Perinatal Mood and Anxiety Disorders: What They Are and What to do About Them

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  • February 25, 2016

Photo courtesy of Britt Fohrman: Doula, Birth Educator and Photographer

Perinatal Mood and Anxiety Disorders: What They Are and What to do About Them

Thanks to increased research, awareness and advocacy, more and more men and women are becoming aware of postpartum mental illness such as postpartum depression (PPD) and postpartum anxiety (PPA).

However, mood and anxiety disorders don’t just occur once the baby is born. Mothers can experience depression and anxiety during pregnancy as well and it can deeply impact mom, her relationships, her partner as well as her baby.

What are Perinatal Mood and Anxiety Disorders (PMAD)?

Perinatal mood and anxiety disorders are clinical disorders that impact a mother’s well-being during pregnancy and after birth.

Postpartum depression is just one example of a PMAD. Other examples include different forms of anxiety disorders (e.g. social anxiety, generalized anxiety, etc.), OCD and psychosis.

All of these can occur during or after pregnancy.

Moms who have experienced episodes of mood or anxiety disorders prior to pregnancy are at higher risk for developing a PMAD during pregnancy or after the baby is born. However, PMAD can happen to anyone, even without prior history of mental illness.

What are the red flags?

Because there is a wide range of clinical disorders that are included under the umbrella of PMAD, and because each woman will experience mood or anxiety changes differently, it can be difficult to pinpoint when exactly you may be entering PMAD territory.

Here are a few red flags that can help guide you toward the right support to help you feel more like yourself again:

  • low mood (e.g. crying often, feeling frequently irritable, feeling hopeless without reprieve, etc.)
  • scary or intrusive thoughts
  • fears about something happening to your baby that interfere with daily functioning
  • nightmares or flashbacks
  • changes in eating or sleeping patterns for at least 2 weeks

Even if you can’t fully identify with any of those symptoms, I like to encourage moms to reach out for support if they feel different and not like themselves more days than not for at least 2 weeks.

Who’s at risk for developing PMAD?

Prior history of a mood or anxiety disorder certainly adds to the risk of developing a PMAD during or after pregnancy. However, there are several other risk factors for developing PMAD as well.

Primarily, stress is a tremendous risk factor for developing PMAD. Chronic stress not only can impact the health of the pregnancy, but it can also affect how well mom bonds with baby and is closely linked to anxiety and depression.

This is especially of concern for women who have a high-risk pregnancy and are overwhelmed by the complications and unknowns. The anxiety from the ups and downs as well as being on bed rest add stress to moms, can exacerbate their pregnancy complications and can increase their risk of developing antepartum anxiety or depression.

Any mom who has experienced a traumatic pregnancy or a traumatic birth is also at high-risk for developing mood or anxiety disorders. There’s no general definition for what is considered traumatic as it is specific to each individual’s perspective and her unique pregnancy or delivery circumstances.

How to support moms at risk for developing PMAD?

Partners, friends, family and doulas can play a significant role in helping moms lower their risk of developing maternal mental illness and helping moms cope with their mental illness.

Here are 4 things you can do to support a mom at risk for developing PMAD:

1) Help her keep her stress low! Make her laugh. Take her outside for a walk. Help her delegate. Remind her of all the ways she’s doing a great job of taking care of the baby. Find out what’s stressing her out and offer support to ease the burden.

2) Get support right away when diagnosed with pregnancy complications. Once the doctor orders bed rest or diagnoses the pregnancy as high-risk, help her set up regular and consistent emotional support right away even if she has no signs of PMAD. Significantly more moms on bed rest or with high-risk pregnancies go on to develop PMAD than pregnant women without complications so set up support early to curb that risk.

3) Be an empathic ear. Don’t try to solve her problems or offer a solution. Listen to her, validate her feelings and show her that you understand why she’s struggling. This can make all the difference to a mom who feels she’s struggling alone.

4) Make a referral. If you notice she’s really having a tough time getting through the days and you noticed a few red flags causing you concern, refer her to a psychologist, psychotherapist or mental health counselor to treat her PMAD. Her therapist may also recommend a referral to psychiatry, as some moms benefit from medication during and after pregnancy as well.

The good news

The good thing about PMAD is that it can be prevented with the right supports set up as early as possible. And once diagnosed, with the proper treatment, women do feel better.


Parijat Deshpande, MS, CWC, CSMC works with women who are terrified of what could happen during their high-risk pregnancy. Combining her professional expertise in clinical psychology as well as her personal experience with a very high-risk pregnancy, Parijat guides moms to cope with their worries and anxiety so they feel more confident and more hopeful during all of the ups and downs.

If you’re struggling with anxiety during your pregnancy, download the FREE Perinatal Wellness Toolbox to start feeling calmer right away.

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