Mental health and wellbeing in pregnancy

Pregnancy and having a baby is a life-changing event: the body undergoes major changes. For most women, this is a happy and positive experience, but for some women there may be considerable discomfort or even ill health while pregnant. Recognising depression or anxiety and supporting pregnant women who experience it is important for maternal health and the ultimate health and welfare of the child.

Mental health and inequalities in pregnancy

Estimates suggest that up to 1 in 7 mothers will experience a mental health problem in the antenatal or postnatal period. Engagement with services during pregnancy offers valuable opportunities to promote mental wellbeing and for the prevention of mental health problems.

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What are health inequalities?

The World Health Organization defines health inequalities as 'differences in health status or in the distribution of health determinants between different population groups'. For a discussion of health inequalities and their relation to pregnancy, please see Inequalities in antenatal care.

Policy context

Activity in this area is consistent with the Scottish Government's action plan for mental health improvement, Mental Health Strategy for Scotland 2012-2015Reducing Antenatal Health Inequalities: Outcome Focused Evidence into Action Guidance, with Equally Well and with the following (external links):

How do inequalities relate to mental health in pregnancy?

Mental health problems can be both a cause and an effect of inequality. Estimates suggest that up to 1 in 7 mothers will experience a mental health problem in the antenatal or postnatal period (NICE - Antenatal and postnatal mental health: implementation advice (external link)).

Women from vulnerable groups, including those experiencing mental health problems, are less likely to access antenatal services and other sources of support - a high risk factor for maternal and infant mortality (Growing Up in Scotland 2011 (external link)).

Women with complex social problems, including mental health problems, report discrimination and judgemental behaviour from healthcare staff and that this impacts on their ongoing engagement with services (Reducing Antenatal Health Inequalities: Outcome Focused Evidence into Action Guidance, pp15)

Overall rates of suicide, schizophrenia, depression and anxiety are all higher among general populations living in the most deprived areas: ISD Scotland - Deprivation and Health (external link).

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What are the risks from mental health problems in pregnancy?

Stress and mental illness can have negative impacts on physical health and wellbeing at any time and may limit an individual's ability to access help and support.

The children of mothers who are stressed or anxious during pregnancy (stress being the experience of pressure that exceeds a person's ability to cope) are more likely to be anxious, have symptoms of attention deficit, hyperactivity and other mental developmental problems Fetal and Neonatal Stress Research Group) (external link).

The Confidential Enquiries into Maternal and Child Health (external link) found that suicide is the leading cause of maternal death, and that women at high risk are often not appropriately identified or managed (NICE - Antenatal and postnatal mental health: implementation advice (external link).

Identifying those at risk

The most powerful predictor of mental ill health in pregnancy is a prior history of mental illness NICE Guideline CG192 - Antenatal and postnatal mental health: clinical management and service guidance (external link). It's important for health professionals to ask individuals sensitively how they feel about their mental health and wellbeing. Linking with other professionals who may know more about the individual, their family and their circumstances, e.g. carers, GPs, social workers, and voluntary sector agencies, is also useful.

Though not predictors of mental illness or a means of clinical assessment, the following general risk factors for poor mental health should be taken into account:

A comprehensive list of socioeconomic and individual determinants of mental ill health is contained in Prevention of Mental Disorders - Effective Interventions and Policy Options: WHO 2004 (external link). For a fuller discussion of risk factors for inequalities, see Inequalities in Antenatal Care.

A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.

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Protective factors for the mental wellbeing of expectant mothers

Protective factors include:

  • positive relationships
  • family connectedness
  • good social supports
  • ability to make choices

Active lifestyles, good nutrition, good sleep habits and awareness of and action on personal stress also promote positive mental health among the general population and are likely to be beneficial in pregnancy. A comprehensive list of protective factors is contained in Prevention of Mental Disorders - Effective Interventions and Policy Options (WHO 2004 - external link).

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Articles in this topic

  • Article

    #PowertotheBump

    #PowertotheBump unites young mothers in fight against pregnancy and maternity discrimination at work.

    • When was this last updated? 5/23/2016
  • Article

    Early Years: The Evidence

    Series of video chapters looking at the evidence behind Early Years Policies. Links to YouTube.

    • When was this last updated? 4/7/2015
  • Article

    Financial inclusion referral pathway toolkit

    A toolkit providing support for developing or improving partnerships between early years services & financial inclusion organisations. It explains the core principles that should underpin these partnerships & uses case studies to illustrate referral pathways and examples of best practice.

    • When was this last updated? 9/8/2016
  • Article

    Getting It Right For Every Child

    Getting it right provides the framework within which all services deliver a child-centred, effective response to children and young people.

    • When was this last updated? 5/22/2013
  • Article

    How can I help address mental health problems in pregnancy?

    Advice for professionals about mental health problems in pregnancy.

    • When was this last updated? 5/27/2013
  • Article

    Maternal stress and ill health

    The adverse effect that maternal stress and prenatal depression can have on the development of the foetus.

    • When was this last updated? 9/24/2010
  • Article

    Physical activity and mental wellbeing

    The importance of physical activity and its link with mental wellbeing.

    • When was this last updated? 6/11/2013
  • Article

    Supporting mental wellbeing

    Community activities to support pregnant women and maintain mental well being.

    • When was this last updated? 9/24/2010
  • Article

    The importance of pregnancy and parenting for positive mental health

    Emphasising the importance of pregnancy and parenting in defining positive mental health outcomes.

    • When was this last updated? 9/24/2010
  • Article

    The Mental Health Strategy 2012 – 15

    The Mental Health Strategy 2012 – 15 highlights the importance of early years in establishing mental wellbeing. Within the strategy, Child and Adolescent Mental Health is a key change area.

    • When was this last updated? 7/22/2013
  • Article

    Towards a Mentally Flourishing Scotland (TAMFS)

    Closely linked to The Early Years Framework, TAMFS aims to improve mental health in Scotland. It underlines the importance of mental wellbeing in the early years.

    • When was this last updated? 8/19/2010

Policy

Evidence

Professional support materials

Information for the public

  • External Resource

    Association for Postnatal Illness (APNI)

    This charity works to provide support to mothers suffering from post-natal illness, and to raise awareness of the condition. Its main areas of work are post-natal depression and baby blues.

    • When was this published? 8/17/2010
  • External Resource

    My Pregnancy My Choice

    Book for expectant parents with learning disabilities. This book is available free of charge to Early Years professionals in Scotland from NHS Health Scotland as an alternative to Ready Steady Baby! To order contact nhs.HealthScotland-EarlyYears@nhs.net.

    • When was this published? 5/27/2013
  • External Resource

    Ready Steady Baby!

    A website for the public providing information and advice through pregnancy and the baby's first days.

    • When was this published? 8/18/2010
  • External Resource

    Take life on website

    This website contains handy tips to help you improve your health and wellbeing

    • When was this published? 9/26/2010
  • External Resource

    Talking About Postnatal Depression (reprinted 2010) - leaflet [219KB]

    This leaflet from NHS Health Scotland is intended for mothers who are experiencing post-natal depression, and for their families and friends. Available in English, Polish and Urdu versions.

    • When was this published? 8/18/2010
  • External Resource

    The Compassionate Friends

    TCF is a charitable organisation of bereaved parents, siblings and grandparents dedicated to the support and care of other bereaved parents, siblings, and grandparents who have suffered the death of a child/children.

    • When was this published? 8/17/2010
  • External Resource

    The Samaritans

    The Samaritans provide confidential support 24 hours a day for people who are experiencing feelings of distress or despair.

    • When was this published? 8/17/2010