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PREGNANCY AND THE MIND
Broadcast starting week of February 25, 2004

In this hour, we explore Pregnancy and the Mind. We think about pregnancy as a time when women glow, right? Full of happy expectation for the future. But for many women, that's simply not the case. We'll break through the myths to explore the truth about pregnancy and mental illness. We'll also look at the way a baby's mind develops, and ask: just how much does a fetus pick up from the outside? Guests include Dr. Shari Lusskin and Dr. Zachary Stowe, both experts in reproductive psychiatry, and developmental psychologist Dr. Janet DiPietro. All this, plus a reading of Oh Baby the Places You'll Go: A Book to Be Read in Utero adapted by author Tish Rabe from the works of Dr. Seuss, and Irish singer-songwriter Susan McKeown performs a ballad of motherhood.

Host Dr. Fred Goodwin begins with an essay in which he says we have learned a great deal about how pregnancy can affect a mother's mental health. We now know that a wide range of pre-existing mental disorders -- including depression, bipolar disorder, anxiety, and obsessive-compulsive disorder -- can worsen dramatically while a mother is carrying a child, and in the weeks immediately following birth. This knowledge has shaped a new clinical consensus among psychiatrists, namely that for women with serious mental illnesses such as bipolar disorder, the risk/benefit ratio favors maintaining medical treatment through and beyond pregnancy, using medications with the lowest risk to the fetus, or, in some cases, electroconvulsive therapy.

But about other issues, questions still abound. What about mothers with less severe mental health problems such as moderate depression or anxiety? And, can a mother's normal responses to stress influence the fetus? Our guests today will describe some fascinating new studies showing that the mother's emotional state can affect her unborn child and that these effects can carry over into the infant's behavior. But research in these areas is still in … well, its infancy. A myriad of factors shape the developing child's mind -- from genes to prenatal environment to parenting style, even to playmates. Sure, a happy pregnancy is probably a good thing, but in the long run what really counts is a stable, affirming, and loving environment, Dr. Goodwin concludes.

Pregnant woman glow. They are one with their bodies and feel at peace with the world. That's the myth right? But it's not the reality for most women, and for women with mental illness -- or who develop mental illness during pregnancy -- nothing could be farther from the truth. Next, we hear from Marcy Levine. She has bipolar disorder and knew pregnancy might be difficult, but nothing could have prepared her for what happened. She and her husband consulted with a specialist in high-risk pregnancies, and she decided to go off all her usual medications, using older, well-researched antidepressants as a back-up. The plan didn't work. Within four weeks, she had fallen into the worst depression of her life, unable to get out of bed and feeling, at times, very little will to live. She ended up having ECT, electroconvulsive therapy, which helped in that it gave her the strength to get out of bed and go through the motions of the day. She had a normal delivery and is grateful that she was able to feel a moment of joy when she held her new baby for the first time. Her son is now three.

Everyone's heard about morning sickness, so women know to expect it. But what about changes that happen in their minds? For some, there are simply emotional ups and downs, but for others, pregnancy can actually trigger a mental illness. And for those already struggling with depression, anxiety or bipolar disorder, pregnancy can bring a relapse, not to mention questions and fears about taking medication. Dr. Goodwin discusses these issues with two distinguished guests. Dr. Shari Lusskin is the Director of Reproductive Psychiatry and Clinical Assistant Professor in Obstetrics and Gynecology at New York University. Dr. Zachary Stowe is a psychiatrist and the founder and director of Emory University's Women's Mental Health Program.

Dr. Stowe begins by saying that most of the problems of pregnancy tend to be downplayed in the lay literature, so women can get surprised by normal things, and then feel guilty because they haven't been educated accurately. He says there is still a popular conception that pregnancy is a pristine time that women will glide through and end up with a cosmetically perfect baby. But, in reality, the data shows that 50% of pregnancies are unplanned, the spontaneous abortion rate is 23-25%, the Caesarian section rate is 20%, and the major malformation rate 3-4%.

Dr. Lusskin adds that she thinks most popular books about pregnancy minimize the risks of mental illness, including at most two or three pages about it, buried at the end. She wishes books focused less on the obstetrical changes of pregnancy and more on the psychological ones.

They then discuss depression during pregnancy. Dr. Lusskin says that if you look at women with postpartum depression, a lot have symptoms during pregnancy. She says depression in pregnancy looks very much like depression at any other time in a person's life, only the normal sleep and appetite disturbances that occur in depression are often dismissed (by women and their doctors) as changes of pregnancy. She says women need to be aware that a sad, blue, hopeless or helpless mood is not normal during pregnancy.

Next, they turn to the topic of women with pre-existing mental illness. Dr. Lusskin says it is important for women with mental illness to enter into pregnancy in as good mental health as possible. Many women think about going off their antidepressants so they can have a medication-free first trimester, but this can be problematic. Women can relapse, and then, once they become symptomatic, it can be much harder to get better during pregnancy.

Dr. Stowe says maternal depression can also impact the baby. His research shows that pregnant women with the highest levels of depression and anxiety have infants with higher levels of cortisol (a stress hormone), and these infants are often non-reactive of hyper-reactive. A couple of years later, these children with high cortisol levels tend to be viewed more negatively by their parents.

Dr. Lusskin then talks about research on the impact of medications on the fetus. She says we must make the best of limited data, since it is impossible to do double-blind placebo-controlled studies in pregnant women. She describes one study that looked at women on Prozac, women on tricyclic antidepressants, and women who were not depressed and not taking any medication. The study found no differences among the groups in the babies' IQ, language development, or cognitive development. Following the same groups further out, within the groups, they found some correlation between IQ and language development with the degree of maternal depression, but not with the degree of medicine. This is good news for women worried about staying on antidepressants during pregnancy. Nowadays, however, a lot of women are on combination therapies, and that can be trickier.

They then discuss bipolar disorder. Some of the medicines taken for bipolar disorder have a high risk for birth defects. Furthermore, studies show a 30-40% relapse rate during pregnancy, even for those women who are being treated. Most of these episodes are depressive, which then presents the doctor with the question, should he or she prescribe an antidepressant to a person with bipolar disorder who is off her mood stabilizer? The risk is that the depression could switch into mania, and mania is even harder to treat during pregnancy. He says it's probably the toughest clinical decision he faces, and he faces it almost every day. Some options for women with bipolar disorder include lithium, which shows a lower rate of birth defects than the mood stabilizer Depakote, and electroconvulsive therapy, which appears to be quite safe in pregnancy as long as it is modified in certain ways.

Finally, they discuss anxiety. Dr. Stowe says that if a woman lies down to sleep, can't turn off her thoughts or is grinding her teeth, there's probably a problem. He then gives another example -- babyproofing is considered a normal nesting activity, but if a women is baby-proofing areas above her shoulders, something's wrong. Dr. Lusskin says anti-anxiety medications (benzodiazepines) have been shown to be quite safe in pregnancy.

The conclude by saying that there is a lot of information out there for women dealing with mental illness and pregnancy, but women need to ask. If they feel like they're not getting the right information, they say, ask someone else.

To contact Dr. Lusskin, please write to: Dr. Shari Lusskin, Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016. Or visit www.med.nyu.edu.

To contact Dr. Stowe, please write to: Dr. Zachary Stowe, Director, Women's Mental Health Program, Emory University School of Medicine, Emory Clinic Building B, 1365 Clifton Road NE, Suite 6100, Atlanta, Georgia 30322. Or visit www.emorywomensprogram.org.

For many women, pregnancy is a time of deep reflection - not only about becoming a mother but also about their own mothers. Next, The Infinite Mind's Marit Haahr speaks with New-York based Irish folk singer and songwriter Susan McKeown, who performs her song "Mother of Mine," accompanied by Jon Spurney on guitar.

She says she wrote the song about her own mother, who passed away when McKeown was 15. She says her mother wrote her and her father and siblings a letter when she was dying, telling them to be independent and offering advice that she hoped they would carry with them to help them in their lives. McKeown feels like she really does carry her mother's words with her, so she wrote a song about it.

She concludes by saying that pregnancy made her appreciate motherhood all the more. She says that it was the most deeply emotional time of her life, and she feels it was a privilege.

To contact Susan McKeown or order her any of her CDs, please visit www.susanmckeown.com.

To order Mother: Songs Celebrating Mothers & Motherhood, click here.

The first part of the show explored mainly the mother's mental and emotional well-being. But what about the baby's developing mind? How much does the outside world impact the fetus? Before we hear from a developmental psychologist researching this question, author Tish Rabe reads from her book Oh Baby the Places You'll Go: A Book to Be Read in Utero. It's adapted from the works of Dr. Seuss, at the request of his widow.

To order Oh Baby the Places You'll Go: A Book to Be Read in Utero, click here.

Oh Baby The Places You'll Go is clearly for parents, too, and the book isn't trying to make claims about teaching the fetus. But what about products that do claim to influence the fetus directly? For example, contraptions that moms strap to their abdomens to play music or specific sounds? What do we really know about the connections between the fetus, the outside world, and the mother's internal state? Dr. Goodwin speaks with Dr. Janet DiPietro, who is an expert in fetal development. Dr. DiPietro is a developmental psychologist and professor at Johns Hopkins University.

Dr. DiPietro begins by saying reading to your fetus is not a terrible idea, but there's really no reason to do it, unless it relaxes the mother or makes the father feel closer to the unborn child. She says parents should definitely not do it to make the fetus smarter. There is simply no evidence that this works, and she questions why people would even want to do this.

She has harsh words to say about playing music for the fetus, especially when it means strapping speakers directly to the belly. First, people turn up the volume way too high, not thinking that the fetus is in fluid, and fluid is an excellent conductor of sound. The level of exposure can be extremely intense. Second, fetuses have sleeping and waking cycles. The equivalent would be putting speakers next to a sleeping baby's crib and blasting Mozart. It sounds ludicrous, but that is essentially what people are doing to the fetus. Third, there is no evidence that playing classical music, or any kind of music, actually makes babies (or adults) smarter, and it troubles her that many of the products are promoted in this way.

Dr. DiPietro then discusses the little we know about how much a woman's emotional state affects the fetus. She says there is research showing that maternal stress, or distress, results in slightly shorter pregnancies and babies with slightly lighter birth weight. Her own study shows something different -- women with greater anxiety during pregnancy had babies who developed faster at two years of age. Her theory is that too much stress or too little stress is bad, but there is probably an optimal level of stress that is helpful. Dr. Goodwin compares this to anxiety -- too much or too little anxiety hinders performance, but a middle range maximizes it.

To contact Dr. DiPietro, please write to: Dr. Janet DiPietro, Professor, Population and Family Health Sciences, 280 Hampton House, 624 N. Broadway, Baltimore, MD 21205. Or visit www.jhsph.edu.

Finally, commentator John Hockenberry describes his wife's two pregnancies - which resulted in four children. He says, "Pregnancy is certainly a transformation for the body. It's also a twist for the mind. And pregnancy with twins takes all of this a step further. What twins do to the female body is more like a special effect from the movie Alien. Its been a long time ago now since my wife Alison delivered her second set of twins but the whole pregnancy experience remains, shall we say, accessible, vivid, something like a combat flashback."

- Marit Haahr

 

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