Being depressed during pregnancy might be bad for the baby, a study suggests. Expectant mothers with symptoms of severe depression are more than twice as likely to give birth prematurely as those with no signs of depression, according to the study, published in the journal Human Reproduction.
Premature births, even just a few weeks short of full term, can leave a baby at greater risk of infection, jaundice and longer hospitalisations.
Doctors don't know whether depression itself causes early births, or whether some underlying problem might cause depression and prematurity.
Either way, they say, women need to be aware that depression in pregnancy is common, might affect the baby and can be treated.
"Having a healthy mood is an essential part of having a healthy pregnancy," said Priya Batra, a Kaiser Permanente psychologist in Sacramento who specialises in women's health. "We want people to know that this is part of what the medical system can offer you."
Women need to be aware that depression in pregnancy is common, might affect the baby and can be treated.
That's an especially important message, because sometimes it can seem like the whole world expects pregnant women to be thrilled.
"That cultural myth, that you should be happy, you should be glowing, that adds to the stigma of being down," Batra said.
Kaiser Permanente facilities in and around Sacramento recently began screening all pregnant women for depression, she said, and offering them help ranging from classes to counselling to medication.
Desirae Tobey, whose son Chase was born healthy and full term in June, knows firsthand that sometimes pregnancy can be emotionally harrowing.
"I was having anxiety attacks at work," she said, made worse because she felt she was supposed to be happy and act as if nothing was wrong.
Meanwhile, she was battling morning sickness, exhaustion and a constant fear that "something bad is going to happen to my baby" because miscarriages run in her family.
Her first obstetrician didn't help, Tobey said, and she didn't feel listened to until she switched doctors.
"I almost had to fight for the health of my baby," Tobey said. "The ob-gyn I got the second time was fantastic. She listened to my fears, however irrational they were."
Tobey was treated for depression when she was a teenager, but she didn't want to take medication during pregnancy. She got counselling, working with Batra to talk through the terrors and get confirmation she wasn't alone.
That's a powerful message Tobey said she wants to share with other mothers-to-be.
"If you are having depression during pregnancy ... it's OK to feel the way you're feeling," she said. "It's just not something you want to deal with by yourself" because with help it can be "really easily treatable."
The new study linking depression with premature births, from Kaiser Permanente's division of research in Oakland, should help raise awareness, Batra said.
The study was based on surveys of hundreds of Kaiser Permanente patients in the San Francisco Bay Area during the early weeks of their pregnancies. Depressive symptoms were measured by a commonly used questionnaire, and nearly half the women had either significant or severe symptoms.
Nine per cent of the women with the worst symptoms had premature babies, compared with 4 per cent of the women with no symptoms. Just under 6 per cent of those who fell in between gave birth early.
A questionnaire isn't as precise as a doctor's diagnosis, but high rates of unhappiness found by the survey suggest pregnancy blues are underdiagnosed, according to Dr De-Kun Li, the study's lead author.
"Medical professionals and pregnant women should pay attention to depression during pregnancy. ... They shouldn't just dismiss it," said Li, a reproductive epidemiologist.
For support with depression and other mental health issues visit the Essential Baby forums.