You have probably read about postpartum depression. Depression after pregnancy is a common problem, but what about depression and other mental health problems that occur during pregnancy. Recent research shows that depression, severe anxiety, and post-traumatic stress disorder (PTSD) are more frequent in pregnancy than you might think. [1-5]
Depression, severe anxiety, and PTSD may affect you, your pregnancy, and your baby. In fact, statistics suggest that the risk of these disorders in pregnancy may be in the range of 8 to 20 percent. You need to know the warning signs, because all of these mental health disorders can and should be treated during pregnancy. [1-5]
According to the American Congress of Obstetricians and Gynecologists, about 20 percent of women may suffer from depression during pregnancy.  A recent study found that 9.5 percent of women met the criteria for generalized anxiety disorder (GAD) during pregnancy, most commonly in the first trimester.  Studies show that PTSD is becoming more common in women of childbearing age. It may affect about 8 percent of pregnant women. About 50 percent of these women may also experience depression. [2,3]
Depression after pregnancy is called post-partum depression. Depression during pregnancy is called antepartum depression. You may be at risk for antepartum depression if you have depression before pregnancy. The stress of pregnancy may trigger antepartum depression or make symptoms worse. Symptoms last for more than 2 weeks and may include: 
- Extreme and persistent sadness
- Feeling guilty or hopeless
- Trouble concentrating
- Changes in sleep and eating habits (both too much or too little)
- Loss of interest and joy
Like depression, GAD may start before pregnancy or during pregnancy, and may get worse from the stress of pregnancy. GAD is a type of uncontrolled worrying. You may have always been a worrier, but pregnancy may push you to new levels. [5,6] Symptoms can include: 
- Inability to control worrying
- Anxiety or irritability
- Trouble concentrating
- Headaches, muscle aches, and body aches
- Trouble swallowing
PTSD is caused by a very stressful event that has occurred in your life. It may be something you saw or something that happened to you. The triggering event probably occurred before pregnancy. Symptoms of PTSD can last for months or years. Symptoms include: [2,3]
- Flashbacks to the event
- Avoidance of anything that triggers memories of the event
How Can Pregnancy Affect Your Mental Health?
There are two ways that pregnancy can affect your mental health, hormones and stress. Mental health disorders like depression, PTSD, and GAD are caused by imbalances in brain chemicals and pregnancy hormones can affect these chemicals. Pregnancy may cause changes that trigger symptoms of these disorders. [1-4]
Pregnancy is emotionally and physically stressful. Pregnancy may increase levels of the stress hormone cortisol. Cortisol is the hormone that triggers your flight or fight response. A recent study found that pregnant women with PTSD related to childhood abuse or trauma had ten times higher levels of cortisol than pregnant women without a mental health disorder. Stress may trigger or worsen a mental health disorder like depression, PTSD, or GAD. [1-4]
How Can Your Mental Health Affect Your Pregnancy?
First of all, your mental health can affect how you take care of yourself during pregnancy. If you are dealing with overwhelming symptoms of depression, GAD, or PTSD, you may be more likely to have poor pre-natal care. You may: [1-4]
- Eat poorly
- Drink or smoke
- Not sleep well
- Not get enough exercise
- Have a high stress level
The combination of poor pre-natal health and stress can affect your pregnancy and your baby. High levels of cortisol over a long period can cause high blood pressure, weight gain, depression and anxiety. The most common problems linked to depression, PTSD, and GAD during pregnancy are: [1-4]
- Preterm birth
- Low birthweight
Maternal depression has been linked to babies that are irritable and less attentive.  Maternal GAD has been linked to high blood pressure during pregnancy (preeclampsia). 
What Can You Do?
The most important thing is to be aware of the symptoms and the dangers of these mental health disorders during pregnancy. If you are struggling with anxiety, worry, or depression, if you feel overwhelmed, talk to your health care provider. It may be a good idea to add a mental health specialist to your pregnancy care team. [3,4]
Diagnosis of mental health disorders in pregnancy are frequently missed. They may be passed off as normal mood swings due to hormone changes.  But if you have depression, GAD, or PTSD, you are considered a high-risk pregnancy. Your doctor needs to know.  The good news is that these conditions can be treated, often without medication. Here are some options: [3-5]
- Talk therapy (psychotherapy). Working with a mental health therapist can help you manage. A common treatment is psychotherapy called cognitive behavioral therapy (CBT). During CBT you learn to replace negative thinking with positive thinking and you learn ways to convert positive thoughts into healthy behaviors.
- Lifestyle changes. Getting regular exercise can help. So can a healthy diet, rest, and sleep. A diet low in sugar and processed carbs is best. Avoid caffeine, and don’t give in to the urge to smoke or drink. Maintain a healthy pregnancy weight.
- Alternative treatments. Many alternative treatments have been found helpful for depression or anxiety. These include acupuncture, light therapy, yoga, and message. Ask your health care provider what type of alternative therapy might help.
- If other treatments have not helped, and your symptoms are severe, medications may be added. Your doctor will have to weigh the risks and benefits. There are medications that are generally safe, but no medication is safest. In some cases, the risk of untreated depression, GAD, or PTSD during pregnancy may outweigh the risk of medication.
The bottom line is not to ignore symptoms of depression, PTSD, or GAD during pregnancy. Do not assume these symptoms are a normal part of pregnancy. Talk to your health care provider. For more information and links to support services, visit this NIH website, Mom’s Mental Health Matters: https://www1.nichd.nih.gov/ncmhep/initiatives/moms-mental-health-matters/moms/Pages/default.aspx.
- University of Michigan, Pregnant women with PTSD have higher levels of stress hormone cortisol.
- Pregnancy & Medicine Initiative, PTSD a Pregnancy Risk, Medicated or Not.
- NIH, Will stress during pregnancy affect my baby?
- American Pregnancy Association, Depression In Pregnancy.
- Massachusetts General Hospital, Anxiety During Pregnancy: Options for Treatment.
- NIH, Generalized Anxiety Disorder: When Worry gets Out of Control.