Experts highlight prevalence of mental health issues during pregnancy at AKUH seminar, highlight lack of knowledge
A pregnant woman is lying on a hospital bed. Source: Reuters
“It’s a mystery why a woman’s uterus contracts early. Is it the baby saying I’ve had enough? Is it the mother asking him to come out?”
This is how the Dean of the School of Midwifery and Nursing (SONAM) at the Aga Khan University (AKU), Dr Salimah Walani, opened the session on Thursday. “Most research [on maternal health] is about how to save babies,” but we don’t know enough about how a mother’s mental health affects her unborn child.
According to Dr. Shahirose Sadrudin Premji, professor and Sally Smith Chair in Nursing at Queen’s University in Canada, research shows that when a pregnant woman’s emotional well-being suffers, it increases the risk of premature birth. She said that in 2020, Pakistan had a premature birth rate of between 15.8% and 21.6%, with just over 61 infant deaths per 1,000 on average and 154 maternal deaths per 100,000 live births (over a 42-day period).
The AKU dissemination seminar on Maternal Mental Health in Pregnancy: Impact on Future Generations detailed the results of seven years of work on a maternal mental health project. Out of 190 million pregnancies each year in low- and middle-income countries, 63 million women face mental health problems during pregnancy, Dr Premji explained.
They recruited 1,404 healthy pregnant Pakistani women from various regions and socio-economic categories, excluding those who used psychotropic drugs, victims of terrorism, those with pregnancy-related illnesses or HIV/AIDS. These factors would have skewed the data, she said. On average, participants were in their 20s or 30s and had varied educational backgrounds.
Read: Brain and mind: Experts argue for multi-level mental health solutions, not just tertiary care
“The primary goals of the project were to understand the pathways linking psychosocial distress and preterm birth…We have 14 peer-reviewed publications that are the result of this effort.”
A publication, presented by AKU-SONAM Assistant Professor Dr Sharifa Lalani, explored whether psychosocial distress during pregnancy could predict preterm birth (PTB). She said all available data on this topic came from high-income countries, which was a misrepresentation of the situation of Pakistani women.
“Six million Pakistani women become pregnant every year…and 20%, or 720,000, report suicidal thoughts and thoughts of self-harm,” she said. “The economic burden related to mental health has increased to $16.6 billion.”
In her paper, she said, her team focused on pregnancy-related anxiety (PRA) and whether this was an indicator of PTB, as well as the additional effect of chronic stress on PTB. They found that pregnant women who were worried about their pregnancy were also more likely to give birth before term. There were many factors, ranging from the effects of socioeconomic status to family planning: Women who had not planned a pregnancy were four times more likely to have an early birth than those who had planned a pregnancy due to PRA.
She highlighted the need to identify stress and depression early in pregnancy and target psychosocial interventions to reduce the risk of pulmonary tuberculosis.
Vice Chair and Associate Professor of the Department of Obstetrics and Gynecology and Head of Medical Services at AKU’s Kharadar Campus, Dr. Sidrah Nausheen, shared some counterintuitive findings from her paper in which she sought to understand the social factors that could modify the effects of PRA, general anxiety and depression during pregnancy.
She found that women who had very little support from family, even though it increased their anxiety, actually had a reduced risk of PTB by almost a quarter, and for women who received family support, they could see an “increase in PTB” even if they did not have chronic anxiety from a hostile family environment.
Learn more: One in three Pakistanis suffers from psychological disorders
Questioned on this subject, she considered that it was possible that “since the woman is used to it [hostile home environment]She may not feel much of the effects.”
Less educated women were found to experience less anxiety about pregnancy overall, leading to a lower risk of PTB. “If I, as a doctor, get sick, I’m going to worry to death about every little symptom. Not knowing what you’re experiencing will naturally make you less worried,” she said.
Assistant Professor of Obstetrics and Gynecology Dr. Neelofur Babar spoke about the need to understand how allostatic load – the “wear and tear” of the body due to chronic stress – affects PTB in his article. “In regular pregnancies, the body becomes less sensitive to stress to protect the baby and the mother,” she said, raising the question of whether there were ways to biologically predict (for example through a blood cholesterol test) PTB.
She found that allostatic load directly leads to premature births (which makes sense), but that the mother’s mental health, such as feelings of anxiety and depression, does not directly contribute to PWB.
This isn’t to say that mental health doesn’t matter here; on the contrary, because of its effect on the “wear and tear” of the body, it is essential to treat and control it.
