The perinatal period encompasses the period from when a woman becomes pregnant to up to 24 months after the child's birth. The postpartum period, also termed the "fourth trimester," begins when the baby is born and extends until about one year after birth. There is some debate about when the postpartum period ends, with timeframes ranging from six weeks to one year after birth (2). 

Mental health disorders experienced during or after pregnancy, collectively referred to as perinatal mood and anxiety disorders (PMAD), are encountered frequently. In the U.S., one in five pregnant or postpartum women are diagnosed with a PMAD; one in eight women reports postpartum depression. Not only do PMADs have negative implications for the mother's emotional and physical health and well-being, but they can also negatively impact the welfare of the child and the general family unit. The high prevalence of PMADs calls attention to raising awareness of maternal mental health during pregnancy and postpartum.

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Common Postpartum Mental Health Disorders

Mental health disorders experienced during the postpartum period include anxiety, bipolar disorder, psychosis, depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Let's discuss some of these in more detail.

Postpartum Depression (PPD)

Postpartum depression (PPD) is one form of depression that occurs after giving birth. It is characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. PPD can manifest in various ways, including changes in appetite and sleep patterns, fatigue, irritability, and difficulty bonding with the newborn. The "baby blues" are common, affecting 70-80% of postpartum women, and typically resolve within a few weeks after giving birth. PPD is more severe and persistent, often lasting several months or even longer.

The prevalence of PPD varies, but it is estimated that approximately 10-15% of new mothers may experience it. Several risk factors contribute to the development of PPD. These include a personal or family history of depression or other mental health disorders, a lack of social support, a difficult or traumatic childbirth experience, birth of multiples, and financial stressors. Additionally, women who have experienced PPD in a previous pregnancy are at a higher risk of experiencing it again after subsequent births.

Diagnosing PPD involves a thorough evaluation by a healthcare provider, often including a discussion of symptoms, medical history, and the completion of standardized screening questionnaires. Treatment options may vary based on the severity of symptoms but often include psychotherapy and medication. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are commonly prescribed. Coping strategies, including building a strong support system and prioritizing self-care, for new mothers dealing with PPD are essential for managing the condition and promoting recovery. (15) 

Postpartum Anxiety Disorders

Postpartum anxiety disorders encompass a range of conditions characterized by excessive worry, fear, and heightened anxiety levels experienced by individuals after childbirth. Three common types of postpartum anxiety disorders include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and panic disorder. Anxiety disorders coincide with PPD in 25-50% of women. (17)  

Generalized anxiety disorder (GAD) involves persistent and excessive worrying about various aspects of life, including the well-being of the baby, health concerns, or everyday responsibilities. Individuals with GAD often experience restlessness, muscle tension, fatigue, and difficulty concentrating.

Obsessive-compulsive disorder (OCD) in the postpartum period can manifest in intrusive and distressing thoughts (obsessions) related to the baby's safety or well-being. These thoughts lead to compulsive behaviors (compulsions), such as excessive checking, cleaning, or seeking reassurance to alleviate anxiety.

Panic disorder involves the sudden onset of intense and overwhelming panic attacks, including symptoms like rapid heartbeat, shortness of breath, and chest pain. New mothers with panic disorder may develop an intense fear of death, losing control, and going crazy. These fears can be debilitating and can trigger more frequent panic attacks.

Several risk factors can contribute to developing postpartum anxiety disorders, including a personal or family history of anxiety disorders and other mental health disorders, a history of pregnancy loss, a traumatic childbirth experience, a lack of social support, and significant life stressors (20). 

Diagnosis of postpartum anxiety disorders involves a comprehensive evaluation by a healthcare provider, including discussions of symptoms, medical history, and the use of standardized screening tools. Treatment options vary but often include psychotherapy, particularly cognitive-behavioral therapy (CBT), medications, building a support group, and self-care lifestyle habits. (20) 

Postpartum Post-Traumatic Stress Disorder (PTSD)

Postpartum post-traumatic stress disorder (PTSD) is a specific form of PTSD that develops in approximately 9% of individuals following childbirth. It is characterized by symptoms related to exposure to a traumatic birth experience. The causes of postpartum PTSD often stem from childbirth complications, medical emergencies, or traumatic events during labor and delivery. Common triggers for postpartum PTSD may include experiencing a life-threatening situation, emergency cesarean sections, severe pain, a lack of control during labor, or perceived mistreatment or neglect during childbirth. (22) 

Recognizing the symptoms of postpartum PTSD is crucial for early intervention and treatment. Symptoms may manifest as flashbacks or intrusive thoughts related to the traumatic event, nightmares, hypervigilance, avoidance of trauma reminders (such as hospitals or medical procedures), mood swings, and changes in sleep patterns. Women with postpartum PTSD may also experience feelings of guilt or responsibility for the traumatic experience. Therapy options, including trauma-focused therapies such as eye movement desensitization and reprocessing (EMDR) or CBT, can be highly effective in treating postpartum PTSD. Medications may also be prescribed to address specific symptoms like anxiety or depression. In addition to professional help, social support and self-care are essential for recovery. (22) 

Less Common Postpartum Mental Health Disorders

It is equally important to recognize and address less common postpartum mental health disorders due to their potential severity and impact on both the parent and the baby.

Postpartum psychosis is a rare but severe and potentially life-threatening condition characterized by hallucinations, delusions, extreme agitation, and disorganized thinking. It typically occurs within the first few weeks after childbirth and requires immediate medical attention. (17, 23) 

For individuals with bipolar disorder, childbirth can trigger manic or depressive episodes. New mothers with bipolar disorder have seven times the risk of hospitalization than those without. Postpartum bipolar disorder can manifest as extreme mood swings, impulsivity, and rapid changes in energy levels. 

Postpartum onset or exacerbation of eating disorders (EDs), such as anorexia nervosa or bulimia nervosa, can occur. Some studies have found that relapse of EDs may occur in up to nearly 70% of women during pregnancy or after childbirth. This calls attention to the need to closely monitor EDs during pregnancy and after birth.

The Impact on Mother-Infant Bonding

PMADs can significantly impact mother-infant bonding, which is a crucial component of a healthy parent-child relationship. When a mother experiences PMADs, it can disrupt the formation of a secure and emotionally nurturing attachment between herself and her infant. (5) 

Low mood, mood swings, fatigue, low self-esteem and sense of doubt, sleep disorders, changes in appetite, fears, difficult concentration, and thoughts of death or suicide are just some of the symptoms of PMADs that can impact maternal-infant interactions. Depressed and anxious parents often smile and talk less and are less likely to touch or engage with their babies throughout the first year of life. Depression and other PMADs in the mother diminish her bond with the baby and adversely affect the child's perception of her. As a result, infants are more likely to develop negative affective states that disrupt their ability to form social relationships. (19, 28) 

Not only do PMADs negatively impact the early bond between mothers and babies, but they have been shown to hold a significant economic burden, responsible for $14 billion annually, and lead to poorer infant developmental outcomes.

How Can Functional Medicine Labs Help Prevent and Manage Postpartum Mental Health Disorders?

Functional medicine labs can play a significant role in preventing and managing postpartum mental health disorders by providing valuable insights into a mother's physiological and biochemical health. Labs assess a variety of biomarkers implicated in the development and severity of mood disorders and allow for a personalized approach to treatment based on individual needs.

Complete Blood Count

Postpartum anemia is common and has been estimated to have prevalence rates between 50-80% in developed countries. Anemia has been associated with increased rates of maternal depression and reduced cognitive function and has major negative health impacts on both mother and baby. Anemia can be diagnosed by measuring red blood cell counts, hemoglobin, and hematocrit with a complete blood count. (14)

Sex Hormones

Fluctuations in hormones occurring naturally during pregnancy and after birth can affect a mother's mental health. Sudden changes and imbalances in estrogen, progesterone, and testosterone have been linked to symptoms such as depression, anxiety, sleep disturbances, and fatigue.

Thyroid Hormones

Some women may experience postpartum thyroiditis, in which hormonal fluctuations related to pregnancy and childbirth result in changes in the thyroid's size and thyroid hormone metabolism. Postpartum thyroiditis typically presents as a transient hyperthyroid state that then converts to hypothyroidism. Thyroid dysfunction, including the over- and underproduction of thyroid hormones, can manifest as anxiety, depression, and other symptoms associated with PMADs.

Nutrition

The body needs nutrients for healthy hormone production and signaling, neurotransmitter synthesis, energy metabolism, and healing. Because nutrient demands are higher during the perinatal period, deficiencies are common among pregnant and lactating individuals. Most studies show positive associations between nutritional deficiencies, poor diet, and maternal depression. Comprehensive nutritional panels can detect deficiencies, insufficiencies, and imbalances in nutrients, such as iron, vitamin D, and omega-3, associated with depression or other mood disorders. (27) 

Prevention and Coping Strategies 

It's important to note that the impact of PMADs on mother-infant bonding can be mitigated with appropriate diagnosis and treatment. Seeking professional help, such as therapy and medication when necessary, can help mothers manage their symptoms and improve their ability to connect with and care for their infants. Moreover, offering social support, understanding, and non-judgmental assistance to mothers experiencing PMADs can play a significant role in helping them navigate the challenges of bonding and ultimately foster a healthier and more secure attachment with their babies.

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Summary

By understanding the prevalence, symptoms, risk factors, and available treatment options for postpartum mental health disorders, new mothers can empower themselves with the knowledge to recognize and seek support when needed. Furthermore, healthcare providers and families can play a pivotal role in ensuring new mothers receive the care and understanding they require during this vulnerable time. By fostering awareness and providing resources, we can collectively contribute to the mental well-being of mothers and their infants, promoting a healthier and happier start to motherhood.