders, there are some risk factors that can predispose a woman to PMADs:
- Having a history of depression or anxiety
- Family history of mental health disorders
- Sensitivity to sleep changes; sensitivity to hormonal changes
- Having chronic medical conditions (e.g., diabetes mellitus, thyroid disorders amongst many)
- Experiencing a traumatic birth
- Preterm birth / parents of babies admitted to NICU (neonatal intensive care unit) – mental health disorders may be 20 – 30% in parents whose newborns are admitted to NICU
- Psychological influences – adjusting to a new role, seeing your new self vs the old, traits of perfectionism, difficulty in coping with changes
- Social aspects – relationship conflicts, domestic abuse / violence, to name a few.
Knowing these risk factors is useful for women, their doctors, and pregnancy / post-natal professionals to safety-net and help early identification of women who may be at risk of developing perinatal mental health conditions.
What are the symptoms?
Women affected by perinatal mental health disorders may experience a range of symptoms:
- Depressive symptoms: feelings of lowness, tearfulness, unable to enjoy anything, sleep disturbances, fatigue / low energy, excessive guilt, feelings of worthlessness, unable to take criticism, impaired concentration, or changes in weight
- Anxiety: excessive worrying, dreading uncertainty, believing that by being ‘hyperalert’ complications for them or their baby can be prevented, engrossed in extensive ‘research’ as lack of confidence in their own problem-solving capacity, checking and tracking infants’ development or their own symptoms.
- Experiencing panic attacks, with sudden fatigue, chills, lightheadedness, nausea.
- Intrusive thoughts, which may be very frightening. These thoughts can lead to compulsive actions, or may be present alone.
- Thoughts of self-harm or suicide, or harm to their infant.
Many women with perinatal mental health conditions may experience physical symptoms, such as body aches and pains, recurring surgical wound pains, exhaustion, fatigue, feelings of constant breast fullness or pain, recurring nipple pain, feelings of emptiness in stomach or sensation of crawling out of one’s own skin when breastfeeding, or an aversion to being touched or nursing.
What should you do?
If you or your loved one has noticed you may be experiencing any of such symptoms, please reach out to us. We can guide you in obtaining the right support and provide you help to make you feel better. This may look like focusing on self-care methods, using psychotherapy, or if required, considering medications.
Perinatal mental health wellbeing is a necessity for both mother and baby. At Osler Health International, we aim to support you by providing a safe and welcoming space for you, your baby, and your family.
Dr Trisha Upadhyaya is a British trained GP who is passionate about perinatal health for women. Dr Trisha has cared for many women with mental health concerns during their pregnancy and post natal. If you would like an appointment please reach out. Dr Trisha is based at Osler Health Star Vista clinic – 6339 2727
