Depression

Managing Depression When You Are Pregnant or Breastfeeding

Disclaimer: This page houses important information and resources pertaining to depression during pregnancy and while breastfeeding, including links to our evidence-based Fact Sheets. However, the resources here should not replace the care and advice of a medical professional.

Anyone can experience symptoms of depression at some point in their life, like when going through relationship problems, grieving the loss of a loved one, or facing job loss. But when the symptoms of depression are severe, persistent, and interfere with everyday activities, these may be signs of clinical depression (also called Major Depressive Disorder, or MDD). When major depression happens during pregnancy or after childbirth, it is called Peripartum Depression (PPD; formerly called postpartum depression). MDD and PPD are serious conditions that may make it difficult to complete daily tasks in order to care of yourself or your baby, and may interfere with bonding, which might have a negative effect on the baby’s development and behavior.

Depression is nothing to be ashamed of. If you think you may be clinically depressed, talk with your healthcare provider or a licensed mental health professional about your symptoms and concerns.

Not Feeling Like Yourself?

Are you a new parent – or about to be – and feeling sad, worried, or concerned that you aren’t good enough? The National Maternal Mental Health Hotline counselors provide 24/7, free, confidential emotional support and resources to help you feel better. Call or text 1-833-TLC-MAMA (1-833-852-6262). Are you currently in crisis? Call or text 988 Suicide Prevention Hotline.

Have a Question?

Need information about depression or a mental health medication during pregnancy or while breastfeeding? Contact a MotherToBaby information specialist.

Pregnant persons with depression – and their babies – typically do better if their depression is treated. Some studies (not all) have reported higher rates of miscarriage, preterm delivery, low birth weight, and pre-eclampsia when depression is left untreated in pregnancy. Treatment for depression can include medications, talk therapy, or a combination of the two. It’s important that you discuss treatment options with your healthcare providers when planning pregnancy, or as soon as you learn that you are pregnant. As always, check out our resources if you’re looking for information about specific medications. And remember: always talk with your healthcare providers before stopping any medication you are currently taking.

Reference: American Psychiatric Association, October 2020.

Please see our library of resources below on depression during pregnancy and breastfeeding.

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Depression

Considerations when you’re eating and drinking for two

Disclaimer: This page houses important information and resources pertaining to foods and beverages during pregnancy and while breastfeeding, including links to our evidence-based Fact Sheets. However, the resources here should not replace the care and advice of a medical professional.

In this day and age, we all know how important a healthy diet is to our overall health. So, it won’t surprise you to know that a healthy diet is even more important during pregnancy, as well as while breastfeeding, when the infant’s only or primary source of nutrition is breast milk. Although many foods provide the nutrients we need to keep ourselves, our pregnancies, and our breastfed infants healthy, it’s important to know that some other foods and beverages should be avoided when you’re pregnant or breastfeeding because they could be harmful.

Some foods have a higher chance of carrying bacteria that can cause food-borne illnesses. Food-borne illnesses are infections, like listeriosis, salmonella, and E. coli, that can be caused by eating or drinking foods or beverages that are contaminated with these bacteria. Common culprits include raw or undercooked meat and fish, deli meat, unpasteurized (that is, raw) milk and milk products, and soft cheeses. Some food-borne illnesses can cause serious complications during pregnancy, which is why these foods should be avoided while you are pregnant.

Foodborne illness during pregnancy can cause serious health problems, miscarriage, premature delivery, stillbirth or even death of the mother.

– U.S. Food and Drug Administration

Some other foods need to be avoided because they might contain toxic elements that are found naturally in the environment but can be harmful when they build up in our food chain. An example is methylmercury, which is found in high levels in certain – but not all – types of fish. High levels of methylmercury are harmful to brain development in a fetus, infant, or young child. While eating fish does provide beneficial nutrients during pregnancy, it’s important to choose those types of fish that are known to have lower levels of methylmercury while pregnant or breastfeeding.

Still other foods and beverages, such as alcohol, can directly affect a baby’s development. Alcohol includes wine, beer, spirits (like vodka, gin, and whiskey), liqueurs, and fermented drinks like kombucha. For over 50 years, we’ve known that drinking alcohol during pregnancy can harm a baby’s brain development and cause Fetal Alcohol Spectrum Disorders (FASD). That’s why leading health experts and medical organizations recommend that people avoid alcohol completely during pregnancy.

Alcohol also passes into breast milk. Breastfeeding women are advised to avoid alcohol completely or postpone breastfeeding for 2 to 2.5 hours after each standard drink. In other words, if you have 2 standard drinks, you should not breastfeed for 4-5 hours; if you have 3 drinks, you should not breastfeed for 6 to 7.5 hours, etc. During this time, you can still pump if needed to keep up your milk supply and to stay comfortable, but pumping will not clear the alcohol from your breast milk any faster.

1 alcoholic drink =

12 ounces of beer

1 ounce of hard liquor

4-ounce glass of wine

Talk with your healthcare provider about any concerns you may have about foods or beverages. Please visit our library of resources on food and beverages during pregnancy and breastfeeding.

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Depression

Managing Anxiety When You Are Pregnant or Breastfeeding

Disclaimer: This page houses important information and resources pertaining to anxiety during pregnancy and while breastfeeding, including links to our evidence-based Fact Sheets. However, the resources here should not replace the care and advice of a medical professional.

Like most people, you might experience anxiety at some point in your life, like when dealing with a problem at work or at home, when you or a loved one is facing a health complication – or when you find out you are pregnant! It can be hard to tell the difference between what is usual worry/fear vs. symptoms that might be more concerning. When anxiety does not go away, gets worse over time, and/or interferes with everyday activities, those may be signs of an anxiety disorder. Some people may have anxiety disorders before they get pregnant, while others may develop anxiety disorders during pregnancy or after delivery.

“The multiple adverse perinatal outcomes associated with anxiety [in pregnancy] highlight the need to both identify and manage [people who are pregnant] with high levels of anxiety.”

— Grigoriadis et al. J Clin Psychiatry. 2018;79(5):17r12011.

Untreated anxiety disorders during pregnancy may increase the chance of adverse outcomes such as preterm delivery (before 37 weeks of pregnancy) and low birth weight; they may also make it more difficult to bond with the baby during and after pregnancy, and could increase the chance of having a mood disorder, such as depression, after delivery. If you are concerned about anxiety, talk to your healthcare provider about the best ways to manage it. These might include non-medication options—such as talk therapy, mindfulness, relaxation techniques, and exercise—as well as medications. As always, check out our resources if you’re looking for information about specific medications while you are pregnant, planning a pregnancy, or nursing.

Reference: Buist et al. J Affect Disord. 2011 Jun; 131(1-3): 277–283.

Not Feeling Like Yourself?

Are you a new parent – or about to be – and feeling sad, worried, or concerned that you aren’t good enough? The National Maternal Mental Health Hotline counselors provide 24/7, free, confidential emotional support and resources to help you feel better. Call or text 1-833-TLC-MAMA (1-833-852-6262). Are you currently in crisis? Call or text 988 Suicide Prevention Hotline.

Have a Question?

Need information about anxiety or a mental health medication during pregnancy or while breastfeeding? Contact a MotherToBaby information specialist.

Please see our library of resources below on anxiety during pregnancy and breastfeeding.

External Resources

Partners

Depression

The Aches & Pains of Psoriatic Arthritis during Pregnancy and Breastfeeding

Disclaimer: This page houses important information and resources pertaining to psoriatic arthritis during pregnancy and while breastfeeding, including links to our evidence-based Fact Sheets. However, the resources here should not replace the care and advice of a medical professional.

Up to one out of every three people who are living with psoriasis (approximately 33%) will develop psoriatic arthritis (PsA), a type of chronic, inflammatory arthritis that affects the joints and where tendons and ligaments connect to bone. It can also develop in people who do not have psoriasis. Symptoms of PsA can range from mild to severe, and include tenderness, pain, swelling, or stiffness in affected areas (like fingers, elbows, knees, or toes) and reduced range of motion. We don’t know if fertility is affected by psoriatic arthritis, but there is no established risk. 

Reference: Tauscher et al., 2002

There’s a lot we don’t know about PsA and pregnancy; there are no studies that have looked at the effects of PsA on pregnancy complications or the risk of having a baby with a birth defect. Some medications used to treat PsA might be concerning during pregnancy or breastfeeding, while others appear to be okay to take. Be sure to talk to your healthcare provider about all of your pregnancy and breastfeeding questions.

Though there is no cure, there is a growing range of treatments available to help stop the disease progression, lessen pain, protect joints and preserve range of motion. If you have or suspect you may have PsA, it is extremely important to work with a rheumatologist to find the right treatment plan.

— National Psoriasis Foundation

Join Our Psoriatic Arthritis Study

If you’re pregnant and have PsA, please consider enrolling into our observational study to give people better answers about how PsA and its management can affect a pregnancy and a developing baby. You will not be asked to take or change any medications, and you can participate from the comfort of your home.

LEarn More

Please see our library of resources below on PsA during pregnancy and breastfeeding.

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Depression

Why the High Isn’t Worth it if Pregnant or Breastfeeding

Disclaimer: This page houses important information and resources pertaining to cannabis in pregnancy and while breastfeeding, including links to our evidence-based Fact Sheets. However, the resources here should not replace the care and advice of a medical professional.

Many moms may not want to hear this, but medical experts agree: cannabis (commonly known as marijuana, weed, or pot, among many other terms) should be avoided if you are pregnant or breastfeeding. Cannabis use during pregnancy has been linked to an increased risk for some pregnancy complications, such as preterm birth and having a low birth weight baby. Babies that are born prematurely or with low birth weight can have higher rates of learning problems or other disabilities. In addition, chemicals in cannabis (in particular, tetrahydrocannabinol or THC, which is the primary component of marijuana that produces a “high”) cross the placenta and reach the baby, and there is some concern that this exposure could cause long-term learning or behavior problems.

“When cannabis (marijuana) is smoked or eaten, the chemicals reach the fetus by crossing the placenta. Research is limited on the harms of marijuana use during pregnancy. But there are possible risks of marijuana use, including babies that are smaller at birth and stillbirth. The American College of Obstetricians and Gynecologists recommends that pregnant women not use marijuana.”

— American College of Obstetricians and Gynecologists Committee Opinion No. 722

THC can also be passed to a baby through breast milk. THC is stored in fat and is slowly released over time, meaning a baby could still be exposed even after mom stops using cannabis. A study led by our own Dr. Christina Chambers found that THC may be present in a mom’s breast milk up to 6 days after last use. Because a baby’s brain continues to develop during the time that they are being breastfed, experts worry about the possible effects this exposure may have on a nursing infant when a mother uses cannabis during breastfeeding.

Reference: American College of Obstetricians and Gynecologists (ACOG) and Business Insider

Please see our library of resources below on cannabis exposure during pregnancy and breastfeeding.

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Depression
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