During pregnancy, hormone changes may lead some women to experience mild mood swings. 

For new moms, having negative feelings after giving birth is not uncommon and often called the "baby blues." 

But when does the stress of having a baby signal a more serious mental health problem?

The number of perinatal women struggling with their mental health is higher than many realize, says Eynav Accortt, clinical psychologist and director of the Reproductive Psychology Program at Cedars-Sinai.

'Perinatal' is a term used to refer to the period before and after birth. While you may know about postpartum depression, a perinatal mood and anxiety disorder (PMAD) can develop at any point during pregnancy and up to one year after having a baby.

Studies indicate that depression and anxiety affect one in seven women during the perinatal period.

In Discoveries: A Real-Life Stress Test: New program addresses postpartum mood disorders

While every woman goes through hormone changes while pregnant and after delivery, not all women develop anxiety or depression, Eynav says. 

Having a history of depression or anxiety, having a pregnancy complication such as preeclampsia or having a baby in the neonatal intensive care unit, or NICU, can all increase risk. 

Also, when a woman may be more likely to experience symptoms of PMADs can vary from person to person.

"A woman might feel fine during the first two trimesters of her pregnancy, then hit her third trimester and feel more anxiety and depression," Eynav says. "Or she may feel OK during her pregnancy and postpartum, only to develop severe anxiety after weaning from breastfeeding six months after delivery."

Read: Beyond Baby Blues: Postpartum Depression

Preliminary research on COVID-19 has shown a significant increase in psychological stress for expectant mothers. 

One recent study suggests that while social support helps pregnant women manage their stressors during this time, inconsistent social support is a significant risk factor for depression among pregnant women. 

As a result of the COVID-19 pandemic, pregnant women may be at risk for psychological problems due to public health strategies like physical distancing.

Read: Exercise During Pregnancy: What's Safe?

The main indication that women might be developing a PMAD is if these feelings of anxiety, depression or panic start to interfere with their ability to function, Eynav says.

At this point, perinatal women should seek psychiatric help or talk to their OB-GYN.

"Untreated PMADs can become lifelong chronic depression or chronic anxiety," Eynav says. "Women shouldn't think, 'Oh, it will go away on its own after I have the baby.'"

Read: Overcoming Postpartum Pain

While the number of women at risk for developing PMADs is cause for concern, there are multiple ways to get treatment.

"One silver lining in the COVID-19 cloud is that many restrictions on telehealth—particularly teletherapy and telepsychiatry—have been lifted," Eynav says.

"Many providers and support groups have quickly pivoted to offer meetings and therapy online."

For those experiencing mild to moderate anxiety or depression, perinatal women could start to feel better within a month or two of weekly psychotherapy sessions, Eynav says.

In Discoveries: Stop the Stigma

If you are expecting a child and feeling anxious or depressed, know that you do not have to suffer alone.

"It's important for perinatal women to realize that they are not the only ones struggling," Eynav says. "In reality, having a baby is very challenging. Having a child can be filled with joy, and there are a lot of wonderful things about pregnancy, but I advise women and couples to balance their expectations of the pregnancy journey. Not everything about motherhood or fatherhood is intuitive."

The Cedars-Sinai Reproductive Psychology Program offers individual psychotherapy and a recurring PMAD Therapy Group for pregnant or postpartum women. Visit the Obstetrics & Gynecology Reproductive Psychology program website for more information.