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Accepted: 29 November 2022    Published Online 8 February 2023
DOI: 10.1111/1471-0528.17389
MI N I COM M EN TA RY
Mental illness during pregnancy and the importance of
well-­developed antenatal care
Gustaf Rejnö1,2
1
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
2
Obstetrics and Gynaecology Unit, Södersjukhuset, Stockholm, Sweden
Pregnancy and childbirth are associated with multiple risks
both for the mother and the child, risks that often can be low-
ered by careful monitoring of the woman during pregnancy.
By intervening, for instance, upon measuring a high plasma
glucose level or elevated blood pressure, pregnancy outcomes
can greatly improve. For this approach, working antenatal
clinics with skilled midwives and obstetricians are a must.
Although caesarean section and forceps-­assisted delivery
or vacuum extraction are important tools in deliveries when
uninterrupted vaginal delivery is not an option, these meth-
ods are also associated with morbidity, both for the mother
and the child.
Addressing mental illness during pregnancy is important
as it has potential impact on not only the mother and possi-
ble future pregnancies, but also the child and the rest of the
family. Maternal anxiety or depression have been previously
shown, among other things, to be associated with increased
odds for instrumental deliveries and emergency caesarean
section. In the current study by Hulsbosch et al. (https://doi.
org/10.1111/1471-0528.17273), data on anxiety and depres-
sion in 1682 pregnant women, collected at each trimester,
were analysed. They found that self-­reported persistently
high symptoms of anxiety and depression during pregnancy
were associated with a lower likelihood of a birth without
interventions. No such association could be seen in women
with intermittently high or persistently low symptoms of
anxiety and depression.
The results from the current study are interesting in that
they confirm that anxiety and depression are associated with
adverse pregnancy outcomes. However, what is even more
intriguing is that if the symptoms were not persistently high,
no association with the adverse outcomes studied could be
seen. There can of course be several reasons for this. As spec-
ulated in the article, persistently high symptoms of anxiety
Linked article: This is a mini commentary on Hulsbosch et al., pp.495–505 in this issue. To view this article visit https://doi.org/10.1111/1471-­0528.17273
506  |  ©
2023 John Wiley & Sons Ltd.
and depression could lead to high levels of stress hormones
that may impact labour. In our previous study of close to a
million births in Sweden in 2001–­2013 we measured anxiety
or depression in the year before pregnancy and until delivery
(Rejnö et al. Sci Rep 2019;9:13101). Instead of self-­reported
anxiety/depression, we used registry data on medication
and clinical diagnoses. As symptoms need to be persistent to
grant a diagnosis (and hopefully the same is true for starting
medication), I suspect that the women in the group in the
current study with persistently high symptoms of anxiety
and depression are also more likely to get a diagnosis and
start medication.
It would be very interesting to see if early detection and
intervention could reduce the risk of adverse outcomes.
Antenatal care would have to play a major role for this
to be possible. For now, it is reassuring that fluctuating
symptoms of anxiety and depression during pregnancy
might not negatively affect the chance of a physiological
birth.
C ON F L IC T OF I N T E R E S T S TAT E M E N T
None declared. Completed disclosure of interests form avail-
able to view online as supporting information.
DATA AVA I L A BI L I T Y S TAT E M E N T
Data sharing not applicable -­no new data generated, or the
article describes entirely theoretical research.
ORC I D
Gustaf Rejnö  https://orcid.org/0000-0002-8095-5629
S U PP ORT I N G I N F OR M AT ION
Additional supporting information can be found online in
the Supporting Information section at the end of this article.
wileyonlinelibrary.com/journal/bjo BJOG. 2023;130:506.