Integrative Medicine and Perinatal Mental Health: An Integrative Approach to Addressing Maternal Stress and Anxiety

According to the World Health Organization, 1 in 5 women will experience mental health challenges during pregnancy or during postpartum. This stark statistic raises a red flag for the need for more support in women’s mental health, especially in regard to perinatal health. As medicine progresses, with more forms of integrative and complementary medicine services being accepted and utilized, there is hope that the gap in care can be filled. 

Education is key in this area: from understanding what mental health conditions perinatal women are most at risk for developing to the impact this can cause on themselves and their unborn child, and finally, how an integrative approach can best support these women. 

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Understanding Perinatal Mental Health

Mental health during pregnancy and up to a year postpartum fall into the category of perinatal mental health. The most concerning issues are perinatal mood and anxiety disorders (PMAD) and perinatal depression, including postpartum depression (PPD). Along with physical examination, a women’s mental health should be screened and assessed during these stages. 

Women who have a mental health condition prior to pregnancy or have a past medical history should especially be screened and observed for any signs of re-emergence or exacerbation of their condition. Perinatal mental health conditions are of utmost concern as 20-50% of women experience this as a side effect of pregnancy and postpartum. While the mother is feeling the immediate impact, this can also negatively affect a growing fetus leading to preterm birth, low birth weight, and the need for a cesarean section. 

Impact Of Maternal Stress And Anxiety On The Mother And Child

Persistent and long-term stress and anxiety can both have negative implications for the health of the mother and child. Everyone experiences some stress in their everyday life, it’s unavoidable to some degree. This issue arises when the stress or anxious feelings are persistent, compounded, or impacting your health, well-being, and activities of daily living. In terms of how stress can affect you during pregnancy, it’s often known to elevate blood pressure leading to premature labor. It’s a primary contributor to things such as loss of sleep and headaches, and it can impact your appetite leading to an increase or decrease in eating. When you're growing a baby, your physiological and psychological changes can influence how they develop. Research has shown that maternal stress during fetal development can increase the child’s risk for developing Attention Deficit Hyperactivity Disorder (ADHD), anxiety, depression, or conduct disorder later in life. 

Anxiety can also have detrimental implications for a mother and her baby. One study found that if a mother was experiencing anxiety before conception, there was an association with negative fetal development. This leads to higher rates of spontaneous premature births, lower birth weight, and small head circumferences. During pregnancy, a mother experiencing anxiety will tend to have symptoms of worry, tension, difficulty sleeping, possibly racing heart or chest pains, nausea, headaches, or feelings of fear. This can impact her perception of pregnancy as well as her physical health if it is untreated. In the postpartum period, anxiety can spike due to the new responsibility and role of motherhood. Recent research reveals that 17% of women report feeling anxious within the perinatal period. Having a supportive network, especially a partner, plays an integral role in rates of perinatal mental health and should be a key factor in the management of these conditions. 

Common Risk Factors And Contributing Factors That Affect Perinatal Mental Health

Mental health during pregnancy can impact by a variety of factors. The most concerning areas include hormonal influences, past medical history, nutrition, and lifestyle.  

Hormonal Changes 

Pregnancy hormonal changes are part of developing a healthy fetus. Sometimes women can have fluctuations in hormones that their body is not responding to in a mentally healthy conducive manner. Both sex hormones and cortisol shifts have been linked to symptoms of depression in pregnancy. These changes can also disrupt sleep, leading to a lack of sleep, fatigue, and a negative toll on one's mental well-being. In the postpartum phase, the drop in progesterone and its metabolite allopregnanolone have been suspected contributors to postpartum depression. Estradiol, endorphins, and testosterone also rapidly fluctuate after birth and can play a role in a mother's mental health. Rebalancing of hormones varies, some women feel better with breastfeeding, some can improve with holistic support, and the majority of women will balance out when their menstrual cycle returns. 

History of Mental Health

If you’ve suffered from anxiety, depression, obsessive-compulsive disorder, or other mental health conditions before pregnancy or at any time in your life, you may be more prone to perinatal mental health issues. Information from eleven pulled studies shows that women with a psychiatric history have a significantly higher risk of developing perinatal depression. Science is still in the early stages of investigating genetics in relation to perinatal mental health, but there is some information that genetic variations in the form of single nucleotide polymorphisms (SNPs) on chromosomes 1 and 9 may be impacted in those with postpartum mood disorders. 

Diet

What you consume can impact your overall health, including your mental well-being during and after pregnancy. Getting adequate nutrition can promote the development of your baby but also reduce your risk of vitamin and nutrient deficiencies, gestational diabetes, preeclampsia, depression, and anxiety. What you consume can also impact your gut microbiome, which plays an integral role in brain health through the gut-brain connection. Supporting a healthy gut flora through consuming nutrient-dense foods can promote proper neurotransmitter production, which plays a role in helping you feel good. Controlling your stress is also important for gut health, as ongoing stress can negatively impact gut health by increasing cortisol production, which can cause a downstream effect on sleep and mental health. 

In addition to these nutritional aspects, getting enough vitamins, minerals, and fatty acids can support your preconception health, which sets you up for a successful pregnancy. Low vitamin D specifically has been linked to higher incidences of depression in pregnancy. Other nutrients such as zinc, iron, selenium, and fatty acids have a suspected correlation to mental health outcomes in pregnancy, but current research is inconclusive. 

Lifestyle Factors

Previous pregnancies, social support, and substance abuse are all lifestyle factors that can impact mental health during the perinatal period. If you have a traumatic experience with a previous birth, such as a premature infant or your child spending time in the ICU, this can trigger anxiety, stress, and PTSD. Lack of social support, whether it be friends, family, or a partner, can make pregnancy and postpartum stressful and negatively contribute to your mental health. Having a history of alcohol and drug use has also been correlated to the development of PMAD.  

Functional Medicine Labs That Can Help Individualize Treatment Options 

Investigating the areas of health that may be impacting your mental health can be achieved through functional medicine testing. Looking at hormonal balance, micronutrient status, and gut microbiome diversity can be insightful information for the direction of care. 

Sex Hormone Panel

Hormonal changes can impact a women’s mental health both during pregnancy and postpartum. Fluctuations occur during pregnancy but should balance out within a few months of giving birth. If you're experiencing anxiety, depression, or symptoms of psychosis in the postpartum period, obtaining a comprehensive Hormone Profile could provide insight into contributory hormones. Measuring sex hormones along with a 24-hour Salivary Cortisol can be a valid test to see if cortisol is interrupting your sleep and mental health. 

Micronutrient Panel

Evaluating your micronutrient status can provide nutritional deficiency information. SpectraCell Laboratories has a comprehensive Micronutrient Test that measures 31 different minerals, vitamins, amino acids, and fatty acids. This test is a great option to see what your micronutrient status is, both extracellularly and intracellularly. 

Gut Health 

Assessing the health of your gut microbiome can be a root-cause approach to improving mental health. Gut diversity is vital in immune function, neurotransmitter production, hormone synthesis, and overall vitality. Comprehensive stool analysis like GI360 Microbiome can analyze the abundance and diversity of your gut flora and determine if an imbalance of microbiota is manifesting as symptoms through the gut-brain axis. While neurotransmitters can be tested, there are no specific neurotransmitters that are evidence-based causes of PMAD. Clinically speaking, investigating gut health would be a first line of assessment before testing specific neurotransmitters, as that’s a primary area of intervention used to address rebalancing a patient's neurotransmitter production.

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Conventional Approaches To Perinatal Mental Health

The American College of Obstetricians and Gynecologists have set out guidelines for treatment and management for women with mental health condition during pregnancy and postpartum. All patients will be assessed for depression, bipolar, anxiety, and PTSD using a mental health screening tool. Illness severity is then determined, and treatment option recommendations are given based on either mild, moderate, or severe mental health status. All levels experiencing mental health issues will be referred out for therapy and be considered for or given a medication prescription. First-line medication options for depression, anxiety, and PTSD include Sertraline (Zoloft), Fluoxetine (Prozac), Citalopram (Celexa), or Escitalopram (Lexapro). In more severe cases, there are second-line medication options. Screening for improvement and medication effectiveness or side effects should happen within 4 weeks of initiation. Close monitoring of PMAD patients, if recommended, with follow-ups every month during pregnancy and postpartum. 

An Integrative Approach to Addressing Maternal Stress and Anxiety

There are various integrative avenues for supporting perinatal mental health. Nutrition, herbs, nutrients, mind-body approaches, as well as traditional Chinese medicine can all support you in restoring mental health. 

Nutritional Interventions 

Eating right for your mental health should be a slogan because it truly can do wonders! Our brain needs adequate fuel to operate, which, as mentioned earlier, is directly influenced by the health of our gut. Eating a whole-foods, balanced diet can promote not optimal nutrition content but also help establish flora and mental well-being. 

Following an anti-inflammatory diet that is full of antioxidant-rich foods can also provide micronutrients that your body needs to create adequate neurotransmitters like GABA, dopamine, and serotonin. While pregnancy has its own nutritional and caloric needs, it’s important to make sure you are getting essential fatty acids in the form of avocado, nuts and seeds, and low mercury wild-caught fish. Eating leafy greens like spinach and kale can support folate intake, B vitamins, and the development of your baby. Eating grass-fed meat is a great way to get B12 in your diet and support your energy during pregnancy. 

Evidenced-Based Supplements And Herbs For Stress And Anxiety Reduction

Botanical medicine and vitamin support are therapeutic interventions to consider when addressing mental and emotional well-being. Here are some evidence-based options to consider using to support you during pregnancy. 

Lavender 

This flower has multiple avenues of administration that can support women both during pregnancy and postpartum. Lavender has been used for decades as a natural anti-anxiolytic, nervous system modulator, and overall mental health support. Research on this plant is more abundant than others and includes the use of it in aromatherapy, internal consumption, and topical application. Lavender cream used topically on the feet can decrease symptoms of stress, anxiety, and depression during pregnancy. Aromatherapy of lavender postpartum has similar results in helping mothers manage their mental health. The versatility of administration that lavender can provide makes it a favorable botanical in perinatal mental health care. 

Chamomile

There is some historical data on this herb being generally safe as a calming agent in pregnancy. However, the literature does not yet support the long-term use of this through fetal development. It is a wonderful herb that can be taken in the form of tea during postpartum. Evidence shows that it can support sleep quality and reduce depressive symptoms.

Lemon Balm 

The calming botanical, also referred to as Melissa Officinalis can be used both during pregnancy and postpartum. It’s an excellent choice if you are dealing with stress, anxiety, or depression. The calming and sedative effects were seen in a study of women who were part of a stress-induced simulation. At 600mg doses, the use of lemon balm mitigated the negative mood and stress effects of the stimulus, compared to their experience taking a placebo. 

Vitamin D

As previously mentioned, a deficiency of vitamin D can impact mental health outcomes. Supporting your body by obtaining this vitamin through safe sun exposure can be helpful, but also supplementing with this micronutrient can help enhance your vitamin D status. A randomized control trial done with pregnant women revealed that supplementation of 2,000 IU of vitamin D3 daily, starting at 26 to 28 weeks gestation and taken until birth, can decrease perinatal depression. 

Mind-Body Interventions For Stress and Anxiety Reduction 

Complementary interventions such as mind-body practices, yoga, and meditation have been scientifically proven to improve your mental and emotional health. Incorporating one or more of these modalities would be a great option in a comprehensive treatment plan. 

Mindfulness-Based Stress Reduction

Intentional awareness of your current situation and applying a therapeutic strategy are the basis of mindfulness practices. Mindfulness cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) are promising avenues for reducing perinatal anxiety and depressive symptoms. 

Yoga and Meditation

Adding relaxation practices to your everyday life can balance your nervous system and stress response. Yoga and meditation can both decrease anxiety, modify your stress response, and improve your quality of sleep. A yoga practice length should be about 30 minutes, not too strenuous nor in a heated environment, and not push you past your physical limits. There are a variety of meditation techniques you can implement. Finding the right balance and method that works for you may take some time and practice, but in finding your groove, you may greatly benefit. 

Safe Exercises For Pregnancy 

The American Pregnancy Association has guidelines for safe exercising during pregnancy, which can also support your mental health. If you are just starting an exercise routine during pregnancy, start slow and work your way up to your comfort level. Moderate-intensity exercise of 150 minutes per week is typically recommended. One study found that physical movement had a profound effect on reducing perinatal depression. 

Acupuncture For Perinatal Mental Depression

Acupuncture is a Traditional Chinese Medicine modality used to address many aspects of health. It’s commonly utilized in female reproductive health, ranging from infertility to menopause. The use of acupuncture to treat perinatal mental health has been utilized for decades. An interesting therapeutic intervention looked at the use of acupuncture plus therapy in comparison to the drug fluoxetine in the treatment of postpartum depression. Results revealed that the acupuncture plus therapy group has just as effective outcomes as the drug group. 

The Importance of Integrative Medicine Collaborative Care

Taking a truly integrative and holistic approach to treating women dealing with perinatal stress, anxiety, and depression can offer them the most comprehensive care. These women must regularly check in with their primary care provider, that is, managing their pregnancy and medication (if necessary). Working with a therapist can help you process your emotions, provide an outlet to express your feelings, and help you gain coping skills. An integrative medicine practitioner such as a naturopathic doctor can play a support role in areas of nutrition, lifestyle modification, functional medicine testing, and the expert in recommending botanicals and nutrients. When all working in collaboration for the patient's best interest, the hope is that the patient will achieve healing. Collaboration in this area is emerging, as the need for effective and efficient systems to support maternal mental health is not yet present. 

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Summary

Maternal stress and anxiety are two prominent areas impacting the well-being of mothers in modern-day healthcare. Along with these two conditions, many women are experiencing depression during pregnancy and postpartum. There are a handful of risk factors that can lead up to this, many of which can be addressed through functional medicine evaluation and holistic medicine intervention. In some instances, women may need to take a conventional route of care, but that does not negate the need for integrative support. Addressing all the areas of health by supporting women in nutrition, mind-body wellness, movement, and natural medicine can be effective and a well-rounded approach to care.