PREMADs – Do You Know About These?

premads

I read this article by Juli Fraga from the Washington Post: “Prenatal Depression May Be The Most Severe Form of Maternal Depression” and it got me thinking… There are probably lots of pregnant women out there who don’t even know that PREMADs exist. What are PREMADs? PRE-natal Mood and Anxiety Disorders. It’s a word I came up with to describe what happens when a woman experiences a mood or anxiety disorder prenatally, during pregnancy.

Our focus in the field of maternal mental health has primarily been on raising awareness of PMADs – Postpartum Mood and Anxiety Disorders. And rightly so! According to PSI International, 1 in 7 women suffer from postpartum depression, and 1 in 10 men do as well.

A recent search I did for information about the rates of prenatal depression yielded this information from a 2009 ACOG report that states somewhere between “14-23% of women will experience depressive symptoms while pregnant.” I would guess that now that we’ve expanded the umbrella of postpartum depression to include anxiety, OCD, PTSD, bipolar and psychosis, that the percentage of women who might be experiencing one of these anxiety or mood disorders during pregnancy has expanded as well.

In the past several years, I’ve witnessed an increased awareness across the board from OBGYNs, midwives and nurses for the need to screen women postpartum for mood or anxiety disorders. And I can speak directly to how much more time Childbirth Educators spend talking about this issue in the classroom.

But I’m beginning to think that there’s a hole in that education and screening, as the focus continues to be on a mood disorder waiting to happen to a women until after her baby is born. What if she’s experiencing anxiety or depression right now – while she’s pregnant? PREMADs might be getting overlooked entirely (seeing as I just made up the word today!) and women end up suffering in silence during their pregnancies hoping that they’ll eventually feel better. I’m afraid this might be leading to higher rates and more intense mood disorders in the postpartum period.

This doesn’t need to happen.

The symptoms of PREMADs might get overlooked during pregnancy because they’re chalked up to just being a part of the hormonal ups and downs of pregnancy. These will all even out in the 2nd trimester, or after childbirth classes begin, or whatever. But they don’t.

We all have days during pregnancy that are really stressful – we may even question whether this pregnancy was a great idea! (Personal confession: In each of my four pregnancies I had a day where not only did I question whether it was a good idea, I actually said it – out loud, to other people. “This was a bad idea. A very, very bad idea.” All four times. No lie.)

But if you’ve been experiencing any of the following symptoms pretty consistently over a two week period, you should really be touching base with your provider – or someone else you trust who can get you the professional support you need.

Signs and Symptoms

  • Being sad most of the time and not being able to “shake it off”
  • Feeling anxious or worried about the pregnancy, the baby, the birth, your relationship… the list goes on and on
  • No enjoyment in the stuff you usually like to do
  • Sleeping a lot – or not being able to sleep very much at all
  • Not being able to focus for very long periods of time
  • Feeling guilty or worthless
  • Thinking about harming yourself
  • Feeling hopeless

Again, after a stressful day at work or following a recent fight with your partner, you might be able to say yes to a few of these symptoms – but they go away after some time has passed. It’s when any of these symptoms are persistent or nearly continuous over a two week period that you need to be checking in with someone.

You don’t have to have all of these symptoms to seek help. Even one of these would be an indication to be talking to your provider so they can screen you further and then create a treatment plan that might include lots of different things that have been shown to help: exercise, diet, support groups, acupuncture, getting more sleep, herbal remedies and Omega 3s, individual psychotherapy and medications.

Please take note of these symptoms and ask your provider to screen you during your pregnancy for your risk of PREMADs.

There’s no reason to not get help as soon as you can. Because if you seek and receive support now, you might not be so overwhelmed in the first few days, weeks and months of postpartum with your newborn.

My biggest concern is that women who are experiencing an undiagnosed PREMAD now, are at a greater risk for a PMAD after the baby is born. Add in a challenging birth experience and the normal – but huge – adjustments involved with new parenting and these women may end up experiencing a PMAD that’s much more severe than it would’ve been if it had been addressed prenatally.

I’d love to see screening for PREMADs become part of the routine care for women as they prepare for birth and parenting. Help me spread the word by sharing this post far and wide so that awareness of PREMADs can be something we’re all on the lookout for when we, or our friends and family become pregnant.

Find the support and care that are available to address anxiety, depression or other mood disorders experienced during pregnancy. Learning how to lessen feelings of anxiety, sadness and fear, might increase feelings of enjoyment of the pregnancy experience. This can lead to feelings of anticipation and joy for the upcoming birth which might translate into an easier postpartum transition. It’s a win-win-win-win-win situation. (That’s a lot of winning!)

Thanks for spreading the word. And I hope that this mini-PSA of mine finds a few of those women who might be wondering if their feelings of anxiety or sadness are beyond the usual hormonal changes brought on by becoming pregnant. Even if only one woman reads this post and seeks support, I’ll feel like raising awareness for PREMADs made an important difference.

Do you know any women who you think might be suffering from something beyond the usual hormonal fluctuations that happen during pregnancy? And now that I’ve named it PREMADs, do you, or someone you know, recognize that this is what was happening at the time? How would seeking help during pregnancy have helped you in the postpartum period? I’d love to hear your thoughts on this. Please leave a comment here.

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4 thoughts on “PREMADs – Do You Know About These?

  1. Thanks so much, Ashley! I’d love to see this post be helpful to even on Momma out there who might be struggling during her pregnancy. I really am humbled by the number of folks who have shared this for me on their social media channels! XO

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  2. Bravo on your contributions to the conversation! It is an important conversation to have. When those working in the field of postpartum depression (PPD) made the push to acknowledge PMADs, the goal was to highlight the spectrum of of mental health disorders that can occur in both pregnancy and postpartum. The P stands for perinatal not postpartum in PMADs. I agree that screening should happen in pregnancy as well as postpartum. Side note: Screening should happen during puberty and menopause too if you ask my opinion.
    Perinatal is also a term used to encompass the partner because it literally means around the birth. This is around the time including before and after the time of birth, but also around the experience of it. I believe babies can and do experience PMADs too. I have walked that as a mother and heard the stories of mothers that experienced have it.

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    • Thanks for your comments, Rose! I appreciate the distinction that PMADs is supposed to cover the full perinatal spectrum, but the discussion still feels relegated to what happens AFTER the baby is born. Maybe making the distinction for screening during pregnancy with my made-up word PREMADs can help with this? Who knows! Screening at other important (and hormonally fluid) times of a woman’s life makes sense to me as well. And I do agree and have seen the research about babies and the potential for their experience as a result of their mother’s experience. I’d be interested to hear more about this – let’s chat! Thanks for taking the time to comment!

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