Causes, Symptoms, Diagnosis Of Perinatal Mental Health In Pregnant & Postpartum Women

“Doctor, what if I am tested Covid Positive?’’, this has become common query in our day-to-day OPDs, tells Dr. Manjula S. Patil, Consultant Obstetrician & Gynaecologist, Motherhood Hospitals, HRBR, Bangalore. We can sense the fear, anxiety and uncertainty of the future in her voice when we hear this from a ‘would be mom’. No doubt this pandemic has affected everyone, in fact, the 2nd wave has hit still harder. Unlike the 1st wave of Covid-19 which had caused the least damage in all pregnant and lactating mothers, within a month of this 2nd wave we are seeing the vulnerability of pregnant women to the disease and chances of severe infection and adverse fetal effects.

During the COVID-19 pandemic, pregnant and postpartum women face specific challenges that may put them at higher risk for mental health issues. Concerns include greater severity of COVID-19 disease, possible effects on mother and the unborn baby, effect on labour and delivery, an increased risk of adverse neonatal outcomes and uncertainty of long term effect of the disease on mother and baby.

Mental health problems in pregnant and lactating women

Perinatal mental health (PMH) issues are those that arise during pregnancy and in the first year of child-birth. This period in general is a more vulnerable phase. Anxiety and Depression are the most common presentation of PMH and affect about 7 to 20 % of perinatal women. Depressive symptoms are more common in postpartum mothers than before delivery and depending on the severity are categorised as post-partum blues the most common but mild variety, post-partum depression and the most severe form post-partum psychosis. Prevalence of these has been reported to increase with this pandemic with anxiety seen in nearly 50-60% and varying degrees of depression in about 30-35%.

Risk Factors for perinatal mental health problems

Common high-risk factors for PPD are- previous psychiatric illness, antenatal depression, stressful life events and lack of social support. If left untreated, mental health problems can have serious and long-term consequences for the mother, her child and the rest of the family. Specialist PMH programmes offer care and treatment for women with specific mental health needs, as well as support for the parent-child relationship. They also provide pregnancy planning tips to women with mental health issues.

Increased risk for PMH in pandemic is due to the following reasons:

• Rapidly spreading disease and more number of pregnant and lactating mothers catching an infection.
• Uncertainty of disease diagnosis, prognosis and treatment
• Loosing near and dear ones to the disease
• Social media and news channels playing a counterproductive role
• Impact of lockdown and poor social support due to restricted movement of people.

Symptoms of anxiety and psychological distress during the perinatal period due to the pandemic are:

• Excessive worry about contracting infection
• Lack of sleep
• Focussing excessively on social media messages about Covid-19
• Getting anxious about infection control procedures in the family members.
• Feeling sad and angry because of isolation and not being able to meet family and friends
• Not being able to stop or control worrying
• Feeling nervous and anxious, becoming easily annoyed and irritable
• Being so restless that it is hard to sit still
• Two simple assessment tests are:
• No interest or pleasure in doing regular things
• Feeling depressed or hopeless

If these things are noticed in more than half of the day in 24 hrs in past 2 weeks please seek the help of a psychiatrist via teleconsultation.

What if I am diagnosed with COVID-19?

If you are diagnosed with covid positive during pregnancy, don’t panic. More than 80% of pregnant women are asymptomatic or mildly symptomatic and can be managed with home quarantine strictly following all home isolation protocols.

• Plan for a teleconsultation with your doctor who will assess the disease severity and suggest home quarantine or hospitalization.
• During 2 weeks home isolation have regular chats and video calls with your family members to remain positive throughout.
• If diagnosed 2 weeks before the expected date of delivery you need to be hospitalised for monitoring. Chances of transmission of covid infection from mother to fetus are least likely (very few case reports), majority of the patients had uneventful pregnancies with healthy babies.
• Caesarean delivery may be preferred mode of delivery in the majority of the hospital through a good number of data available presently indicating caesarean for only obstetric indications.
• If you catch infection following delivery, you can breastfeed the baby if you don’t have severe illness since the virus is not transmitted through breast milk but don’t forget to wear an N95 mask throughout and maintain hand hygiene.

Also, baby can share the same room with 6 feet distance managed by other healthy family member. Baby can be observed for any symptoms of covid and can be tested in 48 to 96 hrs if the need arises but not as routine. There is a serious awareness gap for adequate maternity care at this time. In the absence of such formal data, the pandemic’s potential for negative mental health effects should be recognised as a serious public health issue, with adequate treatment and assistance to avoid and mitigate any negative consequences.

Also Read: COVID-19 Antibodies in Pregnant Women Can Be Passed On To Their Babies

Signs and symptoms of COVID-19 infection in infants

The majority of babies who test positive for COVID-19 have little or very minor signs. There have been reports of severe illness in infants, but it seems to be uncommon. COVID-19 can pose a greater risk of serious illness in babies with underlying medical conditions and babies born prematurely (before 37 weeks). Fever, lethargy (being too tired or inactive), runny nose, cough, vomiting, diarrhoea, poor feeding and increased work of breathing or shallow breathing have all been recorded in newborns with COVID-19. If your baby has symptoms or you suspect your baby has been exposed to COVID-19, contact your baby's healthcare provider immediately and follow the steps for child care. If your baby exhibits COVID-19 emergency alert signs like breathing difficulty, seek medical attention right away.

Also Read: What To Do If A Pregnant Woman Is Infected With Dengue?

How to prevent covid-19 in pregnant and lactating mothers?

‘Stay home, stay safe’ is still the best preventive measure. Step out only when it is essential and follow covid appropriate behaviour(CAB). Don’t forget ‘ SMS ’- social distancing, Mask and Sanitisation all the time.

At this critical juncture self-care, emotional and mental well-being is key to fight the pandemic blues. Yoga or deep breathing coupled with a healthy and balanced diet can provide comfort and relief. Keep your spirits high, reading books, walk in the garden or perhaps having a hearty chat and laughter with your loved ones can soothe your nerves up to a great extent. If you think you're stressed after pregnancy, talk to your doctor. Find out how to deal with depression and how to take care of yourself during the COVID-19 pandemic.

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