Experts highlight prevalence of mental health problems during pregnancy at AKUH seminar, emphasize knowledge gap
A pregnant woman lies in 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 telling it to come out?”
This is how the dean of the School of Midwifery and Nursing (SONAM) of the Aga Khan University (AKU), Dr Salimah Walani, opened the session on Thursday. “Most of the research [on maternal health] is about saving babies,” but we don’t know enough about how a mother’s mental health affects the fetus.
According to Professor and Sally Smith Chair of Nursing at Queen’s University of Canada, Dr. Shahirose Sadrudin Premji, research shows that when a pregnant woman’s emotional well-being is affected, the likelihood of preterm birth increases. It said that in 2020, Pakistan had a preterm birth rate 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 outreach seminar at AKU on Maternal Mental Health During Pregnancy: Impact on Coming Generations detailed the results of seven years of work on a project on maternal mental health. Of the 190 million pregnancies that occur each year in low- and middle-income countries, 63 million women face mental health problems during pregnancy, shared Dr. Premji.
They enrolled 1,404 healthy pregnant Pakistani women from various areas and different socioeconomic levels, excluding those who used mood-altering drugs, victims of terrorism, those suffering from pregnancy-related diseases or HIV/AIDS. These factors would have skewed the data, he said. On average, participants were between 20 and 30 years old and had different educational backgrounds.
Read: Brain and mind: Experts push for multi-level mental health solutions, not just tertiary care
“The main objectives of the project were to understand the pathways linking psychosocial distress and preterm birth… We have 14 peer-reviewed publications that are a result of this effort.”
One publication, presented by AKU-SONAM Associate Professor Dr. Sharifa Lalani, addressed whether psychosocial distress during pregnancy could predict preterm births (PTB). She said all available data on this issue was obtained from high-income countries, and this did not correctly represent Pakistani women.
“Six million Pakistani women become pregnant every year… and 20%, 720,000, report suicidal thoughts and ideas of self-harm,” he said. “The economic burden of mental health has increased to $16.6 billion.”
In their paper, she said, her team focused on pregnancy-related anxiety (PRA) and whether it was an indicator of preterm birth, as well as the added effect of chronic stress on preterm birth. They found that pregnant women who were anxious about their pregnancy were also more likely to have premature births. There were many factors, ranging from the effects of socioeconomic status to family planning: those women who had not planned a pregnancy were four times more likely to have a preterm birth than those who had planned a pregnancy due to PRA.
He emphasized the need to identify stress and depression in the early stages of pregnancy and target psychosocial interventions to reduce the risk of preterm birth.
Vice President 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 conflicting 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.
It found that women who had very little support from their families, even though this increased their anxiety, had actually reduced their chances of suffering from PTB by almost a quarter, and for women who received family support, they could see an “increase in PTB” despite not having chronic anxiety due to a hostile family environment.
Read more: One in three Pakistanis suffers from psychological disorders
When asked about it, she reasoned that it was possible that “since women are used to [hostile home environment]”I may not feel the effects of this as much.”
Women with less education were found to have less anxiety about pregnancy overall, leading to a lower risk of preterm birth. “If I, as a doctor, get sick, I will worry myself to death about every little symptom. Being ignorant of what you are going through will naturally leave you less worried,” he said.
Dr. Neelofur Babar, Associate Professor of Obstetrics and Gynecology, discussed the need to understand how allostatic load (the “wear and tear” of the body due to chronic stress) affects PTBs in her article. “In regular pregnancies, the body becomes less sensitive to stress to protect the baby and the mother,” he said, raising the question of whether there were ways to biologically predict (such as through a blood cholesterol test) preterm birth.
It found that allostatic load directly leads to preterm births (which makes sense), but maternal mental health, such as feelings of anxiety and depression, did not directly contribute to preterm births.
That’s not to say that mental health doesn’t matter here; On the contrary, due to its effect on the “wear and tear” of the body, it is essential to address and control it.
