Pregnancy and Mental Health

Pregnancy can be one of the most challenging and rewarding experiences in any woman’s life. The creation of a new life is a very personal experience which brings enormous pride, pleasure and responsibility¹. ‘Mum guilt’, a term arising from expectations based on what mothers ‘should be like’ and what they ‘should do’, is often high. As a result, mental wellbeing can really suffer at this sensitive time. In this article, we'll look at the different types of mental health issues that may affect women during and after pregnancy, and how supporting gut health with probiotics might be helpful.

For more about using probiotics at this very special time, read Probiotics and Pregnancy in the Probiotics Learning Lab.

Within this article:

• Are mental health issues common in pregnancy?
• Signs of depression during and after pregnancy
• What can cause depression in pregnancy?
• Can you blame it all on hormones?
• What does the microbiome have to do with hormonal balance?
• The importance of the gut-brain axis in pregnancy
• Probiotics for mental health in pregnancy
• Other helpful lifestyle interventions to support mental health in pregnancy
• Support Groups in the UK

Are mental health issues common in pregnancy?

Depression globally affects more than 264 million people of all ages. Statistically it affects more women than men. Whether they have had a history of mental health issues or not, pregnant women may be concerned about whether depression is common in pregnancy. In fact, as many as 1 in 5 women have mental health problems in pregnancy or after birth. Depression and anxiety are the most common mental health problems in pregnancy². Depression in pregnancy may diminish one’s capacity for self-care at this critical time. This may have a knock-on effect on a mother’s overall nutrition status, and even cause an increase in drug and alcohol abuse or a reduction in antenatal clinic attendance. All these factors may compromise a woman’s physical health and may restrict the growth and development of the unborn child³.

Antenatal depression

Antenatal depression is the name given to depression in early pregnancy, or at any time throughout gestation. Sufferers might begin to worry about giving birth and parenthood, feel anxious & emotionally detached from the pregnancy, experience low libido, tearfulness, and be angry or irritable. It is common for new mums to feel some trepidation about the birth, but prolonged feelings of low mood should be discussed with a doctor.

The Baby Blues

A few days after giving birth, it is common to experience a period of low mood known as the ‘baby blues’. This affects 30 to 80% of women, and is thought to be due to a 100 fold drop in oestrogen levels which occurs at this time and for up to 10 days after birth⁴. This can make the mother anxious, tearful, irrational, and irritable. These feelings generally subside after 14 days but for some women they may persist. The weeks and months following childbirth may be a time of extreme exhaustion due to lack of sleep but continuing low mood after giving birth should be discussed with a doctor, as it is possible that the mother may have developed postnatal depression.

Postnatal depression

Postnatal depression has very similar symptoms as general depression. Previous depression, current depression/anxiety, and low partner support are found to be key antenatal risk factors for postnatal depression⁵. It has been suggested that 33% of postnatal depression begins in pregnancy and 27% in pre-pregnancy⁶.

It’s good to know, then, that there are ways of supporting mental health naturally. One of these is supporting gut health – you can read more about the connection between mental health and gut health in this article on our Learning Lab site: The Gut-Brain axis. We’ll find out more about how to support gut health during pregnancy later on, but first, it’s important to understand how to spot symptoms of anxiety and depression in pregnancy.

Signs of depression during and after pregnancy

Whilst pregnancy can be an emotional rollercoaster, especially for new mums, it is important to keep an eye on symptoms that persist. A good phrase to remember is: ‘a bad day is normal; a bad month is not’. Pregnant mums experiencing clusters of the following symptoms for more than 2 successive weeks should speak to their doctor:

• Drop in mood
• Reduced energy levels
• Anxiety
• Disturbed sleep
• Poor appetite
• Difficulty concentrating
• Feelings of low self-worth
• Unexplained physical symptoms - headaches, nausea, digestive issues
• Feeling sad, weepy, hopeless, overwhelmed, guilty or angry
• Unable to find pleasure in any activities you previously enjoyed
• Withdrawing from others

 Additional symptoms post-pregnancy may include:

• Feeling numb or disconnected from the baby
• Not wanting to be around the baby
• Being worried about hurting the baby
• Feeling incapable of caring for the baby
• Feeling guilty about not being a ‘good enough’ mother

Interestingly, these symptoms are common to many other conditions too, one of which is gut dysbiosis. When the balance of ‘good’ to ‘bad’ bacteria is lost in the gut, many physical and emotional symptoms can arise. It is common to experience either anxiety or depression as, amongst other functions, our gut bacteria helps in the metabolism of certain neurotransmitters that affect our mood.

What can cause depression in pregnancy?

Depression at any time results from a ‘complex interaction of social, psychological and biological’ factors. As a result, a ‘one size fits all’ approach doesn’t apply to the treatment of depression. According to Chris Hawley (a consultant psychiatrist) and Celia Feetam (a psychiatric pharmacist), the management of depression is ‘more of an art than a science’⁷.

Social and psychological risk factors include:

• Low income
• History of depression
• History of miscarriage
• High anxiety levels
• Low self esteem
• Low social support³

‘Biological’ risk factors include:

• Low micro-nutrient levels
• Poor gut health
• Heavy metal toxicity
• Hormonal influences

Can you blame it all on hormones?

Hormones tend to get much of the blame when it comes to mood swings and the emotional rollercoaster of pregnancy. Each woman’s experience is different, so it can be difficult to know what is normal in terms of fluctuating moods. There is no consistent evidence that women who develop depression during pregnancy experience lower reproductive hormone concentrations, or experience greater reductions in hormone levels. However, there is evidence⁸ to suggest that hormone fluctuations can trigger dysregulation in sensitive women. It is likely that these hormone fluctuations can cause changes within the body and therefore affect the hypothalamic-pituitary-adrenal (HPA) axis (involved in the body’s response to stress), amongst other areas.

Certain hormones in particular have been identified as playing a part in mood. Oestrogen, involved in baby’s early development, has been shown to increase the number of serotonin (happy hormone) receptors while enhancing its transport and uptake into the cells⁹. It is also interesting to note that the onset of depression in women is often at times when oestrogen levels are relatively low (in early pregnancy, postpartum, and around and following menopause)¹⁰. Reduced release of oxytocin (involved in breastmilk production and bonding between mother & baby) has also been associated with depression in mothers. It is understood that disruptions of the oxytocin system may be implicated in relations between breastfeeding, stress regulation, and mood. These are all affected areas during postnatal depression.

Whilst hormones can be troublesome, they do play a vital role in a healthy pregnancy and baby. The key is to keep them in balance and supporting gut health is one way of doing this.

What does the microbiome have to do with hormonal balance?

Well, a lot more than you might think! As we said above, hormonal changes are natural and needed, but recent research is starting to show the importance of the microbiome in maintaining correct hormone balance.

According to Dr Sara Gottfried M.D, author of the book ‘The Hormone Cure’:

‘Your gut microbiome is one of the conductors of the complex hormonal orchestral playing throughout your body. Your gut microbiome regulates your hormones and for your hormones to be balanced, your gut microbiome should be balanced.’

Dr Gottfried¹² explains that the gut microbiome doesn’t just influence the production of hormones, the bacteria tell the bodily glands how much of each hormone they should be creating and releasing. The microbiome actually synthesises one of the 3 main forms of oestrogen, known as oestriol, whilst also balancing overall oestrogen levels. In fact, a sub-group of the microbiome has recently been named as the ‘oestrobolome’. These bacteria are known to balance oestrogen levels¹³. It would appear then that increasing the number of ‘friendly’ bacteria, and therefore limiting pathogenic strains, might help to prevent hormonal imbalance. This area of study needs more research, but evidence so far suggests that hormonal balance is dependent on good gut and microbial health.

The importance of the gut-brain axis in pregnancy

An imbalance of good and bad bacteria, known as dysbiosis, and inflammation of the gut have been linked to several mental illnesses, including anxiety and depression^{14, 15}. Healthy gut function plays an important role in the functioning of the central nervous system (CNS). Hormones, neurotransmitters and immunological factors released from the gut, and influenced by our microbiome, are known to send signals to the brain. This is called the gut-brain axis. It is thought that probiotics may have the ability to restore normal microbial balance, and therefore have a potential role in the support of anxiety and depression¹⁶. This exciting new area of research is known as Psychobiotics. For more information on this topic, check out our Psychobiotics article.

Probiotics for mental health in pregnancy

Mums dealing with depression in pregnancy should always consult with a doctor. The best treatment is very individual to the mother and both medication and psychological therapies can help¹⁷. Antidepressants are commonly prescribed to help manage symptoms; however these may not be suitable during pregnancy or breast-feeding. In some cases, GPs may recommend talk therapies as an alternative; Cognitive Behavioural Therapy (CBT) and counselling have helped many. 

As pregnant mums are often reluctant to take prescriptions at this special time, there is a growing interest in natural lifestyle interventions. Probiotics are becoming well-known as part of a natural mental health support protocol, with certain strains such as Lactobacillus acidophilus Rosell-52 showing real promise for anxiety symptoms.

Health professionals can learn more about the use of probiotics for stress and anxiety in the Professionals site: Can live cultures help with stress and anxiety?

Probiotics are very safe to take during pregnancy and breastfeeding, but certain strains have been specifically researched in pregnant women, and of particular interest here are those strains which have been researched for the support of mental health during and after pregnancy. Lactobacillus rhamnosus HN001 has been used in gold standard clinical research and showed extremely encouraging results. In the trial of 380 women, this probiotic strain was used successfully for postnatal depression and anxiety¹⁸.

Health professionals can read this article in our Professionals site: Probiotics lower risk of post-natal depression.

Other helpful lifestyle interventions to support mental health in pregnancy

The suggestions below can also be taken to build resilience and to help in recovery once a diagnosis has been made¹⁹:

• Connect with other mothers
• Do something you enjoy
• Ask for help
• Rest when the baby rests
• Be with people who can provide comfort and support
• Look for support within the locality or online (see resources below)

Complementary therapies for mental health include:

Managing gut health with strain-specific probiotics. Health professionals might be interested to visit the Probiotics Database to look at research for Lactobacillus acidophilus Rosell 52 and Lactobacillus rhamnosus HN001. You can find Lactobacillus rhamnosus HN001 in Optibac Pregnancy.

• Physical activity has been shown great results for improving mood and wellbeing. Short intervals of 10 minutes a day can increase mental alertness, energy and promote a positive mood. Regular physical activity that you enjoy can increase self-esteem and reduce stress and anxiety²⁰.
• Diet and nutrition play an important role in mood regulation²¹:
  • Eating regularly to balance your blood sugar levels
  • Eating enough fibre each day to ensure regular bowel movements
  • Staying hydrated
  • Limiting levels of caffeine per day
• Other supplements may also be helpful, and there is preliminary research into depression for some nutrients and herbs, including:
  • SAMe
  • St John’s Wort
  • Omega 3
  • Folic acid²²

Care must be taken with certain nutraceuticals and herbal medicines as they may not all be suitable during pregnancy. Probiotics on the other hand, are becoming a popular choice for exactly this reason, due to their excellent safety profile, even during pregnancy and breast-feeding.

• Mindfulness and meditation are being widely used to help cultivate a calmer mindset and soothe anxiety.

Support Groups in the UK

There are some fantastic support groups and resources throughout the UK that focus on mental health and wellbeing during and after pregnancy. These groups can also give extremely useful and practical tips on what to do if you are concerned about a loved one that may be suffering.

Useful Resources include:

Best beginnings
MIND
Pre and Postnatal Depression Advice and Support (PANDAS)
Maternal Mental Health Alliance

Further reading:

Look at the section on Mental Health on our Learning lab.
Probiotics in Pregnancy

Healthcare professionals can read more on this topic here:
New study finds probiotics may help with post-natal depression​

References

1. Health Service Executive (2008). “Chasing the Blues away”. [Online]. Available: https://www.hse.ie/eng/services/publications/mentalhealth/chasing-the-blues-away.pdf . [Accessed April 2020].
2. Royal College of Psychiatrists (2008). "Mental health in Pregnancy”. [Online]. Available: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/mental-health-in-pregnancy. [Accessed April 2020].
3. Leigh B et al., (2008). "Risk factors for antenatal depression, postnatal depression and parenting stress," BMC Psychiatry, 8:24, doi: 10.1186/1471-244X-8-24.
4. NCCMH (2018). "Antenatal and Postnatal Mental Health - The NICE guideline on cliincal management and service guidance." British Pyschological Society and The Royal College of Psychiastrists, London.
5. Milgrom J et al. (2008). "Antenatal risk factors for postnatal depression: a large prospective study," Journal of Affective disorders, 108:1-2, pp. 147 – 157.
6. Wisner K L et al. (2013). "Onset Timing, Thoughts of self harm, and Diagnosis in Postpartum Women with Screen positive Depression findings," JAMA Phychiatry, 70:5, pp. 490-498. doi:10.1001/jamapsychiatry.2013.87.
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8. Schiller C et al. (2015). "The role of reproductive hormones in postpartum depression," CNS spectrums, 20:1, pp. 48 - 59 , 2015 doi:10.1017/S1092852914000480.
9. Wharton W et al. (2012). "Neurobiological underpinnings of the estrogen-mood relationship," Curr Psychiatry Rev, vol. 8:3, pp. 247-256.
10. Rybaczyk L et al. (2005). "An overlooked connection: serotonergic mediation of oestrogen-related physiology and pathology," BMC Womens Health, 5:12, doi: 10.1186/1472-6874-5-12.
11. Kim S et al. (2014). "Oxytocin and Postpartum Depression: Delivering on what's known and what is not," Brain Res, pp. 219-232, doi: 10.1016/j.brainres.2013.11.009.
12. Sara Gottfried MD (2020). Balance Your Hormones By Stabilizing Your Gut - Sara Gottfried MD. [online] Available at: https://www.saragottfriedmd.com/the-most-important-organ-for-hormone-balance-consider-the-gut-microbiome [Accessed 25 May 2020].
13. Kwa M et al. (2016). “The Intestinal Microbiome and Estrogen Receptor-Positive Female Breast Cancer.” J Natl Cancer Inst, 108(8), doi: 10.1093/jnci/djw029. Print 2016 Aug.
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15. Rogers, G., Keating, D., Young, R. et al. (2016). From gut dysbiosis to altered brain function and mental illness: mechanisms and pathways. Mol Psychiatry 21, 738–748. https://doi.org/10.1038/mp.2016.50
16. Clapp M et al. (2017). "Gut microbiota's effect on mental health: The gut-brain axis," Clinics and Practice, vol. 7:4, pp. 987, doi: 10.4081/cp.2017.987.
17. National Childbirth Trust (2018). "Antenatal or prenatal depression: signs, symptoms and support”. [Online]. Available: https://www.nct.org.uk/pregnancy/how-you-might-be-feeling/antenatal-or-prenatal-depression-signs-symptoms-and-support. [Accessed 14 April 2020].
18. Slykerman, R.F., Hood, F., Wickens, K., Thompson, J.M.D., Barthow, C., Murohy, R., Kang, J., Rowden, J., Stone, P., Crane, J., Stanley, T., Abels, P., Purdie, G., Maude, R., Mitchell, E. A. (2017). 'Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial', EBioMedicine.
19. National Institute of Health (2018). "National Child and Maternal Health Education Program”. [Online]. Available: https://www.nichd.nih.gov/ncmhep/initiatives/moms-mental-health-matters/moms. [Accessed April 2020].
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