The babies at risk from the blues

Foetuses can be affected by antenatal depression - yet the condition gets little attention.

BELINDA MUNDY was happily married and living in her own home and, in theory, should have been delighted about her pregnancy. In reality, she was dogged by a depression that only lifted once her daughter was born. "I was in shock, I felt totally numb and just hoped it would go away. I nearly had a miscarriage at about 12 weeks and, although I don't like to say so now, I would have been relieved if I had lost the baby".

Studies have shown that one in 10 women gets depressed while pregnant. Statistics for postnatal depression are the same. Yet while the latter is a key area for research, the detection, prevention and management of antenatal depression are not part of standard clinical practice.

Belinda's pregnancy was unplanned, and she believes the shock may have contributed to her feelings. Christine (not her real name), on the other hand, had been trying for a baby for some time. "I thought when I got pregnant I'd be delighted but I was devastated. I felt as if having a baby was the worst thing that could happen to me. I cried every day of the pregnancy and even when in labour I couldn't get out of my head the dread of having a baby."

Dr Vivette Glover, the head of the foetal and neonatal stress research unit at Queen Charlottes Hospital, in London, is studying how the maternal mood affects the foetus. "Very little research has been done to find out how the mother's emotional state affects the baby. Yet there is a belief that it may do as much damage as smoking or drinking and that foetal stress syndrome should become a recognised condition".

Dr Glover believes there is increasing evidence to suggest that, if a mother is depressed or anxious, then the baby in the womb may suffer similar emotions. "When you are stressed or depressed there's a marked increase in the production of a stress hormone known as cortisol. It could be that this is passed on to the baby so that it also becomes stressed." Dr Glover also believes that a traumatic pregnancy may result in a more troublesome child.

Perhaps more worrying is the effect of depression and stress on a baby's size. "Women who are more anxious tend to have smaller babies. It seems that anxiety may restrict the blood flow to the womb, directly affecting the development of the baby." To back this theory Dr Glover points to Danish research that found that women who had suffered major stress, such as divorce or rape, while pregnant had much smaller babies with less developed neurological systems.

There are various explanations for antenatal depression. It has been linked to unplanned pregnancies and unpleasant side-effects such as nausea. Some psychiatrists believe many women simply become pregnant at a time when they are more vulnerable to depression, ie in their thirties. Others say the major life change brought about by the imminent arrival of a child can be a trigger.

Antenatal depression may also pose a risk to the baby as a result of the associated health behaviour of the mother. Sara Clement, a research fellow at Guy's Hospital, in London, points to studies "which show that women who are depressed tend to smoke more".

Christine is a prime example of someone who may have put her baby at risk by ignoring health advice. "I had such a bad attitude towards the baby that I didn't do any of the recommended things like taking folic acid or avoiding blue cheese. I don't smoke but I drank for the full nine months and I found it hard to relax. By the time it came to having the baby I was exhausted".

About one in three women who becomes depressed when pregnant goes on to develop postnatal depression. While it can be argued that postnatal depression is more problematic because the mother experiences it at a time when she faces exceptional demands, Ms Clement argues that antenatal depression is just as significant. "It's been shown that targeting women who are depressed when pregnant not only helps them but may help prevent postnatal illness".

Perhaps one of the greatest stumbling blocks in treating antenatal depression is that admitting to negative feelings about the baby remains taboo. Belinda Mundy says: "At the beginning I told just about anyone who cared to listen how I was feeling but then I realised I was getting these bad reactions so I stopped. All the magazines and books make you feel as if you should be blooming - but I don't think you should be made to feel such a wicked person if you don't".

Dr Glover hopes that her research may encourage women to seek help early on in their pregnancies. "I don't want to scare women because, in most cases, they give birth to perfectly healthy babies. But if we can show that the emotional state of the mother directly influences the baby's mental and physical development then it will lend weight to the argument for earlier intervention to prevent depression in pregnancy. This should benefit both the mother and the baby."