Cape Town - With close to 50% of South African women reportedly experiencing depression during pregnancy, psychiatrists are highlighting the risks of increased complications during that period and at childbirth ahead of Pregnancy Awareness Week.
- What is Pregnancy Awareness Week?
Observed between February 10 and 16, the Department of Health uses Pregnancy Awareness Week to strengthen pregnancy education and stress important issues that promote healthy pregnancies and safe motherhood.
- Pregnancy and depression
While postnatal depression is well known, depression during pregnancy is almost as common, and carries the risks of increased complications during pregnancy and childbirth, according to Dr Bavi Vythilingum, a member of the South African Society of Psychiatrists (Sasop).
However, treatment is available and effectively reduces the risks, she said.
“Psychotherapy, group therapy and even antenatal support groups are all very helpful. Antidepressants are effective and, used in consultation with the mother’s healthcare provider, most are safe in pregnancy,” Dr Vythilingum said.
According to a 2019 study on depression among mothers from pregnancy to 18 months postpartum, between 21% and 47% of South African women experience depression during pregnancy, and 31% to 50% suffer postnatal depression, compared with the global rate of approximately 12%.
Antenatal depression increases the risks of hypertension (high blood pressure), which puts both mother and baby at risk of complications during the pregnancy and during childbirth, and of low birth weight and premature births, Dr Vythilingum said.
Depression is one of the greatest risk factors for alcohol and substance abuse during pregnancy, not only worsening the depression but putting the unborn child at risk of developmental delays, congenital abnormalities and intellectual disabilities, she added.
“The lack of awareness and stigma around mental health conditions, along with the tendency to focus more on a woman’s physical health than her mental health during pregnancy, means that depressive symptoms are often not picked up. In addition, some of the symptoms of depression, such as changes in sleep patterns, appetite and energy levels, are sometimes simply attributed to the physical changes of pregnancy.”
- Treatment
Dr Vythilingum said women experiencing moderate to severe depression should ideally be treated with both psychotherapy and medication.
“Ideally, when women have persistently high levels of depression symptoms, an integrated approach should be followed to deal with pregnancy-related depression, domestic violence if present, and other stressful life events and substance use.
“Group therapy is very helpful - as is the support and interaction, a sense of community and of not being alone - in support groups with other expectant mothers and mothers of newborns,” she said.
Many clinics, both public and private, have antenatal support groups and there are mothers’ support groups active on social media that also meet in-person in various centres, she said and advised women who are on antidepressants when they fall pregnant to consult their health-care provider before stopping the medication. If necessary, an alternative can be prescribed or the dosage altered.
“Antidepressants are very effective for moderate to severe depression, or where a patient has not responded to psychotherapy. In cases where the woman doesn’t have access to psychotherapy, antidepressants are a recommended and effective solution.”
- Resources
The South African Depression and Anxiety Group (Sadag, www.sadag.org) lists toll-free helplines for general depression and anxiety, and has free support groups around the country for various issues, including support for expectant and new mothers. Call 0800 21 22 23 for help and information.
In addition, the Mums Support Netnwork (mumsupport.co.za) is a community of women supporting women.
Cape Times