Mental health of pregnant women: modern realities




mental health, stress, post-traumatic stress disorder, pregnancy, gestational complications, premature birth, postpartum period


This review provides data on the impact of the war in Ukraine and the COVID-19 pandemic on the mental health of Ukrainian women during pregnancy, childbirth, and the postpartum period. It is noted that even in peacetime, the perinatal period is quite vulnerable.

The aim of the study is to analyze the impact of post-traumatic stress disorder (PTSD) on the course of pregnancy, childbirth and the postpartum period.

According to statistics, one in five women may have a perinatal mental disorder. In today's realities, mental health is given considerable attention. Mental health disorders, such as depression, anxiety and PTSD, manifested by negative thoughts, loss of interest and/or pleasure, fatigue and/or increased anxiety, are the most common diagnoses. It is clear that pregnancy and the postpartum period, although they can be joyful, are also times of stress and difficulty for mothers as they face physiological and psychosocial changes.

Particular attention is paid to the connection of maternal depression and anxiety with an increase in inflammatory biomarkers in the mother during pregnancy, which is associated with an increased risk of neurodevelopment in children. Despite the contradictory results of the hypothesis about fetal programming, it is important to recognize that caring for the mother and the child are interconnected.

Pregnant mothers who have PTSD are at increased risk of premature termination of pregnancy and premature birth, the development of preeclampsia, gestational diabetes, and other obstetric and perinatal losses.

A review of the literature confirms the relevance of studying the impact of PTSD on the perinatal period, since timely diagnosis and treatment of mental disorders is a key element of preserving the health of pregnant women and ensuring the stable development of the nation.

The authors declare no conflict of interest.


Ancheva I, Morozova K. (2016). Post-traumatic stress disorder amongst internally displaced pregnant females. URL:

Andersen LB, Melvaer LB, Videbech P, Lamont RF, Joergensen JS. (2012).Risk factors for developing post-traumatic stress disorder following childbirth: a systematic review. Acta Obstet. Gynecol. Scand.91: 1261-1272.; PMid:22670573

Arnetz J, Rofa Y, Arnetz B, Ventimiglia M, Jamil H. (2013).Resilience as a protective factor against the development of psychopathology among refugees.J. Nerv. Ment. Dis. 201: 167-172.; PMid:23407208 PMCid:PMC3584239

Bornstein E, Eliner Y, Chervenak FA, Grunebaum A. (2020). Racial Disparities in US Pregnancy Risks and Complications: Temporal Changes 2007-2018. Journal of Clinical Medicine. 9(5): 1414.; PMid:32397663 PMCid:PMC7290488

Braithwaite ЕС, Hill J, Pickles A, Glover V, O'Donnell K, Sharp H.(2018, Aug). Associations between maternal prenatal cortisol and fetal growth are specific to infant sex: findings from the Wirral Child Health and Development Study. J Dev Orig Health Dis. 9(4):425-431. Epub 2018 Apr 10.; PMid:29631648 PMCid:PMC6075696

Cherak SJ, Giesbrecht GF, Metcalfe A, Ronksley PE, Malebranche ME. (2018, Aug). The effect of gestational period on the association between maternal prenatal salivary cortisol and birth weight: A systematic review and meta-analysis. Psychoneuroendocrinology.94:49-62. Epub 2018 Apr 24. doi: 10.1016/j.psyneuen.2018.04.023. Erratum in: Psychoneuroendocrinology. 2021 Sep; 131:105337. PMID: 29754005.’ PMid:34175555

Chrzan-Dętkoś M, Rodríguez-MuñozMF, KrupelnytskaL, Morozova-LarinaO, VavilovaA, LópezHGetal. (2022). Good practices in perinatal mental health for women during wars and migrations: a narrative synthesis from the COST action Riseup-PPD in the context of the war in Ukraine. Clinica y Salud.33: 127-135.

Cox J. (2019). Thirty years with the Edinburgh postnatal depression scale: voices from the past and recommendations for the future. Br. J. Psychiatry. 214: 127-129.; PMid:30774059

Davis EP, Sandman CA. (2010). The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Dev. 81: 131-148.; PMid:20331658 PMCid:PMC2846100

Deer LK, Su C, Thwaites NA, Davis EP, Doom JR. (2023, May 8). A framework for testing pathways from prenatal stress-responsive hormones to cardiovascular disease risk. Front Endocrinol (Lausanne).14:1111474.; PMid:37223037 PMCid:PMC10200937

Fatusic Z, Kurjak A, Grgic G, Tulumovic A. (2005). The influence of the war on perinatal and maternal mortality in Bosnia and Herzegovina. J. Matern. Fetal Neonatal Med. 18: 259-263.; PMid:16318977

Falah-Hassani K, Shiri R, Vigod S, Dennis C-L. (2015). Prevalence of postpartum depression among immigrant women: a systematic review and meta-analysis. J. Psychiatr. Res. 70: 67-82.; PMid:26424425

Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. (2019).The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis.J. Clin. Psychiatry. 80:18r12527.; PMid:31347796 PMCid:PMC6839961

Fellmeth G, Plugge EH, Nosten S, Oo MM, Fazel M, Charunwatthana P et al. (2018). Living with severe perinatal depression: a qualitative study of the experiences of labour migrant and refugee women on the Thai-Myanmar border. BMC Psychiatry. 18:229.; PMid:30012124 PMCid:PMC6048862

Gilles M, Otto H, Wolf IAC, Scharnholz B, Peus V, Schredl M et al.(2018, Aug). Maternal hypothalamus-pituitary-adrenal (HPA) system activity and stress during pregnancy: Effects on gestational age and infant's anthropometric measures at birth. Psychoneuroendocrinology.94:152-161. Epub 2018 Apr 22.; PMid:29783163

Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. (2017). Economic and health predictors of National Postpartum Depression Prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front. Psych. 8:248.; PMid:29449816 PMCid:PMC5799244

Heslehurst N, Brown H, Pemu A, Coleman H, Rankin J. (2018). Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. BMC Med. 16: 89.; PMid:29890984 PMCid:PMC5996508

Hong SA, Buntup D. (2023, Mar 12). Maternal Depression during Pregnancy and Postpartum Period among the Association of Southeast Asian Nations (ASEAN) Countries: A Scoping Review. Int J Environ Res Public Health.20(6):5023.; PMid:36981932 PMCid:PMC10049420

Hoppen TH, Morina N. (2019). The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers. Eur. J. Psychotraumatol. 10:1578637.; PMid:30834069 PMCid:PMC6394282

Hoppen TH, Priebe S, Vetter I, Morina N. (2021). Global burden of post-traumatic stress disorder and major depression in countries affected by the war between 1989 and 2019: a systematic review and meta-analysis. BMJ Glob. Health. 6: e006303.; PMid:34321235 PMCid:PMC8319986

Horlings A, Hein I. (2018, Feb). Psychiatric screening and interventions for minor refugees in Europe: an overview of approaches and tools. Eur J Pediatr.177(2):163-169. Epub 2017 Nov 10.; PMid:29124447

HuangC, LiJ, QinG, LiewZ, HuJ, László KDetal. (2021, Sep 28). Maternal hypertensive disorder of pregnancy and offspring early-onset cardiovascular disease in childhood, adolescence, and young adulthood: A national population-based cohort study. PLoS Med. 18(9): e1003805.; PMid:34582464 PMCid:PMC8478255

Julian M, Somers JA, Dunkel Schetter C, Guardino CM. (2024, Feb). Resilience resources, life stressors, and postpartum depressive symptoms in a community sample of low and middle-income Black, Latina, and White mothers. Stress Health.40(1):e3275. Epub 2023 May 23.; PMid:37220227

Juruena MF, Eror F, Cleare AJ et al.(2020).The role of early life stress in HPA axis and anxiety. Adv Exp Med Biol. 1191:141-153.; PMid:32002927

Katrinli S, Smith AK, Drury SS, Covault J, Ford JD, Singh V et al.(2023, Dec). Cumulative stress, PTSD, and emotion dysregulation during pregnancy and epigenetic age acceleration in Hispanic mothers and their newborn infants. Epigenetics.18(1):2231722.; PMid:37433036 PMCid:PMC10337495

Kaufmann C, Zehetmair C, Jahn R, Marungu R, Cranz A, Kindermann D et al. (2022). Maternal mental healthcare needs of refugee women in a state registration and reception Centre in Germany: a descriptive study. Health Soc. Care Community.30: 1608-1617.; PMid:34250665

Keasley J, Blickwedel J, Quenby S. (2017). Adverse effects of exposure to armed conflict on pregnancy: a systematic review. BMJ Glob. Health. 2: e000377.; PMid:29333283 PMCid:PMC5706483

Legazpi PCC, Rodríguez-Muñoz MF, Olivares-Crespo ME, Izquierdo-Méndez N. (2022).Review of suicidal ideation during pregnancy: risk factors, prevalence, assessment instruments and consequences.Psicologia Reflexão e Crítica. 35:13.;PMid:35606474 PMCid:PMC9127017

Mesa-Vieira C, Haas AD, Buitrago-Garcia D, Roa-Diaz ZM, Minder B, Gamba M et al. (2022). Mental health of migrants with pre-migration exposure to armed conflict: a systematic review and meta-analysis. Lancet Public Health. 7: e469-e481.; PMid:35487232

Muzik M, McGinnis EW, Bocknek E, Morelen D, Rosenblum KL, Liberzon I et al. (2016). PTSD symptoms across pregnancy and early postpartum among women with lifetime PTSD diagnosis. Depress Anxiety.33(7):584-591.; PMid:26740305 PMCid:PMC4930405

Nasreen HE, Pasi HB, Rifin SM, Aris MAM, Rahman JA, Rus RM, Edhborg M. (2019, Jun 14). Impact of maternal antepartum depressive and anxiety symptoms on birth outcomes and mode of delivery: a prospective cohort study in east and west coasts of Malaysia. BMC Pregnancy Childbirth.19(1):201.; PMid:31200677 PMCid:PMC6567652

Ozdemir B, Celik S, Oznur T. (2015, Apr). Post-traumatic stress disorder and the risk of spontaneous premature birth. Ozdemir B, Celik S, Oznur T. Obstet Gynecol. 125(4): 988.; PMid:25798978

Padin AC, Stevens NR, Che ML, Erondu IN, Perera MJ, Shalowitz MU. (2022, Jun 14). Screening for PTSD during pregnancy: a missed opportunity. BMC Pregnancy Childbirth.22(1):487.; PMid:35701731 PMCid:PMC9195376

Panelli DM, Chan CS, Shaw JG, Shankar M, Kimerling R, Frayne SM et al.(2023, Mar-Apr). An exploratory analysis of factors associated with spontaneous preterm birth among pregnant veterans with post-traumatic stress disorder. Womens Health Issues.33(2):191-198. Epub 2022 Oct 28.; PMid:37576490 PMCid:PMC10421070

Panelli DM, Nelson DA, Wagner S, Shaw JG, Phibbs CS, Kurina LMJ.(2023, Jul). Physical fitness in relation to depression and posttraumatic stress disorder during pregnancy among US Army soldiers. Women's Health (Larchmt).32(7):816-822. Epub 2023 May 17.; PMid:37196157

Ponting C, Ong E, Dunkel Schetter C, Chavira DA. (2023, May 11). Exposure therapy acceptability among pregnant Latinas with anxiety: A qualitative content analysis. Cultur Divers Ethnic Minor Psychol.10.1037/cdp0000589.; PMid:37166932

Rezaie-Keikhaie K, Arbabshastan ME, Rafiemanesh H, Amirshahi M, Ostadkelayeh SM, Arbabisarjou A. (2020). Systematic Review and Meta-Analysis of the Prevalence of the Maternity Blues in the Postpartum Period. J. Obstet. Gynecol. Neonatal Nurs. 49: 127-136.; PMid:32035973

Romanenko IY. (2020).Dynamics of psychoemotional indicators of internally displaced women with threatened miscarriage against the background of comprehensive treatment.Int. J. Endocrinol.16: 686-691.

Ross KM, Mander H, Rinne G, Okun M, Hobel K, Cousons-Reed M, Dunkel-Shetter K. (2023). Pregnancy-related anxiety and duration of pregnancy: the mediating role of diurnal cortisol indices. Psychoneuroendocrinology. 153: 106114.; PMid:37084672 PMCid:PMC10952551

Roumieh M, Bashour H, Kharouf M, Chaikha S. (2019). Prevalence and risk factors for postpartum depression among women seen at primary health care Centres in Damascus. BMC Pregnancy Childbirth. 19: 519.; PMid:31870326 PMCid:PMC6929307

Sanjuan PM, Fokas K, Tonigan JS, Henry MC, Christian K, Rodriguez A et al.(2021, Dec 1). Prenatal maternal posttraumatic stress disorder as a risk factor for adverse birth weight and gestational age outcomes: A systematic review and meta-analysis. J Affect Disord.295:530-540. Epub 2021 Sep 1.; PMid:34509068 PMCid:PMC10481878

Seok DB, Ju HO. (2023б Mar). Impact of the COVID-19 pandemic on depression during pregnancy: a cross-sectional study. Korean J Women Health Nurs.29(1):44-54. Korean. Epub 2023 Mar 31.; PMid:37037450 PMCid:PMC10085663

Shafran R, Rachman S, Whittal M et al.(2021). Fear and anxiety in COVID-19: Preexisting anxiety disorders. Cogn Behav Pract. 28(4):459-467.; PMid:33897249 PMCid:PMC8054545

Shaw JG, Asch SM, Katon JG, Shaw CA, Kimerling R, Frein SM et al. (2017). Posttraumatic, stress disorder and prenatal complications: a new risk factor for gestational diabetes and preeclampsia. Pediatrician Perinat Epidemiol. 31(3):185-194.; PMid:28328031

Shorey S, Chee CYI, Ng ED, Chan YH, Tam WWS, Chong YS. (2018). Prevalence and incidence of postpartum depression among healthy mothers: a systematic review and meta-analysis. J. Psychiatr. Res. 104: 235-248.; PMid:30114665

Shriyan P, Sudhir P, van Schayck OCP, Babu GR. (2023, Jul). Association of high cortisol levels in pregnancy and altered fetal growth. Results from the MAASTHI, a prospective cohort study, Bengaluru. Lancet Reg Health Southeast Asia.14:100196.; PMid:37461746 PMCid:PMC7614758

Thomas JL, Carter SE, Dunkel Schetter C, Sumner JA. (2021, May). Racial and ethnic disparities in posttraumatic psychopathology among postpartum women. J Psychiatr Res.137:36-40. Epub 2021 Feb 16.; PMid:33647727 PMCid:PMC8522483

Trost SL, Beauregard JL, Smoots AN, Ko JY, Haight SC, Moore Simas TA et al. (2021).Preventing pregnancy-related mental health deaths: findings from 14 US Maternal Mortality Review Panels, 2008-2017 Health Aff. 40(10):1551-1559.; PMid:34606354 PMCid:PMC11135281

Troyer EA, Kohn JN, Hong S.(2020). Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 87:34-39.; PMid:32298803 PMCid:PMC7152874

Tuovinen S, Lahti-Pulkkinen M, Rantalainen V, Kajantie E, Räikkönen K. (2020).Prenatal programming of child neurocognitive abilities and maternal mental health.Curr. Opin. Endocr. Metab. Res.13: 28-38.

Urato AC. (2015, Apr). Post-traumatic stress disorder and the risk of spontaneous premature birth. Obstet Gynecol. 125(4): 988-989.; PMid:25798979

Van Ngo T, Gammeltoft T, Nguyen HTT, Meyrowitsch DW, Rasch V. (2018, Nov 2). Antenatal depressive symptoms and adverse birth outcomes in Hanoi, Vietnam. PLoS One.;13(11):e0206650.; PMid:30388162 PMCid:PMC6214542

Wenz-Gross M, Weinreb L, Upshur C. (2016, Oct). Screening for Post-traumatic Stress Disorder in Prenatal Care: Prevalence and Characteristics in a Low-Income Population. Matern Child Health J.20(10):1995-2002.; PMid:27400916

Yonkers CA, Smith MW, Forray A, Epperson CN, Costello D, Lin H et al. (2014). Pregnant women with post-traumatic stress disorder and the risk of preterm birth. JAMA Psychiatrist. 71(8): 897-904.; PMid:24920287 PMCid:PMC4134929

Yu Y, Arah OA, Liew Z, Cnattingius S, Olsen J, Sørensen HT et al.(2019, Dec 4). Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up. BMJ.367:l6398.; PMid:31801789 PMCid:PMC6891797

Zhabchenko IA, Korniiets NH, Tertychna-Teliuk SV, Kovalenko TN. (2018). Osoblyvosti psykhoemotsiinoho stanu vahitnykh-pereselenok. Resp. Vinnyt. Natl. Med. un-t. 22: 99-103.; PMid:37283668