Inequities in pain medication treatment received postpartum, after giving birth, were found in a Cedars-Sinai study of 18,000 women. The disparities were observed even among patients reporting the highest pain levels.

The retrospective cohort study was published in The Joint Commission Journal on Quality and Patient Safety.

Both opioid and non-opioid pain medications given to patients were examined. Investigators wanted to see if the lower opioid doses reported in some studies finding racial and ethnic differences in peripartum pain management could be due to those patients receiving other kinds of drugs for their discomfort.

“Even after adjusting our analysis to include non-opioid medications, Black and Hispanic patients who reported the highest pain scores received lower doses of opioid-containing medication. The fact that they also received non-opioid drugs could not explain the lower opioid treatment they received when compared with white patients,” said Naomi Greene, PhD, principal investigator of the study and research assistant professor of  Obstetrics and Gynecology.

Pain associated with labor and delivery can make it challenging for women to care for themselves and their newborns. Investigators looked at many variables available in the electronic medical records of the patients who delivered at Cedars-Sinai over a three-year period, 2019−2021. White, Black, Asian and Hispanic women were part of the large cohort.

“We attempted to identify factors that might have mitigated the apparent differences, such as the number of pain assessments, use of epidurals, the amount of non-opioid medication, maternal age, the number of pregnancies, and body mass index. But none of these factors could account for the racial and ethnic disparities in the amount of effective opioid pain management given to them,” said Sarah J. Kilpatrick, MD, PhD, the Helping Hand of Los Angeles Chair in Obstetrics and Gynecology and senior author of the paper.

Investigators emphasize that further study is needed to identify what factors might explain the persistent racial and ethnic disparities in pain management that could point to potential interventions to eliminate the inequities.

“This study adds to the growing body of literature on peripartum pain medication disparity. While confirming previous findings, we added to it by showing that the amount of non-opioid medication used could not explain those disparities in opiate-based therapy given to patients in pain,” Greene said.

It is likely that pain perception and assessments are affected by a complex set of factors, the study authors noted.

“Healthcare provider beliefs, attitudes, and biases concerning pain rating in patients of different races and ethnicities are part of the challenge. Exploring this would necessitate a prospective intervention, such as a survey distributed to nurses and doctors to assess these beliefs and biases. Also, beyond recording a number for a pain score, we need to find ways to allow patients to directly assess their satisfaction with the pain management they are receiving,” Kilpatrick said.

Read more on the Cedars-Sinai Blog: Equitable, Personalized Care for Women and Children of Color

In a special conversation to mark Women’s Health Month, maternal-fetal medicine specialist Melissa Wong, MD, spoke with the Cedars-Sinai Newsroom about specific AI applications developed at Cedars-Sinai and being used to improve maternal health outcomes and gynecological cancer screening. Wong is also director of Informatics and Artificial Intelligence Strategies for the Department of Obstetrics and Gynecology.

What are some significant results of using AI to improve pregnancy and childbirth outcomes?

Two important studies looked at the leading causes of death during pregnancy and childbirth: preeclampsia and postpartum hemorrhage.

We know that low-dose aspirin can reduce the risk of developing preeclampsia, a dangerous hypertensive complication of pregnancy that can cause serious illness or death. Black pregnant women are particularly vulnerable to being overlooked for aspirin treatment. Our study found that using artificial intelligence to identify patients at risk for preeclampsia—and then automate the decision-making about prescribing the aspirin—led to an increase in appropriate aspirin treatment and also eliminated the racial disparity in care.

In another study using an application of AI, machine learning, we developed an algorithm that can help predict which patients are at an increased risk for severe complications from bleeding after childbirth. The key was to analyze data at many different points of a patient’s labor and delivery—from underlying medical conditions to the kind of anesthesia the mother received. Our next step is to see if the algorithm can help predict hemorrhages in real time and allow for intervention and saving lives.

What future uses of AI for OB-GYN care are being considered?

In the area of gynecological care, we are wrapping up a study that could improve the evaluation of the Pap smear used to check for cervical cancer. We do hundreds of Paps a week in our health system. The results are most meaningful when you can put them in the context of the patient’s history. We’ve developed an AI application using ChatGPT that performs a contextual analysis of results, produces a recommendation for next steps, if needed, and even generates a letter to the patient about the results.

Gestational diabetes and hypertension during pregnancy are two conditions we believe could also benefit from AI interventions to identify trends and patterns in patient-submitted data and recommend interventions.

In the case of diabetes, about 80% of the patients submitting data from their glucose monitors are probably doing well or just need straightforward adjustments to their insulin. But our expert diabetes educator still has to analyze all of the data, even if only 20% of the patients will require direct intervention with medication or nutrition counseling to get them back on track. AI could help us focus on the smaller group of patients who need more complex and nuanced support, more expeditiously.

As for managing high blood pressure during pregnancy, this is often a new skill patients learn in pregnancy or postpartum. It’s also a complicated one. Trying to distinguish between a somewhat worrisome reading and one where you need to call your provider asap is not intuitive. A good AI model could send an alert when subtle pattern changes signal a need for medication modifications or urgent attention by the patient and provider.

What is the approach to AI innovation at Cedars-Sinai?

I feel incredibly fortunate to be here, not just because we are at the forefront of investigating the use of artificial intelligence across a wide variety of specialties and procedures, but because we do it with implementation in mind. There is a lot of AI research in the U.S. but not much that goes beyond the lab. At Cedars-Sinai, the goal is to research the myriad possible applications, and then when we’ve refined and tested them, to “turn it on,” so to speak. We are highly motivated to implement what we have developed and to help improve the delivery of care and the health of our patients.

What is the primary goal of harnessing AI for healthcare?

It’s about how AI can help healthcare providers free up their brains and their time to focus on delivering the best possible care. It can be a remarkable tool that brings us front and center with the patient again and moves us away from the kind of work that AI and machine learning do more effectively, quickly and accurately.

Whether a provider is in a healthcare desert with limited resources or at an academic medical center, the best applications of artificial intelligence will have a democratizing impact—reducing healthcare inequalities and providing care that could be more personalized across a broad spectrum of patient populations.

Read more from the Cedars-Sinai Blog: How Women Can Strengthen Their Health at Any Age

Fluctuating estrogen levels can cause hot flashes, mood swings, insomnia and irregular periods in women who are experiencing perimenopause—the years leading up to menopause. After menopause, which is defined as 12 months without a period, the symptoms can continue because the body is producing less estrogen.

Chan told Women’s Running that hormone therapy—medication that contains estrogen—is safe and effective for many women, including masters runners (those who are 40 and over) and people who are physically active.

“A vast majority of my patients experience an immediate relief of their menopausal symptoms once they start their hormone therapies,” Chan said. “I’m a huge proponent of using hormone therapy to treat menopausal symptoms on the appropriate patients experiencing poor quality of life.”

A widely publicized study in 2002 indicated that hormone therapy increased the risk of breast cancer, stroke and other serious conditions, but the study’s findings were later disproven. 

“For my healthy and active patients who don’t have underlying cardiovascular diseases, their risks of blood clotting, stroke, and cancer are even lower,” Chan told Women’s Running. “Even among women with a family history of breast cancer, I think they can still make great candidates.”

Chan encouraged patients who have questions about hormone therapy to speak with their physician. 

“For highly active athletes, continue doing what you’ve been doing, see your OBGYN or an endocrinologist if you are curious about MHT [menopause hormone therapy],” Chan told Women’s Running. “Have a conversation.”

Click here to read the complete article from Women’s Running. 

Women who received standard recommended immunizations during their pregnancy were more likely to accept the COVID-19 vaccine, according to new research from Cedars-Sinai. Investigators also identified disparities in vaccination linked to race and insurance status.

The findings on COVID-19 vaccine uptake during pregnancy are published in the Journal of Infection.

“We found that patients were more likely to accept COVID-19 vaccination if they were Asian, had private health insurance, and had received the recommended pregnancy vaccinations for Tdap (tetanus-diphtheria-acellular pertussis) and the flu,” said corresponding author Laura Ha, MD, a maternal-fetal medicine fellow in the Department of Obstetrics and Gynecology.

Maternal age and weight, in addition to race, also played a role in vaccine hesitancy.

“Pregnant women who were Black, under 35 years of age, not obese or had public insurance were less likely to accept COVID-19 vaccination,” Ha said.

In this retrospective cohort study, investigators examined the medical records of 7,857 patients who delivered at Cedars-Sinai in Los Angeles between December 2020 and March 2022. Immunizations received during pregnancy were among the health variables evaluated.

In May 2022, when the last of the cohort was included in the study, 78% of the U.S. adult population had received at least one dose of the COVID-19 vaccine, according to the Centers for Disease Control and Prevention. However, the rate among pregnant women was much lower; just 42% were vaccinated in spite of the recommendation of healthcare organizations, including the American College of Obstetricians and Gynecologists.

“COVID-19 infection is associated with an increased risk of severe illness and death in pregnant patients. The vaccine decreases the risk of hospitalization and death from the virus, which is why we recommend that pregnant patients get vaccinated,” said  Mariam Naqvi, MD, a maternal-fetal medicine specialist and co-author of the study.

The research also supports the growing body of evidence on the safety of the COVID-19 vaccine for mothers and their newborns.

Our findings were consistent with existing data showing that receiving the COVID-19 vaccine during pregnancy does not increase the risk of preterm birth, low birthweight, low Apgar scores, or admission to the neonatal intensive care unit,” Ha said. The Apgar score is a test given to newborns soon after birth. It assesses the baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed.

Investigators urge continued research on COVID-19 vaccination in pregnant women to ensure equitable and widespread vaccine distribution and to provide safety data that could improve vaccine acceptance and perinatal outcomes.

Read more on the Cedars-Sinai Blog: COVID-19 Vaccine and Pregnancy

Cedars-Sinai investigators found no established link between the use of assisted reproductive technologies and potential problems in DNA methylation that might impact genetic expression or embryonic development.

BACKGROUND

Infertility treatments with assisted reproductive technology (ART) are on the rise and account for over 8 million births worldwide. ART, such as in vitro fertilization, is associated with several adverse maternal and neonatal outcomes, including low birth weight, preterm delivery, preeclampsia, gestational diabetes and increased maternal morbidity. The precise cause of these elevated risks is unknown.

Cedars-Sinai investigators analyzed previous ART research for any genomic data suggesting DNA methylation—a biochemical process that can impact gene expression—could be linked to changes in embryonic cell development and growth.

METHOD

Investigators performed a systematic review of research that undertook a genomewide analysis of human methylation differences attributed to ART or infertility. Any tissue types across the lifespan were assessed for inclusion. Seventeen studies met the inclusion criteria and included examinations of samples from a wide variety of sources, including placental and fetal tissue and cord blood and adult peripheral blood. Tissues from various infertility treatments, including in vitro fertilization (IVF) and intracytoplasmic sperm injection, were used in some of the studies reviewed. Specimens from unassisted conceptions were part of some of the research analyzed.

IMPACT

Information from this systematic review of existing data can assist patients and their healthcare providers to better understand DNA methylation and genetic development risks relating to the use of assisted reproductive technology to treat infertility.

JOURNAL

The study is published in the journal Fertility and Sterility.

EXPERT COMMENTARY

“As we develop a better understanding of the genetics and epigenetics of the infertility etiology and the effect of fertility treatment on epigenetics, we are in the best position to develop modifications and new approaches to treatment that may lead to improvements in pregnancy outcomes and maternal health,” said Margareta Pisarska, MD, director of the Fertility and Reproductive Medicine Center at Cedars-Sinai and corresponding author of the study.

“The goal of fertility treatment is to achieve a successful pregnancy and a healthy mother and child. Despite the risk of some adverse outcomes associated with infertility and fertility treatments, these risks are small,” Pisarska emphasized.

AUTHORS

Other Cedars-Sinai authors include Amelia M. Schaub, MD; Tania L. Gonzalez, PhD; Anna E. Dorfman, BA; Allynson G. Novoa, BS; Rimsha A. Hussaini, BS; Paige M. Harakuni, BS; Mayaal H. Khan, BS; Brandon J. Shabani; Akhila Swarna, BS; Erica T. Wang, MD; Jessica L. Chan, MD; and John Williams III, MD.

FUNDING

The research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD074368), the National Institute of Allergy and Infectious Diseases (R01AI154535) and the genomic analysis company Sequenom.

Follow Cedars-Sinai Academic Medicine on X, formerly Twitter, for more on the latest basic science and clinical research from Cedars-Sinai. 

Formerly known as the California Pregnancy-Associated Mortality Review (CA-PARM), the committee conducts in-depth investigations of deaths during—and up to one year after— pregnancy. The goal is to identify the causes of maternal loss of life, and any contributing factors, in order to develop evidence-based recommendations for prevention.

CA-PARM was established in 2006 by the California Department of Public Health, in partnership with the California Maternal Quality Care Collaborative, where Gregory has also served.

“We couldn't be more excited about Dr. Gregory's appointment to lead CA-PARC. Her leadership experience with the state committee, a distinguished career as a maternal-fetal medicine specialist, and her critical research on maternal health outcomes and disparities make her perfectly suited for this role,” said Amanda Williams, MD, MPH, the Clinical Innovation Advisor at the California Maternal Quality Care Collaborative.

Gregory is the director of Maternal-Fetal Medicine and vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology at Cedars-Sinai.  

“Death associated with pregnancy is a tragic event, impacting families and communities. Each woman who died while pregnant, or in the postpartum period, deserves a thorough and respectful review of what contributed to their death. It is my honor to serve as chair of CA-PARC and to work with a team who is thoughtful and diligent with this sensitive review process. We are dedicated to work that may keep others from dying from preventable causes,” said Gregory, who holds the Helping Hand of Los Angeles–Miriam Jacobs Chair, Maternal-Fetal Medicine.

Gregory joined Cedars-Sinai in 1992, after receiving her medical degree from the Drew/UCLA Medical Education Program and completing her residency in obstetrics and gynecology at Beth Israel Deaconess Medical Center in Boston. She went on to earn a master’s degree in public health from Harvard University before completing a fellowship in maternal-fetal medicine at LAC+USC Medical Center.

A major focus of Gregory’s research over the past decade has been examining the hospital childbirth experience from the mother’s perspective. Her goal is for hospitals to provide a safer and more meaningful experience for women in their care, addressing concerns that range from better pain management to breastfeeding policies.

“Dr. Gregory has been steadfastly committed to improving obstetric outcomes for women for her entire career. She is a compassionate physician whose dedication to providing her patients the best possible care also drives her innovative research to identify and reduce racial and ethnic disparities that can impact the healthcare women of color receive. She wants every pregnant patient to receive the best possible care available,” said Sarah Kilpatrick, MD, PhD, the Helping Hand of Los Angeles Chair of Obstetrics and Gynecology at Cedars-Sinai.

Read more on the Cedars-Sinai Blog: Equitable, Personalized Care for Women and Children of Color

concluded that further research is needed to clarify the reasons for this disparity.

“We’ve known for years that Black women with endometrial cancer have lower survival rates than white women, largely because they are more likely to have an aggressive subtype and to be diagnosed at an advanced stage,” said Kristin Taylor, MD, assistant professor of Obstetrics and Gynecology at Cedars-Sinai and lead author of the study. “But our study found this disparity persists even when we compare patients with the lowest-risk form diagnosed at the earliest possible stage.”

Taylor and fellow investigators reviewed data on more than 23,000 Black and white women from the National Cancer Institute’s SEER database, which collects data from registries in 18 geographic areas in the U.S. All of the patients had the earliest-stage, least-aggressive endometrial cancer—a type called stage 1A low-grade endometrioid endometrial carcinoma.

“Low-grade endometrioid tumors account for about 80% of endometrial cancers, and most of these are stage 1 at diagnosis,” said Taylor. “For these patients, standard treatment is hysterectomy, and many should be cured without the need for radiation or chemotherapy.”

The SEER data showed that the vast majority of patients, both Black and white, were treated with hysterectomy and had high overall survival rates. However, while just 1% of white women did not receive hysterectomies, 3% of Black women in the study didn’t receive this lifesaving surgery.

“We had hoped that when we looked only at the lowest-risk patients, the disparity between Black and white women would disappear, but it did not,” Taylor said. “It’s disappointing.”

Residing in the South, being insured with Medicaid, and residing in a county with low median income were also associated with not receiving surgery.

Study investigators said doctors might recommend against hysterectomy for women—both Black and white—with underlying health conditions that increase risk of surgical complications. Doctors might also offer women of childbearing age a fertility-sparing hormone treatment that lets them temporarily postpone surgery, Taylor said.

However, a slightly higher—though not statistically significant—number of Black women than white women refused surgery when their doctors recommended it, the study found.

“Although there was no data collected on the reason for refusal,” Taylor said, “there is likely an element of mistrust of the medical community that contributes to this difference.”

One factor that might help account for this disparity is structural racism, Taylor said. She pointed to historical policies that caused more Black people to be of lower socioeconomic status, and thus more likely to be uninsured or underinsured and have less access to quality healthcare. She also noted prior medical experimentation on Black people (e.g., the Tuskegee syphilis study) as recently as a few decades ago.

“Even though they might not always be in our conscious memory, I think that the downstream effects of those insults from decades ago get passed on culturally, particularly in the South. Among my own family, I see geographical differences in how members perceive their relationships with their doctors,” said Taylor, who was born in the South but grew up in Illinois.

Taylor said that further studies should be conducted to delve into the roles of these social factors.

“Disparities in survival that persist even among patients with the same stage and subtype of cancer must be investigated and addressed,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE One Distinguished Chair. “Dr. Taylor’s work is an example of the many ways investigators at Cedars-Sinai Cancer are working to understand these disparities and bring the highest level of care to all of the diverse patient groups we serve.”

Going forward, Taylor and team plan to address some limitations of the current study by looking at a different dataset.

“One major limitation with the SEER database is that socioeconomic factors are recorded at the county level, which is so broad,” Taylor said. “We're essentially repeating this study using the California Cancer Registry, which gives information including median income, education level, insurance status, primary language and immigration status at the neighborhood level. We'll have a much richer, more granular view of the lives of these patients, which should be really informative.”

Another planned study goes in a completely different direction.

“Some data suggest that there are different genetic pathways, even within this narrow subset of tumors, that could be driving disparities between outcomes in Black and white women,” Taylor said. “We’re hoping to develop models in the lab derived from the tumors of Black and white women with this subtype of cancer to look for biologic differences that could help inform treatments for each population.”

Read more on the Cedars-Sinai Blog: Uterine Cancer: What Women Need to Know

Accortt and Cedars-Sinai patient Angelina Spicer also spoke with ABC 7 about the new medication, zuranolone (Zurzuvae).

Postpartum depression is a potentially life-threatening condition that affects about 1 in 7 new mothers, interfering with their ability to function and bond with their newborn.

Bamgbose told AirTalk host Austin Cross that individuals who develop severe postpartum depression respond differently to the sudden drop in hormone levels at delivery than those who experience the more common “baby blues.”

“If they’re starting to have thoughts like, ‘I can’t do this. My child would be better off without me,’ or ‘I’m a terrible mother. I’m a terrible parent,’ and they’re not eating or they’re not sleeping, then I really start to get concerned,” Bamgbose told Cross.

Accortt said zuranolone can start working in three days and lasts up to 45 days—an improvement over treatments with a slower response time or that involve inpatient psychiatric care.

“Considering that you could stay at home, take a medication such as this and feel better within three days is a pretty incredible achievement,” Accortt told Cross.

Accortt told ABC 7 reporter Denise Dador that a fast-acting therapy could be a game-changer: “When you are pregnant or postpartum, every day is critically important for you to bond with your newborn.”

The new medication could reduce stigma and encourage those who are experiencing postpartum depression to seek treatment, said Cedars-Sinai patient Angelina Spicer. She received in-patient psychiatric treatment for postpartum depression at a Southern California hospital following the birth of her daughter in 2015. Spicer now uses comedy and activism to support others who have the condition—many of whom are women of color.

“Now we also have a pill to go with it,” Spicer told Dador. “I’m so excited.”

Click here to listen to the complete episode of AirTalk. Click here to watch the entire segment on ABC 7.

Endometriosis is a disease which affects more than 10% of women and causes tissue to grow outside the uterus on the ovaries, fallopian tubes, tissue lining of the pelvis and in the abdominal cavity. Prominent symptoms include chronic pain, fatigue, infertility, heavy menstrual bleeding, and bowl and bladder dysfunction. As of now, the treatment options—pain medication, hormone therapy or surgery—for women diagnosed with endometriosis are limited.

“We can’t ignore conditions like this that are really robbing us of … many talented women who can’t reach their full potential because of this disease that we just haven’t studied well enough to be able to treat it effectively,” Lawrenson said.

Lawrenson, co-author of the study, told Kwong that she and her team analyzed and profiled 400,000 individual cells from different patients using single-cell genomics technology. Investigators then developed a cellular atlas containing the molecular information of the disease to serve as a resource for further endometriosis research.

“This has been a real game-changer for diseases such as endometriosis, where there are lots of different cell types conspiring to cause that disease,” she said.

Lawrenson and her co-authors hope the data helps improve diagnoses and identify high-risk patients.

“I’ve been in research for, I think, 18 years now, and I’ve seen a big change in that time,” Lawrenson told Kwong. “So, hopefully, the next 18 years we’ll really see differences in how we understand endometriosis and how we can treat it more effectively and diagnose it more efficiently.”

Click here to listen to the complete “Short Wave” episode.

Because most of the research used to guide patient care has been conducted on men, little is known about how to best care for women, Kilpatrick told AirTalk host Larry Mantle.

“Federal funding underfunds areas of research that are about women with high-burden diseases … that lead to early death or significant disability over one’s life,” Kilpatrick said. “Cervical cancer and ovarian cancer are underfunded compared to male-based cancers like prostate cancer, for example.”

Endometriosis, a common condition that occurs in 10% of women, has long been underfunded, but Kilpatrick said it’s “finally beginning to get the attention it deserves.” She has been working with other specialists to diagnose the illness and start patients on earlier treatment to reduce morbidity.

Kilpatrick told Mantle she believes there has been a historical reluctance to include women in clinical trials because they experience a menstrual cycle, menopause and may be taking birth control pills. “Those factors really change the physiology of the patient, so it’s much harder to actually do those studies,” she said. 

Despite recent advances, there is still more work to be done, Kilpatrick said.

“We’re so far behind in our knowledge gap for women and how women’s health is different that we just need to be on superspeed to get this moving forward so that we can have the information that we need,” Kilpatrick told Mantle.  

Click here to listen to the complete episode of AirTalk.

Having a child is a major life event accompanied by physiological changes and the stress of caring for a completely dependent little human. That experience is commonly referred to as “the baby blues.”  

But 15% to 20% of women who give birth will experience major changes in their mood and overall wellbeing that can linger for months. These new mothers can suffer from perinatal mood disorders that can include depression, anxiety, obsessive-compulsive disorder and even post-traumatic stress.

Cedars-Sinai clinical psychologist Eynav Accortt, PhD, director of the Reproductive Psychology Program, shares information on what is known about these changes in mental health faced by millions of women and the types of treatment and support that are available to help mothers recover.

Newsroom: What do we know about the scope of maternal mental health disorders?

It's a much wider range of symptoms and diagnoses than described by the term postpartum depression or “the baby blues.”  Perinatal mood and anxiety disorders can be experienced during pregnancy and up to a year after birth, when symptoms often develop. When diagnosed, this can include major depressive disorder, bipolar depression, generalized anxiety, panic disorder, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder.

Newsroom: What are the risk factors for developing perinatal mood disorders?

Things that may increase the risk for developing a perinatal mood and anxiety disorder include genetic factors such as a family or personal history of mental illness. Even medical complications during pregnancy, such as preeclampsia or gestational diabetes, can elevate a woman’s risk. At Cedars-Sinai, we are investigating a possible connection between these pregnancy illnesses and inflammation. We want to know if inflammation may increase the risk of developing depression during and after pregnancy.  

Parents with a newborn in a neonatal intensive care unit have twice the risk of developing postpartum depression, anxiety and PTSD. Research also points to race and ethnicity as risk factors for mental health problems associated with maternity. Black mothers are twice as likely to develop a perinatal mood or anxiety disorder than white women, primarily due to the impact of  racial discrimination.

Newsroom:  When should a new mother be concerned about her mental health?

If two weeks post-delivery a woman continues to experience symptoms of depression and anxiety that interfere with her ability to function or to care for herself and her baby, it’s important to get some professional help. A good first step is to speak with your obstetrician and let them know what you are going through. In addition to feeling sad or crying all the time, persistent feelings of anger, worthlessness and inadequacy, or feeling disconnected from the baby, are associated with perinatal mood and anxiety disorders. In extreme cases, intrusive, negative thoughts about self-harm, or hurting the child, can be part of mental illness associated with pregnancy, childbirth and motherhood.  

Newsroom: What kind of help is available to women experiencing anxiety and depression during pregnancy and postpartum?

Therapy, including cognitive behavioral therapy. interpersonal psychotherapy or other modalities, can provide meaningful help. Antidepressants can be part of a treatment plan by providing relief and helping improve mood and regulation of emotions. In particular, Zoloft proved to be a safe and effective antidepressant to use during pregnancy and breastfeeding.

The Reproductive Psychology Program at Cedars-Sinai is dedicated to helping women experiencing mental health conditions before, during and after pregnancy. We make sure women can receive the resources, support, care and treatment they need to improve their emotional and mental wellbeing.

Mothers should not suffer in silence. The important first step is to talk to someone—a partner or other family member, a friend, a co-worker, or your physician—and let them know you are struggling. The well-baby checkups that happen frequently in the first six months of life offer a perfect opportunity for a new mother to talk to a healthcare provider about her problems.

Newsroom: As a therapist who counsels women struggling with their mental health during pregnancy or postpartum, what encouragement do you offer?

Every reproductive journey is different. Getting pregnant, having a baby, and going through the postpartum period can be stressful, life-changing experiences. It's important to give yourself grace, and to reach out to your loved ones. If you don't feel well, and you're not able to take care of yourself or your baby, there are services and providers available to help you. There is no reason to lose hope.

Read more on the Cedars-Sinai Blog: The Difference Between Postpartum Anxiety, OCD and Psychosis