The First Step to a Healthy Baby: Protecting Mom’s Mental Health

Sep 4

By Dr. Layne A. Gritti, DO
Adult, Addiction, and Perinatal Psychiatrist

When we talk about pregnancy and mental health, the very first point I want to emphasize is this: the most important thing for a baby is having a mentally healthy mother. A mom who feels stable, supported, and cared for can provide the kind of nurturing environment that helps babies thrive.

The value of having a mentally well mother during pregnancy is substantial, particularly for women with mood or anxiety disorders. These conditions are common in pregnancy and the postpartum period, affecting up to 20% of women, and are associated with significant risks if left untreated, including increased maternal morbidity, suicide, impaired maternal-infant bonding, and adverse obstetric and neonatal outcomes such as preterm birth, low birth weight, and developmental delays. Untreated illness can also negatively impact family functioning and long-term child development. Thus, the mother’s well-being has become my guiding light for treatment during pregnancy.

How Common Are Mood and Anxiety Disorders in Pregnancy?

Mood and anxiety disorders are not rare in pregnancy. Depression and anxiety affect about 10-20% of pregnant women, and bipolar disorder affects about 1-2%. These conditions carry real risks if left untreated.

The Risks of Untreated Mental Illness

When mood or anxiety disorders go untreated during pregnancy, the risks increase for:

Maternal complications (like poor self-care, substance use, or worsening illness)
Obstetric complications (such as preterm birth and low birth weight)
Challenges bonding with the baby

Infants exposed to maternal mood or anxiety disorders and maternal mental unwellness during pregnancy are also at increased risk for adverse neurodevelopmental, behavioral, and emotional outcomes. Research shows small but consistent associations between maternal depression and anxiety during pregnancy and poorer infant social-emotional, cognitive, language, and motor development, as well as adaptive behavior. These effects persist into childhood and adolescence, with no evidence that they fade over time.

These issues don’t just affect pregnancy; they can impact the long-term health of both mother and child.

The Role of Medication

For many women, continuing medication during pregnancy significantly lowers the risk of recurrence of symptoms, especially if they’ve had severe or recurrent depression or bipolar disorder. Stopping medication due to pregnancy has been linked to higher rates of recurrence and even psychiatric emergencies.

For bipolar disorder, staying on a mood stabilizer during pregnancy reduces recurrence risk by about two-thirds. In other words, treatment helps keep mothers stable during one of the most important times for both them and their baby.

But What About the Risks of Medication?

This is where things get complicated. Studies on psychiatric medications in pregnancy are often conflicting and limited because it is unethical to do randomized controlled trials on pregnant persons. One reason is what we call confounding factors, other influences that can blur the results. For example, women who need medication may already have more severe illness, may smoke or drink more, or may have other health conditions. That makes it hard to know how much risk comes from the medication itself versus the underlying illness or lifestyle factors.

What we do know is this: most medications, especially SSRIs and SNRIs, are associated with only small increases in risk for certain outcomes, like preterm birth, small size at birth, or the need for NICU admission. Neonatal adaptation syndrome (when a baby has temporary symptoms like fussiness or increased Moro reflex) can happen, but it is short-lived and does not cause lasting problems.

Certain medications do carry more specific risks. For example, paroxetine has been linked to a slightly higher chance of heart defects, and lithium has a small risk of a heart condition called Ebstein’s anomaly. But even here, the absolute risks remain low. Valproic acid is the only medication that has been consistently shown to cause malformations.

If you would like to contribute to the research about psychiatric medications, please sign up at the National Pregnancy Registry for Psychiatric Medications, done by MGH Center for Women’s Mental Health.

Balancing Risks of Medication and the Risks of Untreated Mental Illness

The reality is there is no such thing as a “no-risk” option in pregnancy. Both medication and untreated illness carry risks. When I work with patients, I do a risk-risk analysis, weighing the risks of treatment against the risks of not treating. And for many women with moderate to severe illness, the risks of untreated mental illness equal or outweigh the modest risks of medication exposure.

That’s why the safest approach usually includes:

Shared decision-making between you and your doctor
Eliminating any unnecessary medications
Sticking to the lowest effective dose
Regular monitoring during pregnancy and postpartum

Takeaway

Staying mentally healthy in pregnancy is essential. Medications may carry small risks and untreated illness carries substantial risks for both mom and baby. Each situation is unique, which is why personalized planning and close monitoring matter so much.

References

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Desaunay P, Eude LG, Dreyfus M, et al. Benefits and risks of antidepressant drugs during pregnancy: a systematic review of meta-analyses. Paediatr Drugs. 2023;25(3):247-265. doi:10.1007/s40272-023-00561-2.

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Layne Gritti