November 17, 2009 – Blogging to Promote Awareness of Premature Births

They say that the reason for nearly half of all the preterm births–which amounts to 10 million babies– that occur each year is unknown.   While thanks to the miracles of modern technology and medicine, many preterm babies are nursed to health, the rate of preterm births is increasing, and all too many that are nursed to health face lifelong challenges.  Per the Bloggers Unite site, the rate has increased 31% since 1981.  Per the March of Dimes website, one in eight babies born in the U.S. is premature (coincidentally, postpartum depression rate is one in eight new mothers), and  the rate of premature birth in America is higher than that of most other developed nations).   I wouldn’t be a bit surprised if there’s a correlation between the increase in preterm births and the increase in fertility issues (refer to past post on infertility and anxiety/depression).

Just as PPD is more common that you realize, depression during pregnancy—or antepartum (or antenatal) depression—is more common than you realize.  Again, due to the lack of public education about this kind of perinatal depression, many women do not seek treatment because they think that feeling tired, having trouble sleeping, and experiencing mood swings, irritability, anxiety and weepiness are normal pregnancy experiences.  The key indicators of PPD—namely, persistent and debilitating sadness and other symptoms that interfere with your ability to function for longer than two weeks—would also apply to antepartum depression and should prompt you to seek help immediately.  

In Perinatal Depression: Hiding in Plain Sight – The Canadian Journal of Psychiatry. August 2007; 52(8), page 483 by Shari I. Lusskin, MD, Tara M. Pundiak, MD, Sally M. Habib, MD:

• “[The] patient with antenatal depression often worsens postpartum in the setting of sleep deprivation and the stress of caring for the newborn.”  As I’d mentioned in my 11/9 post, since approximately 50% of women with antepartum depression will go on to develop PPD, you will need to decide—in consultation with your doctor—whether to take medication.  Whether to take antidepressant medication or undergo some form of alternative medicine (including therapy) while pregnant is a hard one to make and also depends on the severity of your depression–not to mention, taking into consideration the impact on the developing fetus.  Avoiding treatment altogether will only expose your developing baby to the effects of untreated depression and increase your risk for pregnancy complications and premature birth.  There is risk that untreated depression and anxiety during pregnancy can lead to poor nutrition from loss of appetite, self medication through substance abuse (drinking, smoking or drugs), and/or suicidal thoughts/behaviors.  Preterm births, low birth weight, smaller head circumference, developmental problems, and even infant deaths have been associated with anxiety and depression during pregnancy. 
• Signs of fetal distress (i.e., alterations in heart rate variability, fetal movement patterns, fetal sleep-wake cycles) have been detected in pregnant women during their 2^nd and 3^rd trimester obstetrical visits, and studies seem to indicate that 2^nd trimester anxiety may have a negative impact on fetal brain development.
• “The fetuses of highly anxious mothers who had also scored high on depression and anger measures also had growth delays, compared with the fetuses of mothers with less anxiety.  Findings at birth for the same cohort included lower dopamine and serotonin levels, lower vagal tone [which is linked with poor emotion regulation and vulnerability to stress in infancy and childhood].  At age 8 months, infants exposed to antenatal anxiety were found to be highly reactive, to have poorer interactions with their mothers, and to have poorer scores on Bayley Scales of Infant Development [which is a standard series of measurements used to assess motor, language, and cognitive development of infants and toddlers ages 0-3].  At age 24 months, they were also reported by their mothers to have more sleeping, activity, and feeding problems.”

As I mentioned in my November 9th post, 1 out of 10 women experience antepartum (antenatal, prenatal) depression (or depression during pregnancy), though unfortunately many cases go undiagnosed, and as mentioned over at Postpartum Progress, research has shown that preterm births are twice as likely to occur for women suffering from prenatal depression (or depression during pregnancy).  Given the correlation between antepartum depression and preterm births, there should be an increase in public awareness of antepartum depression and not just of postpartum depression, which you hear so much more about—relatively speaking—than depression during pregnancy.  The following are needed if we hope to reduce the number of preterm births due to antepartum depression:

• increase in public awareness and destigmatization associated with perinatal mood disorders, so women will recognize when there is a problem and seek treatment without hesitation
• increase in research for earlier detection of antepartum depression
• increase in research into safer/improved treatment options for antepartum depression. 
• increase in public awareness of the effects of stress (and provide the spectrum of the range of stressors) on pregnancy

For more information about antepartum depression, check out this March of Dimes page and the Beyond Postpartum blog.

For more information about efforts to promote awareness of premature births, visit the Bloggers Unite and March of Dimes websites.  Many bloggers share their stories on the Bloggers Unite site.  There’s also the touching story about Charlotte.