by Brenda Stubbs, Triad Regional Coordinator & Jennifer Vickery, Western Regional Coordinator
Smoking status, alcohol and drug use, folic acid intake, chronic health conditions like diabetes, hypertension, asthma, STIs…these are all things that are routinely screened for and monitored in the preconception or early prenatal period because they can lead to poor birth outcomes. However, screening for mental health status is often glossed over or skipped altogether. Why is that such a big concern? Poor maternal mental health – namely perinatal mood and anxiety disorders (PMADs) – are the #1 complication of pregnancy and childbirth AND a leading cause of premature birth. They affect about 15% of women (and some medical experts say 20%) – nearly 1 million women nationwide each year. Yet only about 15% of women are screened for mental health status. Compare that to gestational diabetes, another leading complication of pregnancy, which affects only 3-5% of women but is universally screened for during prenatal visits. More women will develop a PMAD than all of the other pregnancy complications combined, but unfortunately these disorders are highly misunderstood and under-diagnosed.
It’s important to note that while many women who develop a PMAD have never experienced any mental health issues prior to pregnancy, more than half – about 54% — had a pre-existing mental health disorder in their preconception years. These can include depression, anxiety, OCD and bipolar disorder, and they can put the women who have these pre-existing conditions at much greater risk of developing a PMAD during pregnancy and in the postpartum period. In addition, a woman who experienced a PMAD or postpartum depression with a previous pregnancy is also at a higher risk. So, if we could identify and treat mental health issues in the preconception (and interconception) period, it would be a big step toward reducing the risk/incidence of PMAD. All preconception health visits with women of childbearing age should include an assessment of their mental health status, and once pregnant, a woman should be screened for PMADs as a routine part of prenatal care.
As health professionals, we need to help women understand that PMADs are very treatable and there IS a light at the end of the tunnel. “Becoming a mother is…one of the most significant physical and psychological changes a woman will ever experience,” (Dr. Daniel Stern, The Birth of a Mother) but by normalizing and validating the many feelings a new mother may have – guilt, shame, disappointment, extreme worry or fear – we can help reduce the stigma associated with PMAD/postpartum depression. Consider the fact that 400,000 babies are born each year to mothers who are already experiencing depression, and this number does not include the babies born to mothers who will become depressed or develop a PMAD in the postpartum period. And since we know that poor maternal mental health can lead to poor maternal physical health, premature birth, and poor mother-baby attachment (which can cause problems/delays with the child’s emotional, social and cognitive development), the benefit of identifying and addressing maternal mental health issues becomes quite clear.
There is much more to discuss about this important topic. Part two of “The Intersection of Physical and Mental Health and Its Impact on Birth Outcomes” will be posted Oct. 12. Receive an alert from us by joining our mailing list!
Affect Disord. 2017 Aug 1;217:34-41. doi: 10.1016/j.jad.2017.03.049. Epub 2017 Mar 30. Preconception gynecological risk factors of postpartum depression among Japanese women: The Japanese Environment and Children’s Study (JECS)
Silverman, M.E. (2017) The risk factors for postpartum depression: A population based study. Depression and Anxiety, 34, 178-187. DOI: 10.1002/da.22597