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The singer Meghan Trainor recently opened up about her mental-health journey and pregnancy, saying that medical professionals seemed to blame her for her son's minor health problems when he stayed in the neonatal intensive care unit shortly after his birth.
"They kept asking me if I was on antidepressants during the pregnancy, and I was, but on the lowest dose possible, and all my doctors said it was safe and wouldn't affect him," the 28-year-old told the parenting website Romper in an interview.
Taking mental-health medication is a personal decision, one that should be made with a healthcare provider. But it's a decision that often comes with stigma. For pregnant people tasked with caring for themselves and a growing fetus, this stigma can often cause shame, both internally and from others — including uninformed medical professionals.
Doctors say that in many cases, it's beneficial — as well as medically necessary — to take mental-health medication during pregnancy.
Lindsay Standeven, an assistant professor of psychiatry and behavioral sciences and the clinical and education director at the Johns Hopkins Center for Women's Reproductive Mental Health, said that while medication isn't without risk, neither is untreated mental illness during pregnancy.
"If someone has a history of anxiety or depression, there are actually risks of not treating that illness to both the pregnant person and the newborn," she said. "But people look at the risk profile of the medicine rather than the risk of the illness."
Standeven said untreated anxiety and depression is associated with an increased risk of gestational diabetes and preeclampsia, a form of high blood pressure that can lead to preterm delivery and stillbirth.
Danielle Panelli, an ob-gyn and maternal-fetal medicine specialist at Stanford Medicine Children's Health, said that having untreated mental illness can also increase the risk of emotional trauma surrounding childbirth and during the postpartum period.
For these reasons, medical providers often encourage pregnant people to treat their mental illness with medication.
Standeven said that older research suggested antidepressants could lead to birth defects and malformations in the fetus, many of these studies didn't take into accountwhether a parent taking an antidepressant used other substances, had other medical conditions, or routinely went to perinatal appointments.
Newer studies that account for these factors, she said, do not suggest antidepressant use poses serious harm to a growing fetus. Still, no medication is completely without risk. That's why medical providers take an individualized approach with each patient, weighing the risk of the untreated illness against the risk of the medication.
If the risk of untreated mental illness is greater, a provider may prescribe a new medication or advise a pregnant person to continue taking their current prescription. "The most important thing for any medical condition is to have a stable disease state when becoming pregnant and throughout the pregnancy," Panelli said. "For mental-health conditions, if a person has achieved a stable mood with medications prior to pregnancy, we would generally recommend continuing the same therapy during pregnancy."
If someone has new anxiety or depression during pregnancy, a provider may recommend starting medicine for the first time. Standeven said medical providers often recommend the lowest effective dose of selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs) for anxiety and depression. "The truth is, most of these medications are compatible with pregnancy and breastfeeding," she said.
Certain medications — such as valproic acid, used to treat bipolar disorder — are known to pose serious risks to growing fetuses during the first trimester. If you're pregnant or planning to become pregnant and you have a history of mental illness, Standeven recommended speaking to your medical provider sooner rather than later to come up with a medication plan.
She also advised against abruptly stopping medication without talking to a medical professional due to the potential mental-health risks. Not taking mental health may seem like the right thing to do during pregnancy, but experts agree self-care is an important part of caring for another person.
"Birthing parents think they are doing right by their child by denying themselves of something they need, but that's not the right way to think about it," said Standeven. "A healthy parent is better able to sustain a healthy pregnancy and care for a baby."
If your mental health is in crisis, seek medical care or call the NAMI Hotline at 800-950-NAMI (6264).
