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Happy Mama, Healthy Baby

Pregnancy brings about a multitude of emotions – from happiness to anxiety to excitement. From planning nutritious meals to attending antenatal classes, many mums-to-be focus on their physical health for the sakes of their unborn babies. However, research shows that it is equally important for expectant women to look after their mental well-being as it affects how their children develop in the future.

By Michelle Kee

Maternal Mental Health

Why motherhood makes women moody
As a pregnant mother undergoes a massive physical transformation during pregnancy, her hormones surge to give and sustain her baby’s lease on life. Once a woman conceives, her body begins to produce human chorionic gonadotrophin (hCG). About two weeks post-conception, it eventually reaches a level high enough to be detected by over-the-counter pregnancy test kits. This hormone is important as it supports the production of the progesterone hormone until the placenta is properly formed to produce progesterone on its own. Her heightened sense of smell could also be due to the increase in hCG levels. Some women, however, may be more sensitive to the sharp rise of hCG levels in the body, thus feeling more nauseous and exhausted compared to others.

Progesterone and estrogen are the two main hormones that rise drastically during the first two trimesters. They also play a vital role in promoting pregnancy. Progesterone – a “pro-gestational” hormone – keeps the uterine lining thick and healthy to allow successful implantation of the egg onto the uterine wall. It also acts as a muscle relaxant, reducing discomforts from gastrointestinal tracts to allow the baby to grow in the expanding womb. As relaxed muscles in the lower intestines allow more gases to distend the bowel, pregnant mothers develop a more bloated belly. More importantly, acting as a muscle relaxant also means that progesterone prevents the womb from contracting until the onset of labour. Meanwhile, estrogen activates and regulates other key hormones, such as progesterone. Besides being responsible in developing milk-machinery in the breasts, estrogen also promotes an increase in blood vessels formation to provide nutrition to the baby. This increase in blood flow can also cause some mothers to have that “pregnancy glow”, feel more tender and sore in the breasts, or feel an urgent need to visit the bathroom more often. The increase in both estrogen and progesterone is also associated with the classic irritability a woman experiences in the pre-menstrual period – this may explain the extreme moodiness an expectant mother feels during pregnancy.

Struggling with stress
Hormones may not be the only underlying causes of extreme moodiness during pregnancy. Some expectant mothers may be more anxious, especially if this is their first pregnancy, they’ve had a history of miscarriages, or they’re about to have a rainbow baby. Women with pre-existing anxiety or depression may also feel elevated symptoms of these conditions during pregnancy. Given the current pandemic, mothers may also worry more about the uncertainty and financial costs of raising a child.

While some expectant mothers are able to manage their emotions, others are unable to deal with the overwhelming load and calm the emotional roller coaster within. The World Health Organization reported that at least 10 percent of pregnant mothers suffer from a mental health disorder and cannot function properly on a day-to-day basis1. Hence, it is crucial to take care of a mother’s mental well-being during pregnancy. 

Impact of maternal mental health on children
Maternal stress and anxiety during pregnancy has been linked to differential cognitive outcomes in the offspring. Children of mothers with high prenatal anxiety or depression levels have been found to perform worse on mathematics and IQ2, 3. These children also have poorer short-term memory involved in perceptual and language processing. In Singapore, similar preliminary findings are also observed from the GUSTO study, which has been studying mother-child dyads since 2009. Children of mothers with poorer mental well-being during pregnancy not only perform worse in school readiness tests compared to their peers, but also display more anxiety and depressive-like features at 2 to 4.5 years of age. 

Poor maternal mental well-being during pregnancy also influences brain development in newborns and babies4, 5. Newborns and six-month old infants who underwent magnetic resonance imaging (MRI) of the brain provided clues on the impact of prenatal maternal mood on brain development. The results showed that neonates born to mothers with higher prenatal depression levels showed decreased microstructures in the right amygdala. This brain region is involved in stress reactivity and susceptibility for mood anxiety disorders. Brain imaging of six-month old infants born to mothers with higher prenatal maternal depressive symptoms also showed greater functional connectivity of the amygdala to other prefrontal regions of the brain. This observed connectivity is commonly found in adolescents and adults with major depressive disorder.  

In contrast, when mothers reported feeling more positive attributes during pregnancy, such as being self-confident, relaxed, calm and secure, their children performed better in communication and competency skills, such as attention and imitation, at 1 and 2 years of age6, 7

These scientific evidences suggest the powerful impact of maternal mood during pregnancy on the prenatal environment and child’s neurodevelopment, cognitive and socio-emotional outcomes. 

MAINTAINING MATERNAL MENTAL WELLNESS
One must remember that mental health is not solely defined by having mental illness. Rather,  mental health moves up and down along a continuum – it can get better or worse.  It is not realistic and can be extremely tiring to remain happy and positive at all times. So how should one tackle the high and lows of the emotional roller coaster ride during pregnancy? Here are some ways to help you ride the waves:

  • Share your feelings with your spouse, friends and family members. Be open with your loved ones, so that they understand how you are feeling. Let them know if you cannot cope with any demands or expectations, so that they can help you alleviate your load.
  • Be kind to yourself. Everyone is different. Mothers may feel different levels of fatigue from others. Some may feel envious of the physical appearance of other mothers, or pregnancy goals posted on social media. As everyone is unique, set your own goals and expectations for yourself. Give yourself the chance and flexibility to adjust your expectations when you feel the inability to cope.
  • Be present in the moment and enjoy it. Were there moments when you subconsciously got irritated by your younger children, as your mind was preoccupied with the seemingly never-ending to-do lists from work or household duties? Try being exclusively in the moment instead – whether you are spending quality time with your spouse, or playing with your children. Doing so not only frees you from distracting thoughts, but allows you to focus on and savour the moments spent with your loved ones.
  • Exercise. Physical activity has been shown to help alleviate mental health burdens. Walking, stretching and moderate exercises during pregnancy also lower incidences of gestational diabetes mellitus, gestational hypertension-related illnesses (such as preeclampsia), and preterm birth8. Mothers who exercise during pregnancy also had a faster postpartum recovery8.
  • Care for yourself. Being pregnant is not solely about the baby. Spend some time on yourself as well – go for a well-deserved prenatal massage, read, or indulge in some of your favourite hobbies. Self-care allows you to be more comfortable in your own skin, and provides an opportunity for you to think about your goals and expectations. 

Remember, pregnancy is just the beginning of a new and exciting parenting journey. Take care of your mental well-being now to give you and your child a better future.


References

  1. https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/
  2. Evans J, Melotti R, Heron J, et al (2011) The timing of maternal depressive symptoms and child cognitive development : a longitudinal study.
  3. Pearson RM, Bornstein MH, Cordero M, et al (2016) Maternal perinatal mental health and offspring academic achievement at age 16: The mediating role of childhood executive function. J Child Psychol Psychiatry Allied Discip 57:491–501.
  4. Rifkin-Graboi A, Bai J, Chen H, et al (2013) Prenatal maternal depression associates with microstructure of right amygdala in neonates at birth. Biol Psychiatry 74:837–844.
  5. Qiu A, Anh TT, Li Y, et al (2015) Prenatal maternal depression alters amygdala functional connectivity in 6-month-old infants. Transl Psychiatry 5:e508.
  6. Phua DY, Kee MZL, Meaney MJ (2020) Positive Maternal Mental Health, Parenting, and Child Development. Biol Psychiatry 87:328–337.
  7. Phua DY, Kee MKZL, Koh DXP, et al (2017) Positive maternal mental health during pregnancy associated with specific forms of adaptive development in early childhood: Evidence from a longitudinal study. Dev Psychopathol 29:1573–1587.
  8. Nascimento SL, Surita FG, Cecatti JG (2012) Physical exercise during pregnancy: A systematic review. Curr Opin Obstet Gynecol 24:387–394.

ABOUT THE AUTHOR
A senior research fellow under the Translational Neuroscience programme at SICS, Michelle Kee’s research focuses on antenatal maternal well-being, maternal childhood adversity and parenting styles. The key projects she’s involved in look into understanding maternal well-being and parenting styles on a child's cognitive and socio-emotional outcomes; and studying how genetic profile scores of psychiatric disorders, traits and susceptibility associates with maternal parenting styles, well-being and a child's outcomes. She’s also leading the Mapping Antenatal Maternal Stress (MAMS) study, where she and her team aim to build a biologically informed prediction model of maternal well-being.