By Tammy Jones, RN, DNP  

Most pregnancies follow an uncomplicated path and both mother and baby are healthy and happy. However, statistics indicate that up to 22% of all pregnancies in the United States can be classified as “high-risk” (Mirzakhani et al., 2020). When a mother experiences a high-risk pregnancy, sometimes their mental health can be compromised. While postpartum depression is becoming more commonly identified and treated, mental health concerns during pregnancy are not as widely recognized and addressed. Any pregnant woman has the potential to develop a mental health concern, but those with a high-risk pregnancy are at a much greater risk.

What Is a High-Risk Pregnancy?

A high-risk pregnancy is commonly accepted as a pregnancy in which the mother or baby, or both, are at an increased risk of complications as a direct result of the pregnancy (Yale Medicine, 2022). Some women are considered high-risk due to preexisting conditions. This can include diabetes, heart disease, hypertension, or a history of significant issues in past pregnancies. Even the age of the mother can cause the pregnancy to be considered high-risk. Some common pregnancy-related complications can include pre-eclampsia, placenta previa, multiple babies (twins, triplets, etc.), gestational diabetes, and preterm labor. With these conditions, more frequent medical appointments can be necessary. Additionally, some women will end up being placed on bed rest. This can significantly impact the mother and her family.

How Does a High-Risk Pregnancy Impact Mental Health?

When a woman is experiencing a high-risk pregnancy, it can have an adverse effect on her mental well-being. Many emotions may be experienced, including anger, fear, guilt, despair, worry, restlessness, loss of control, and anxiety. Pregnancy can be an emotional experience, but the emotions associated with a high-risk pregnancy can lead to significant distress. Clinical anxiety or depression can result from the heightened emotions associated with a high-risk pregnancy. Women with a history of mental health concerns are at greater risk, but a woman experiencing complications with their pregnancy can experience these emotions and develop these conditions. 

A mental health diagnosis can also compound potential complications associated with a high-risk pregnancy. If left unrecognized, this can become a vicious cycle. Hormonal changes during pregnancy, along with changes in routine, sleep, diet, and role responsibilities, can all contribute to increased stress and anxiety. Warning signs can include sleeping too much or too little, constant worry, a significant change in eating habits, and frequent mood swings. If thoughts of self-harm are present, the pregnant woman must get immediate help. This is an emergency and requires timely intervention.

What to Do?

First and foremost, it is essential for women to avoid self-blame. Self-blame only adds to the stress, guilt, and loss of control often felt by high-risk mothers. A proactive approach is best when dealing with a high-risk pregnancy, whether it is a physical or emotional concern.

A good place to start is with the healthcare provider. They likely identified the risk factor(s) initially and are usually well-equipped to provide guidance and support. One important strategy to help minimize the impact of pregnancy complications on mental health is fully educating the mother on her risk factors and conditions. Knowledge is power, and this can greatly reduce the stress and worry associated with a high-risk pregnancy. A healthcare provider may refer the mother to therapy or suggest a support group. Online and virtual options are widely available; however, with all things internet, a pregnant woman should only engage with reputable, clinically accurate, and reliable online resources. There is a vast amount of inaccurate information online, so caution is key.

Another potential resource includes the mother’s personal support system. This may consist of family members, close friends, or work associates. However, this can sometimes be a challenge. Women who lack a strong preexisting support system have a higher risk of developing mental health issues during and after pregnancy. Therefore, some women who need the most personal support are the ones who have the least. In these cases, healthcare provider referrals and support groups are essential in supporting the pregnant woman.

If the healthcare provider feels that it is most beneficial for the mother’s mental and physical well-being, medications to reduce anxiety or depression may be prescribed. Women are often reluctant to take medications during pregnancy, but the healthcare provider can provide guidance and reassurance related to medication safety during pregnancy. Many options have been thoroughly tested, and medication may be an option if the healthcare provider feels that the benefits outweigh any risks.

After Pregnancy

Once the pregnant woman delivers, the risk factor may be reduced or even eliminated. However, this doesn’t mean that the emotions and mental health conditions will immediately disappear. The early postpartum period is another time when there are significant hormonal changes, which could initially worsen a woman’s mental health. It is essential for the woman and her support team to carefully assess for worsening symptoms and the potential for postpartum depression. New stressors may arise, especially if the risk(s) result in a baby being born with significant needs, like preterm delivery. The stress of having a new baby at home and losing sleep can contribute to negative emotions. 

Concerning symptoms are similar to those during pregnancy, and thoughts of self-harm or harming the baby require immediate intervention. This is an emergency. It is imperative not to ignore symptoms of a mental health concern or explain them away as “baby blues.” The baby blues pass in a few days and will not persist or worsen.

Remember that at every step of the journey, individuals and resources are available to help. It is important to take steps to prevent or minimize the impact of a high-risk pregnancy on the mother’s mental health. If concerning emotions and symptoms arise, it is important to acknowledge them and seek help.

References

Mirzakhani, K., Ebadi, A., Faridhosseini, F., & Khadivzadeh, T. (2020, September 11). Well-being in high-risk pregnancy: An integrative review. BMC pregnancy and childbirth. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488451/#:~:text=Almost%2022%25%20of%20pregnant%20women,anxiety%20%5B3%E2%80%935%5D.

Yale Medicine. (2022, September 24). High-risk pregnancy. Yale Medicine. https://www.yalemedicine.org/conditions/high-risk-pregnancy#:~:text=A%20high%2Drisk%20pregnancy%20is,cancer%2C%20diabetes%2C%20or%20lupus. 

About the Author

Tammy Jones, RN, PhD

Tammy Jones, RN, PhD, has been in nursing for 30 years, with a clinical specialty in high-risk OB and women’s health. She has worked as a nurse educator for almost 20 years in many academic settings and roles. Her educational background includes a Bachelor of Science in Biology, a Master of Science in Nursing, and a Doctorate in Nursing Educational Leadership. She has written several consumer-facing articles related to pregnancy, postpartum, and women’s health for AWHONN.

Tammy lives in Ohio with her two teens and nine pets. She enjoys running, growing flowers, and spending time in nature.

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