GinPolMedProject © 1 (59) 2021: 014-020 • REVIEW ARTICLE Pregnancy depression – a potential factor for postpartum depression Urszula Sioma-Markowska (ABDEF) Department of Nursing in Obstetrics and Gynaecology, Department of Women’s Health, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Poland AUTHORS’ CONTRIBUTION: (A) Study Design · (B) Data INTRODUCTION Collection · (C) Statistical Analysis · (D) Data Interpre- tation · (E) Manuscript Preparation · (F) Literature Se- The World Health Organisation predicts that in arch · (G) Funds Collection 2030, depression will take first place among social diseases. It is estimated that around 1.5 Interest in the mental health of women in the perinatal period has increased significantly in recent years. The number of million people in Poland suffer from depression. publications treating postpartum depression as a mental disor- The age at which depression is most common- der requiring early diagnosis and therapy has grown. Until now, SUMMARY ly diagnosed is 20-40 years, affecting pregnant few researchers have addressed the impact of pregnancy on a woman’s mood. The term pregnancy depression is not wi- women. The term pregnancy depression is not dely known. According to literature data, 15-20% of women widely known in Poland. According to litera- develop depression during pregnancy. In Poland, from 2019, ture data, depression in pregnancy affects from according to the guidelines of the organizational standard of perinatal care, it is mandatory to monitor mental health du- 10% of pregnant women [1] to 15-20% [2-4], ring pregnancy and after childbirth. The publication briefly and and even 25% of pregnant women [5]. There- synthetically summarizes the reports on the issue of pregnancy fore, nowadays, the greatest interest is aroused depression - risk factors and symptoms of pregnancy depres- sion and the initial diagnosis of depressive disorders in pre- by cases related to pregnancy and childbirth. gnancy. This is due not only to the focus of scientific Keywords: pregnancy depression; risk factors; symptoms; dia- research but also to recognising the needs of gnosis pregnant women seeking to maintain their Address for correspondence: mental health. Modern society demands women Urszula Sioma-Markowska a triple role in life: wife/partner, mother and Department of Nursing in Obstetrics and Gynaecology, De- worker. Several studies have painted a picture partment of Women’s Health, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice of a woman in the 21st century, lonely and 12 Medyków Street, 40-752 Katowice-Ligota, Poland often isolated. Social context and assigned ta- e-mail: [email protected] sks are some of the important causes of mental Word count: 3391 Tables: 1 Figures: 0 References: 40 health disorders. Besides, increased levels of stress and anxiety in pregnant women are in- Received: 03.03.2021 fluenced by the current COVID-19 pandemic, Accepted: 08.03.2021 Published: 31.03.2021 which has been ongoing since March 2020. Depression most often has an unseen, insi- dious, chronic course that can lead to severe mental health problems in pregnancy, labour and the postpartum period. According to the National Institute of Clinical Excellence (NICE) guidelines, mental disorders should be detected and diagnosed as soon as possible in pregnant and postpartum women [6]. Impor- tant tasks of obstetricians and midwives inclu- de screening to detect mental disorders of pre- gnancy and the postpartum period and provi- ding psychoeducation in this area. The Regu- lation of the Minister of Health on the orga- nisational standard of perinatal care, in force since January 2019, indicates a 3-fold asses- sment of the emotional state and the risk of severity of depressive symptoms. In the 11.- 14th week of pregnancy (1st trimester), in the 14 U. Sioma-Markowska – Pregnancy depression – a potential factor for postpartum depression 33.-37th week of pregnancy (3rd trimester) and an adjustment phase. The ambivalence of fe- after delivery during a midwife visit in the place elings and changeable mood dominate – this of residence stay of the mother and child. Pre- period can be dominated by anxiety and emo- gnancy and postnatal depression are areas that tional tension. In the second trimester, a phase have not yet received thorough treatment in of hormonal and emotional stabilization takes Poland. The care of women’s mental health place. In the third trimester, anxiety increases during pregnancy, labour and puerperium requ- again, mainly due to the approaching birth. ires management procedures. In the UK, there Anxiety, as a negative emotional state, usually are specific management procedures developed remains unrecorded and may go unnoticed. Its by NICE. In addition to healthcare facilities, presence affects the way of thinking, acting and support groups and voluntary organizations interacting between the parturient and her play an important role. caregivers. Anxiety reduces the ability to reason, leads to stressful relationships, lowers percep- MENTAL HEALTH DURING tion and affects behaviour. It can be one of the elements that interfere with childbirth. Partu- PREGNANCY rients experiencing negative emotional states are In the field of perinatal mental health, postpar- found to have longer labour duration, a stron- tum depression has received the most attention. ger need for analgesics and epidural analgesia, Few researchers have investigated the effects of higher risk of elective and emergency caesare- pregnancy on a woman’s mood. In 1968, Pitt an section [9,10]. Anxiety and fear is often the was the first psychiatrist to draw attention to reason for requesting a caesarean section witho- atypical postpartum depression complicating the ut medical indications [11,12]. puerperium [7]. Since then, the focus has been Birth phobia has been described by Hofberg on assessing a woman’s mental health after and Brockington, among others [13]. The symp- childbirth. The view has also become established toms of primary phobia may already appear in that pregnancy protects a woman from negati- adolescence. It is sometimes so strong that the ve emotions such as sadness, depression, disco- woman avoids pregnancy. Another manifesta- uragement or despair. A wide swathe of socie- tion of phobia is a persistent desire to avoid ty believed that a pregnant woman experiences natural childbirth and request a caesarean sec- a positive and joyful mood during pregnancy. tion. Tocophobia is an incompletely understo- However, parenthood is a challenge that requ- od phenomenon; hence there is little data on ires maturity, material stability and much pre- its prevalence. It is estimated that tocophobia may affect up to 10% of pregnant women, of paration. The adaptation to being a parent is which 2% are extremely intense and require not easy. A woman becoming a mother adapts specialist care. The Scandinavian countries have to a new life situation, sometimes difficult so- pioneered research into tocophobia. Most of matic and psychological problems concerning them have multidisciplinary clinics that exten- the mother, the child and other family mem- sively investigate and treat women experiencing bers. Studies show that 90% of women expe- tocophobia [14]. A large study involving 7200 rience their motherhood differently than they women living in six European countries found anticipated, and emotional disturbances occur significant differences in the prevalence of to- at this time far more often than at other times cophobia between countries, ranging from 1.9% in a woman’s life [8]. to 14.2%. Residents of Sweden and Estonia Pregnancy is an event of great significance. were more fearful of childbirth than residents It can’t be an emotionally indifferent event. The of Belgium [14]. Increased social and clinical process of psychological and biological adapta- knowledge about tocophobia has contributed to tion to pregnancy and motherhood is individu- a decrease in the prevalence of tokophobia in al. It depends on many factors, including the Sweden over the past decade from 6-10% to woman’s age, family situation, current life plans, 2.5-4.5%. The percentage of multiparous wo- husband’s/partner’s attitude to pregnancy, pre- men with knowledge of tocophobia in 1997 vious procreative experiences, social and emo- was 1.5% vs 7.8% in 2010, the percentage of tional maturity, social and living situation. firstborn women in 1997 1.1% vs 3.6% in There is a description of the phases of the 2010. [14]. Heimstad et al. report the preva- pregnant woman’s emotional state in the lite- lence of severe fear of childbirth at 5.5% [15]. rature, depending on the trimester of pregnan- In Poland, there are no data in this respect. cy. In the first trimester of pregnancy, there is There are no unambiguous diagnostic criteria 15 © GinPolMedProject 1 (59) 2021: 014-020 that would make it possible to determine the and an increased risk of depression in postna- presence of tocophobia. The study by Sioma- tal life. A link between chronic stress in pre- Markowska et al. attempted to assess the seve- gnant women and the development of eating rity of anxiety/tocophobia and to analyse its behaviour in their children has also been ob- causes in a group of Polish pregnant women served [19]. [16]. The prospective study involved a group of Women who are neurotic, hypersensitive, pregnant women in the third trimester of pre- have a pessimistic view of the world and them- gnancy hospitalised in the clinical department selves, are anxious, or perfectionist is more of obstetrics and gynaecology. The standardi- likely to experience pregnancy and postnatal sed Childbirth Anxiety Questionnaire (KLP II- mood disorders. Sometimes, a woman who is Revised Version) developed by Putyński and lost and anxious if she is not very in touch with Paciorek and published in 1997 was used to her emotions may not notice or deny that she assess the level of labour anxiety. A very high is experiencing something difficult. It can also level of childbirth anxiety was found in 6.7% happen that the young mother thinks that her of the examined women.