Understanding PMADs: Risk Factors All Parents-To-Be Should Know

Perinatal Mood and Anxiety Disorders (PMADs) impact one out of every five birthing parents, and one out of every 10 partners. PMADs can occur at any time during the perinatal period, which includes pregnancy and the first one to two years postpartum. Perinatal Mood Disorders include Depression, Bipolar Disorder, and Psychosis. Perinatal Anxiety Disorders include Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, and Post-Traumatic Stress Disorder. These conditions can impact individuals at any point throughout their lives; however, there is a heightened risk during the perinatal period, and these disorders may present differently during the perinatal period due to hormonal changes.

Understanding risk factors for PMADs can empower you with knowledge and help you build a support system before you need it. If you do develop a PMAD, it is not your fault, and there are treatment options available. Here is what the research tells us about who may be most vulnerable to PMADs.

Personal or Family History

The strongest predictor of a PMAD is previous experience with a mood or anxiety disorder. A history of depression, anxiety, or another mood or anxiety disorder, even if symptoms are currently in remission, increases risk of developing a PMAD. If you experienced a PMAD during a previous pregnancy, you are more likely to experience one again during subsequent pregnancies.

Genetics also play a role. If there is a family history of mood and anxiety disorders (even outside of the perinatal period), your biological risk may be higher. This is due to a combination of increased genetic vulnerabilities, as well as shared environmental factors (source).

Biological or Hormonal Sensitivities

Pregnancy, birth, and postpartum involve significant hormonal shifts in a short period of time. Some individuals are more sensitive to the rapid changes in hormones than others. Specifically, those with a pre-existing thyroid disorder and those with Premenstrual Dysphoric Disorder (PMDD) are at an increased risk.

It's also important to note that it's not just the mother's hormones that change! Fathers or partners often experience a decrease in testosterone, and a rise in oxytocin, prolactin, and cortisol (source). This is helpful as it can promote bonding with the baby and an increased alertness and ability to care for the baby. However, these hormonal shifts can also contribute to PMADs in fathers or non-birthing parents.

Social and Environmental Risk Factors for PMADs

Mental health does not exist in a vacuum - our environments, social circles, and other life circumstances strongly influence our emotional wellbeing. Lack of social supports, relationship strain, and financial stress can all add to the load of an already overwhelming time. Any sort of change or loss can also increase risk of PMADs. Job changes, moving, loss of a pet, etc. can make one more vulnerable to stress. Some parents won't notice symptoms of PMADs until they return to work, so it's important to look for symptoms throughout the postpartum period.

Additionally, members of "high stress groups" are also at an increased risk for PMADs. These include parents of multiples (twins, triplets, etc.), teen parents, single parents, LGBTQ+ families, families of color, and military families.

Pregnancy and Birth Complications and Trauma

Conception, pregnancy, birth, and postpartum can all be stressful in and of themselves, and they rarely go exactly as planned. Any sort of reproductive trauma or complication contributes to an increased risk of PMADs. This includes:

• Infertility

• IVF or use of other assisted reproductive technology

• History of loss (miscarriage, termination, stillbirth, infant loss)

• Unwanted or unplanned pregnancy

• Pregnancy complications (gestational diabetes, hyper-emesis, growth restriction, etc.)

• Premature birth, NICU stays

• Traumatic birth

• C-section, vacuum, forceps delivery

• Maternal near-miss

• Breastfeeding challenges

Those who have a C-section, vacuum, or forceps delivery, as well as parents whose babies are in the NICU, are specifically at an increased risk of developing post-traumatic stress disorder (PTSD).

Knowledge is Power

Understanding risk factors for PMADs can't necessarily help prevent them, because again, PMADs are not your fault. However, knowing if you are at an increased risk can help you build your support system as early as possible. Early intervention and support is one of the best gifts you can give to yourself and your baby. As the Postpartum Support International slogan so perfectly states, "You are not alone. You are not to blame. With help, you will be well."

A perinatal mental health specialist can help you navigate risk factors, develop coping skills, and get you back to feeling like yourself again. If you're looking for therapy for PMADs in Boston, MA, I am currently accepting new clients and would love to be part of your support system. Reach out to schedule a complimentary 15-minute intro call to learn more about how we can work together.

Disclaimer: The content provided on this blog is for informational and educational purposes only and is not intended as a substitute for professional therapy, diagnosis, or treatment. Reading this blog does not establish a therapeutic relationship. If you are in need of mental health support, please seek help from a licensed mental health professional.