As I lay on the hospital bed, two elastic belts encircling my pregnant belly, I tried to concentrate on the intake nurse’s questions: “Have you had any recent thoughts of harming yourself? Are you sleeping? Do you feel safe at home with your partner?”
It had been 24 hours since I last felt the reassuring kicks of my baby at 28 weeks pregnant, and anxiety gripped me. My husband and I rushed to the hospital for a nonstress test to monitor our baby’s heart rate and movement. In my heightened focus on my baby, I hadn’t anticipated being asked about my emotional state.
Mental health has only recently become a recognized component of prenatal care. Historically, pregnancy was thought to shield women from depression and other mental health disorders. In 2010, a committee reviewing the Diagnostic and Statistical Manual of Mental Disorders (DSM) found little evidence distinguishing postpartum depression from other forms of depression. However, today’s understanding acknowledges the unique hormonal, emotional, financial, and social changes associated with pregnancy and childbirth, leading to the term “perinatal depression,” which encompasses mental health concerns during pregnancy and the postpartum period.
Current research indicates that mental health issues such as stress, anxiety, and depression are now recognized as some of the most common complications of pregnancy. Approximately one in five women experiences perinatal depression worldwide. Notably, the United States has the highest maternal mortality rate among 11 wealthy nations, with nearly a quarter of pregnancy-related deaths linked to mental health conditions—80% of which are deemed preventable, according to the Policy Center for Maternal Mental Health.
The effects of maternal mental health extend beyond the mother. Doctors have long understood the connection between a mother’s well-being and her baby’s health. This relationship explains why physicians advise pregnant individuals to take prenatal vitamins, exercise regularly, and avoid certain foods. Recent studies, however, reveal that a mother’s mental wellness significantly influences her children’s future physical, mental, and behavioral health. Women with mental health issues are more likely to experience serious delivery complications, including preeclampsia, preterm birth, and low birth weight. High levels of maternal stress—regardless of whether they meet the criteria for a mental illness—can hinder fetal brain development, leading to long-term cognitive and behavioral issues in children.
“Depression, stress, or anxiety—whatever we call this negative state during pregnancy—negatively affects the fetus and may influence the overall epigenetic environment of the fetus,” explains Katherine Wisner, associate chief of perinatal mental health at the Developing Brain Institute in Washington, D.C.
Understanding Maternal Stress
In a 2016 study, psychiatrist Robert Freedman observed an unusual trend: Black women in his research exhibited significantly lower levels of choline, a nutrient critical for brain development, compared to their white counterparts. This disparity persisted even after accounting for genetics and geographic differences.
Choline, which is found in foods such as eggs, meat, beans, and nuts, stabilizes our genomes and is essential for fetal brain development. To explore this further, Freedman traveled to Uganda, where women in tribal areas with limited diets did not show low choline levels and delivered babies on time. The difference? Elevated stress levels among American women, who had higher cortisol—the stress hormone—concentrations in their hair.
Freedman found that stress prevented these mothers from making choline available to their babies, leading to preterm births and potential attention and behavioral issues in the children due to impaired brain growth.
Subsequent research showed that administering choline supplements improved outcomes. In a double-blind study, pregnant women who received choline delivered on time, and three-and-a-half years later, their children exhibited fewer behavioral problems. As infants, babies access choline through breast milk or formula, which must contain this nutrient according to FDA guidelines.
Freedman’s team has studied around 800 women across five clinical trials, revealing a consistent narrative: prenatal choline and phosphatidylcholine help produce babies less likely to encounter attention issues or social difficulties, thereby promoting healthier development and reducing the risk of mental illness as they grow.
Despite its benefits, choline supplementation is not widely prescribed by physicians, even though it is available over the counter in many prenatal vitamins—often in insufficient amounts. Recently, Colorado’s governor signed legislation to cover choline supplements for all pregnant women on Medicaid, a significant step as nearly 40% of U.S. births are Medicaid-funded.
Addressing Maternal Mental Health
Chronic or high-level stress can impair placental function, limiting oxygen and nutrients for the baby. Additionally, it can trigger inflammation in the mother, leading to changes in newborn brain structure that persist into early childhood and increase the risk of developmental disorders, including autism.
Yao Wu, a fetal and neonatal brain imaging specialist at Children’s National Hospital, notes that elevated maternal psychological distress during pregnancy correlates with negative social, emotional, and cognitive outcomes in children. Such impacts can manifest as early as 18 months of age, including cognitive language delays and heightened risks for anxiety and depression.
Moreover, babies exposed to high stress levels in utero may adapt to anticipate a stressful environment after birth. Functions like suppressing or filtering out stimuli—skills that individuals with schizophrenia, bipolar disorder, or attention deficit disorder struggle with—begin developing as early as 16 weeks of gestation.
While research into these connections is still emerging, experts emphasize that mothers and healthcare providers can take proactive steps to alleviate stress through therapy, medication, and universal mental health screenings—assuming access to such resources is available.
Challenges in Accessing Care
Nancy Byatt, a perinatal psychiatrist dedicated to enhancing maternal mental health services, highlights a troubling reality: less than 25% of pregnant women who screen positive for depression receive initial mental health appointments. Access to care is limited across the U.S., with about 70% of counties lacking sufficient maternal mental health services.
Byatt, now executive director of the Lifeline for Families center and Lifeline for Moms program in Massachusetts, states, “We’ve been in a mental health crisis for a long time, and now we’re in an emergency. These gaps in care are especially pronounced for pregnant and postpartum individuals.”
To address this, she co-founded the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, which provides training and resources for perinatal professionals and ensures access to consultations for patients. The program is insurance-blind, offering support regardless of coverage status. Randomized clinical trials have shown that patients served by MCPAP experience improvements in depressive symptoms, and treatment rates rise.
Lifeline for Moms aims to expand this innovative care model across the country and globally, evaluating efficacy and aiding other states in developing similar initiatives.
Since its launch in 2014, MCPAP has inspired the establishment of perinatal psychiatry access programs in 30 states, covering nearly 70% of U.S. births, according to Byatt.
Most women may not be aware of programs like MCPAP unless their healthcare providers connect them for consultations. Much of the work occurs behind the scenes, as reflected in the questioning I encountered at the hospital, likely influenced by Lifeline training.
Understanding how maternal stress can impact my baby initially heightened my anxiety—an unfortunate paradox of parenthood. However, I have engaged in proven stress-reduction practices: regular therapy, deep breathing exercises, morning walks, and prenatal massages. Despite these efforts, some factors remain beyond our control, particularly during pregnancy. Fortunately, the increasing availability of mental health resources means more mothers can access the support they need, ultimately fostering healthier futures for their children and alleviating some parental worries.
You Might Be Interested In:
-
Disturbed Sleep Tops List of Complaints Received on Mental Health Helpline
-
Maternal Serum Folate Levels During Pregnancy Linked to Congenital Heart Disease Risk
-
Key Triggers for Food Allergies in Children After Organ Transplants
