The Role of Integrative Medicine in PMADs: What is the Evidence?
You are not alone if you admit to being confused by the maddening amount of health advice and opinions aimed at those who are trying to conceive, pregnant, or postpartum. There are literally not enough hours in the day to accomplish all the things other people say you should be doing to be healthy. So what does the research say is actually most important?
A 2018 study reported that >75% women studied had used integrative medicine either while trying to conceive, during pregnancy, or in postpartum (1). But what do we know about the evidence for and safety of these therapies?
For the purpose of this article, the focus will be on integrative therapies that have the most evidence for efficacy and safety beyond what is commonly accepted and recommended to women from preconception through postpartum by most women’s health specialists, namely generalized recommendations for a prenatal vitamin, healthy nutrition, and daily physical activity. There is no doubt that these basic recommendations are helpful, but what about for those struggling with perinatal mood and anxiety disorders (PMADs)?
It is important to remember that psychotherapy & social support are the best supported interventions for anyone struggling with PMADs. There are several medications that have been shown to be safe and effective in pregnancy and lactation and evidence shows that untreated psychiatric symptoms pose more risks to mom and baby than many medications. While integrative therapies may not take the place of counseling and medications, when combined with the following recommendations the synergistic effect may be better than any single treatment.
It is also important to rule out any possible underling contributing factors that may increase the risk for or severity of PMADs. Thyroid dysfunction and nutritional deficiencies that are common in the perinatal timeframe and may exacerbate symptoms should be screened for. Prenatal vitamins should be started in advance of trying to conceive and continued throughout the reproductive period to give a baseline level of nutrients needed for perinatal mental and physical health of both mom and baby. However, there are specific supplements in addition to a basic prenatal vitamin that have been shown to benefit perinatal mental health, specifically: (2-6)
- Fish oil
- Folate & B12
- Vitamin D
Research suggests decreasing stress, anxiety, and depression have significant impact on fetal health & future health of child by decreasing negative impact of cortisol & following birth via improved bonding. Sleep deprivation, stress, and lack of activity may increase symptoms while interventions like yoga, mindfulness, and acupuncture can often help and be added with no risk of side effects or interactions with conventional treatments for PMADs.
Several studies have shown the positive impact of acupuncture, yoga, and mindfulness on stress and anxiety & depression scores and improve sleep during preconception, pregnancy & postpartum (7-17). In addition, yoga and mindfulness practices are activities that partners can do together, incorporating children as they get older.
The take home message is, despite what the gurus on social media might say, there are no magic pills or quick fixes, but you might find that a combination of evidence based integrative therapies and conventional medication and therapy can provide the support needed to weather the perinatal period, allowing you to take care of yourself and your growing family.
Leigh K. Lewis (she/her) worked for several years in the field of community mental health before relocating to the Pacific NW for medical school. Leigh is a graduate of Bastyr University and completed a 2-year post-graduate training program in integrative women’s health. Leigh is credentialed by NAMS as a certified menopause practitioner, ABORM as a fellow of oriental reproductive medicine, PSI in perinatal mood & anxiety disorders as a prescriber, and has completed her yoga teacher training including a certification in prenatal yoga. Leigh is active as Vice Chair for both the PSI-AZ Chapter Board of Directors and the Integrative Medicine group for the America Society for Reproductive Medicine.
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