Pregnancy and birth are important life events. It causes major changes in the lives of both the woman and her husband. It cannot be said that every couple is successful in adapting to these changes. Sometimes it can become a pathological process. A woman's well-being during this period is not something that affects only her. It is a condition that has long-term effects. It is important for expectant mothers to be in a state of physical, mental and social well-being in terms of the upbringing and well-being of the next generations.
The mental state and life of the woman affects the course of the pregnancy; Pregnancy itself also creates important reflections on one's spiritual-emotional life. External stresses and challenges unrelated to pregnancy can increase adjustment problems during pregnancy. Pregnancy is divided into three trimester weeks. 1st trimester 1-13. weeks, 2nd trimester 14-26. weeks, 3rd trimester 27-41. determined as weeks. Psychiatric disorders are more common in the 1st and 3rd trimesters compared to the 2nd trimester. During pregnancy, all emotional, vital, spiritual, behavioral expectations, conflicts, hopes and desires regarding the mother role, beyond the female role, come to the fore. During pregnancy, mother and daughter go through a process of adapting to changing roles and identities. It has been reported that each trimester of pregnancy has its own psychological adaptation process. The first trimester is often about adjusting to the new situation and the fact of being pregnant. The woman's family situation, work situation, relationship with her husband, and the new difficulties and requirements that pregnancy will create are effective in the attitude towards this reality. Psychological attachment to the fetus begins in utero, and by the beginning of the second trimester most women have a mental picture of the baby. In the second trimester, the biological bond with the fetus is felt deeper and closer. In the third trimester, as birth approaches, concerns about how the birth will be and whether the child will be healthy come to the fore. Maternal attachment (mother and baby bonding); It becomes increasingly stronger as the pregnant woman's body changes, the uterus grows and the fetal movements are felt. Strong mother-baby attachment motivates parents to health practices such as not using tobacco or alcohol during pregnancy, receiving prenatal care, healthy eating and sleeping habits, and adequate exercise. It is stated that it facilitates adaptation to the human role and serves a protective function against depression during pregnancy and postpartum. 10-30% of women during pregnancy are diagnosed with at least one psychiatric disorder. These are listed below:
- Depression
- Panic disorder
- Sleep disorders
- Obsessive compulsive disorder
- Illness anxiety
- Generalized anxiety disorder
- Bipolar disorder
- Psychotic disorders
Depressive symptoms and findings in pregnant women; It can sometimes be difficult to diagnose pregnancy depression because it is similar to the physiological changes and complaints of pregnancy and may have subsyndromal features. Main depressive symptoms and findings in the first trimester of pregnancy: sleep and appetite changes, fluctuations in mood and anxiety, extreme fatigue, loss of libido, difficulty in concentration. Similarly, anxiety, extreme fatigue, sleep and appetite disorders, and birth-related concerns can be observed in the third trimester of pregnancy. These depressive symptoms are less common in the second trimester of pregnancy. It is stated in the literature that depressive symptoms are seen at least as frequently and intensely in pregnant women as in postpartum or non-pregnant women. Somatic complaints such as nausea, stomach ache, rapid breathing, and headache are significantly more common in pregnant depressive patients than in other depressive patients. These anxious thoughts are the insecurity caused by having a problematic birth in the past, fear of death, fear of pain and fear of losing control during birth. Due to anxiety during pregnancy, it upsets the woman and contributes to complications such as ineffective uterine contractions.
What are the causes of mental status changes during pregnancy?
Physiological changes during pregnancy. Pregnancy can cause depression. Weight gain, one of these changes, can increase depressive symptoms both during pregnancy and in the postpartum period, as it creates dissatisfaction in the pregnant woman. Social support relieves pregnant women emotionally and cognitively, helps them benefit more from social opportunities and cope with stressors and anxiety. It helps and facilitates the transition to the motherhood role. Social support is the support provided by spouse, family and friends. Unintended pregnancies in the first trimester are associated with anxiety and depression. In the 3rd trimester, there may be fears about birth and doubts about the normality of the fetus. Psychiatric symptoms during pregnancy are more common in women with a history of psychiatric disorders. Depression is the most common mental disorder seen during pregnancy, and the prevalence of depression and depressive symptoms during pregnancy varies between 12-36%.
Due to increased progesterone, the expectant mother who experiences short sleep attacks during the day may experience insomnia at night. The reason for sleep problems in the last 3 months of pregnancy is that the growing baby puts pressure on the internal organs and the mother has difficulty finding a comfortable sleeping position. In addition, due to pressure on the bladder, the pregnant woman goes to the toilet frequently and this may disrupt comfortable sleep. It has been determined that severe nausea and vomiting in the early stages of pregnancy are associated with anxiety and depression during pregnancy. They found that the risk of pregnancy depression is high in women who have low self-esteem, experience anxiety, have little or no social support, have a tendency to constantly think negatively, have experienced a major trauma in their lives, and have been subjected to violence in their past. A significant relationship was also found between the stress of becoming a parent for the first time and pregnancy depression. Getting pregnant during adolescence or at a young age is another risk factor for depression. At the same time, lack of family support and changing hormone levels are also risk factors.
The effects of untreated psychiatric disorders on the mother and baby
The stress, anxiety and depression experienced by the expectant mother. Nowadays, it is known that it has negative effects on the baby and the mother's health.
Depression during pregnancy, preterm labor, pre-eclampsia, difficult birth, need for more surgical intervention at birth, small fetus according to the gestational age, low birth weight and low Apgar score. It can lead to adverse pregnancy and obstetric complications such as neonatal complications. In addition, pregnancy depression is of great importance because of its potential to increase the risk of suicide attempts and postpartum depression.
Effects of depression on the baby and mother:
Hypertensive disease of pregnancy (preeclampsia-eclampsia), spontaneous abortion, antenatal bleeding, increased uterine artery resistance, low Apgar score, giving birth to a baby requiring neonatal intensive care, neonatal growth retardation, spontaneous premature birth, fetal death, giving birth to a baby with low birth weight, small for gestational age. increased risk of childbearing, perinatal and birth complications, preterm labor, postpartum depression. They stated that babies of depressed mothers cry more often, console themselves later, and fall asleep later due to increased cortisol and catecholamine levels. It has been determined that the babies of these mothers in the intrauterine period are hyperactive and their fetal heart beats are above normal, and they are more frequently admitted to intensive care units during the neonatal period. It has been determined that generalized anxiety disorder in the mother has negative effects on the neurodevelopment of the baby.
Treatment of psychiatric disorders during pregnancy
Deciding whether the psychiatric disorder detected during pregnancy will be life-threatening for the mother and the baby. It is very important. If there is a psychotic attack, suicide attempt or environmentally damaging situation, hospitalization and emergency treatment methods are applied. If depressive symptoms are moderate or severe, treatments can be applied in cooperation with the family. If there are mild depression and anxiety symptoms, non-drug treatments, that is, psychotherapy methods, can be applied. Exercising for a pregnant woman will also help her cope with stress and relieve spinal pain caused by pregnancy. In this respect, pregnancy yoga will be a good option.
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