Why Your Mood Matters During Pregnancy and Postpartum

It’s two pink lines! It’s two pink lines. It. Is. Two. Pink. Lines. 

The excitement of finding out you are pregnant, mixed with the anxiety and fear that often come with a new pregnancy can be extremely overwhelming. The elevated hormones boost your mood, but with the rapid fluctuations, you may find yourself irritable, anxious, and you may cry more easily. The first trimester may not feel the way you thought it would. You are nauseated, your body is changing, and you may be emotionally unstable. Feelings you have never experienced before are unsettling. 

Many individuals feel that pregnancy is supposed to be the “most exciting time in their life;” however, this is not always the case. In fact, it is common for anxiety and fear to overpower feelings of excitement.

Screening for Perinatal Mood and Anxiety Disorders

Maternal mental health conditions are the most common complications of pregnancy and childbirth, affecting 1 in 5 mothers in the United States. It is also the leading cause of maternal mortality. What is even more striking is that 75% of women who experience a mental health condition during pregnancy or the postpartum period do not get the care they need for recovery. Untreated mood disorders interfere with a mother’s ability to respond to and interact with her baby and may have lasting effects on her child’s emotional, cognitive, and social development; thus, it is essential that we identify perinatal mood and anxiety disorders early and offer support and effective treatment. 

The American College of Obstetricians and Gynecologists (ACOG) recommends that obstetric providers screen for mental health conditions during pregnancy and postpartum. A standardized, validated tool, the Edinburgh Postnatal Depression Scale, also known as the EPDS, is commonly used to identify perinatal depression and anxiety. It is ten questions long, and it asks you to reflect on how you have been feeling over the past week. This tool also helps identify those struggling with thoughts of self-harm, so there is close attention to the answer on question ten. Your clinician administers the EPDS at the initial prenatal visit, later in pregnancy, and at postpartum visits. Your child’s pediatrician may also have you complete the screen as well to assess your mood during the first year of becoming a parent. 

What Happens if You Screen Positive?

If you score a ten or more (out of a total score of 30) on the EPDS or report thoughts of self-harm, this could indicate a mood or anxiety disorder. If this happens, ambulatory OB/GYN practices throughout Mass General Brigham would refer you to a social worker (therapist) or behavioral health coaches for evaluation and support.

Providers help to educate their patients about treating perinatal mood and anxiety disorders, connecting them to the appropriate resources. Those resources can be individual talk therapy, medication management, and support groups. Perinatal mood and anxiety disorders are treatable with either talk therapy, medication management, or a combination of both.

Patients are often reluctant to answer EPDS questions honestly for several reasons. Patients may feel unsure about the reason behind the screen, fearful of the stigmatizing diagnosis of postpartum depression, or scared that their children may be taken away from them. Cultural factors can also play a significant role.

Your healthcare provider is trained to address these fears, as well as the mood changes that occur during pregnancy and the postpartum period. They want to make sure you feel your best so that you can properly care for your baby. 

Help is always available through the National Maternal Mental Health Hotline and Postpartum Support International. You are not alone. You are not the only one who feels this way. We just do not talk about perinatal mood and anxiety disorders enough.

References

1. Fawcett, E. J., Fairbrother, N., Cox, M. L., White, I. R., & Fawcett, J. M. (2019). The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian MetaAnalysis. The Journal of Clinical Psychiatry, 80(4). https://doi.org/10.4088/JCP.18r12527 

2. Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal Depression: A Systematic Review of Prevalence and Incidence. Obstetrics and Gynecology, 106(5 Part 1), 1071–1083. https://doi.org/10.1097/01.AOG.0000183597.31630.db 

3. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees (2026). U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/maternal-mortality/php/data-research/mmrc/index.html

4. Byatt, N., Levin, L. L., Ziedonis, D., Moore Simas, T. A., & Allison, J. (2015). Enhancing Participation in Depression Care in Outpatient Perinatal Care Settings: A Systematic Review. Obstetrics and Gynecology, 126(5), 1048–1058. https://doi.org/10.1097/AOG.0000000000001067