Why Mental Health Starts Before We Are Born: The Importance of Mental Wellbeing in Pregnancy
Mental health is a growing topic in the media and features prominently in modern conversations. We are improving in our ability to talk about mental wellbeing and understand what measures to take to keep ourselves mentally healthy. However, it is becoming increasingly apparent that if mothers suffer with mental health problems while they are pregnant, their children are more likely to develop poorer mental health themselves, later in life. Perhaps we need to start considering the mental wellbeing of a child even before he or she is born.
A commonly discussed disorder in this area is antenatal depression, that is, depression during pregnancy. Although not as well-known as postnatal depression (depression after the baby is born), it is almost as common, with estimates ranging from 7–20% for antenatal depression versus 7–30% for postnatal depression. These figures may vary depending on the mental health services offered to women in different geographical areas, not just in terms of the treatment on offer which might help to reduce the rates, but also depending on how well the services routinely ask women about their mental health and therefore identify those women who need support.
As with other mental health problems, babies born to mothers suffering with antenatal depression show poorer mental wellbeing as they develop. You may think the explanation to this is obvious: surely it is because they have shared genes? Or perhaps a mother who is depressed may care for her baby slightly differently? These two things are likely to play a role, but what is often less considered is the specific impact that antenatal depression might have on the developing foetus. We call this ‘foetal programming’, a fairly new area in which we are trying to understand how the biological environment of the mother might ‘program’ the growing baby while in the womb, in preparation for the outside world after birth. For example, a mother who is pregnant during a time of famine might give birth to a baby ‘programmed’ to expect an environment with low food availability, which in turn might shape how the baby’s body absorbs calories from food.
We are now starting to understand how the psychological environment in which a foetus develops in the womb may impact the development of that person’s mind, brain and body throughout their life. Our recent paper, published in Molecular Psychiatry, compiles the results of a vast body of literature to explore what effects all these factors may have when brought together. It is thought that this ‘foetal programming’ mechanism, in the context of mothers with mental health problems, might be a reason why we observe higher rates of mental health problems in their children. The more we can understand about how this ‘transmission’ of poor mental health occurs, the better-equipped we are to identify those most in need, as well as offer the most effective support.
In our review article, we identified a number of studies which showed, for example, differences in the birthing process in mothers suffering from antenatal depression, whose babies are more likely to be born earlier and with a lower birth weight. From a psychological point of view, studies also show that these children may show difficulties with emotional regulation and behaviour in early life, and are more likely to be diagnosed with a mental health disorder in adolescence or later. There are also clear biological differences found when comparing the children of depressed and healthy women, such as our own study which finds increased response of the stress system to the pain of vaccination in the babies of depressed women.
Of course, these studies also have to take into account the wider environment in which these children are raised, for example, it is often observed that mothers with depression have lower levels of social support, which might be indicative of a more unstable family environment. Furthermore, statistically they are often lesser educated and of a lower socioeconomic background, which might shape the learning and enrichment opportunities available to the children as they grow and develop. However, even when we take these factors into account, there still seems to be a specific effect that antenatal depression is having on the child’s development, which supports our idea that ‘foetal programming’ is an important mechanism that we need to understand more about, if we want to offer the best interventions to women and their unborn children.
But, it is important to stress that not all stories are the same; not all children born from mothers who were depressed in pregnancy (or postnatally) go on to develop physical or mental health problems. What was very striking when looking at all of this research overall, was how the results varied across studies, sometimes with one study directly contradicting another. When we looked into this in more detail, we were able to find many aspects of a child’s environment which may help to protect against any negative consequences a mother’s depression might have. For example, the presence of a supportive father figure, a pleasant mother-baby bond, and good childhood education, were all factors which helped to improve outcomes for the child.
It is important that we remember this, so that women who suffer with antenatal depression do not feel guilty about any potential impact their condition might have had on their child. Instead, the focus should be on the things that mothers can do to ensure that the impact of antenatal depression is reduced.
And we, not only as mental health professionals but also as a whole society, need to be providing psychological and social support to these women at the right times, which might even include pre-conception, as well as during pregnancy and motherhood. Where possible, these initiatives should also include other family members, or the father of the child.
If we can do this, we can improve the emotional wellbeing of the whole family, leading to better outcomes for all.