Question

Discuss the benefits of prenatal screening tools for postpartum depression.  What should be done after delivery to monitor for PP depression and anxiety?

Answer 1

Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women. It is important to identify pregnant and postpartum women with depression because untreated perinatal depression and other mood disorders can have devastating effects. Several screening instruments have been validated for use during pregnancy and the postpartum period. The American College of Obstetricians and Gynecologists recommends that obstetrician–gynecologists and other obstetric care providers screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. It is recommended that all obstetrician–gynecologists and other obstetric care providers complete a full assessment of mood and emotional well-being (including screening for postpartum depression and anxiety with a validated instrument) during the comprehensive postpartum visit for each patient. If a patient is screened for depression and anxiety during pregnancy, additional screening should then occur during the comprehensive postpartum visit. There is evidence that screening alone can have clinical benefits, although initiation of treatment or referral to mental health care providers offers maximum benefit. Therefore, clinical staff in obstetrics and gynecology practices should be prepared to initiate medical therapy, refer patients to appropriate behavioral health resources when indicated, or both.

​​​​Prenatal diagnosis has also helped reduce the mother’s risk of hemorrhage or stroke during childbirth by detecting conditions like placenta previa and preeclampsia.

• Placenta previa is a condition in which the placenta is too close to the cervix to allow for a safe vaginal delivery. Women with placenta previa are at a heightened risk of hemorrhaging, particularly during childbirth.
• Preeclampsia is a unique pregnancy disorder in which the expectant mother has continuous high blood pressure. This disorder can lead to stroke, kidney and liver damage, fluid in the lungs and seizures.

Prenatal blood tests are a sophisticated, highly sensitive and noninvasive method that can pick up very unexpected issues. If a woman’s fetus tests positive for genetic conditions, but her baby is born healthy, the test could reveal an underlying issue with the mother. Doctors are noticing that imbalances in the genetic material of the expectant mother may be associated with a tumor. Researchers and doctors were unaware that tumors could be a source of the false positive DNA results until 2013, however, it’s an extremely rare finding and will not be used as a cancer screen. While broad benefits of this finding have yet to be discovered, doctors continue to look for patterns that might suggest which expectant mothers are at risk for cancer.

• This testing can help to ease anxiety. It is more relaxing when you are informed about the health of your baby in advance. ...
• It allows you to arrange for procedures during and after birth for your baby. If your baby has a condition, you can be able to make plans to fix the problem or post-birth.

The prevalence of perinatal depression is a significant cost to individuals, children, families, and the community. In 2011, 9% of pregnant women and 10% of postpartum women met the criteria for major depressive disorders

1)It is important to identify pregnant and postpartum women with depression because untreated perinatal depression and other mood disorders can have devastating effects. Regular contact with the health care delivery system during the perinatal period should provide an ideal circumstance for women with depression to be identified and treated. The College recommends that obstetrician–gynecologists and other obstetric care providers screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. It is recommended that all obstetrician–gynecologists and other obstetric care providers complete a full assessment of mood and emotional well-being (including screening for postpartum depression and anxiety with a validated instrument) during the comprehensive postpartum visit for each patient

2) If a patient is screened for depression and anxiety during pregnancy, additional screening should then occur during the comprehensive postpartum visit. When indicated, obstetrician–gynecologists and other obstetric care providers share a role in initiating medical therapy or referring patients to appropriate behavioral health resources, or both.

Depression, the most common mood disorder in the general population, is approximately twice as common in women as in men, with its initial onset peaking during the reproductive-age years

3) Therefore, it is not surprising that perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women

4) Perinatal depression and other mood disorders, such as bipolar disorder and anxiety disorders

5) Can have devastating effects on women, infants, and families; maternal suicide exceeds hemorrhage and hypertensive disorders as a cause of maternal mortality

6) Perinatal depression often goes unrecognized because changes in sleep, appetite, and libido may be attributed to normal pregnancy and postpartum changes. In addition to health care providers not recognizing such symptoms, women may be reluctant to report changes in their mood. In one small study, less than 20% of women in whom postpartum depression was diagnosed had reported their symptoms to a health care provider

7) Therefore, it is important for obstetrician–gynecologists and other obstetric care providers to ask the pregnant or postpartum patient about her mood. Newborn care appointments also may be an opportunity to ask a mother about her mood. Obstetric providers should collaborate with their pediatric colleagues to facilitate treatment for women with mood disorders identified during newborn care

8) Anxiety is a prominent feature of perinatal mood disorders, as is insomnia. It may be helpful to ask a woman whether she is having intrusive or frightening thoughts or is unable to sleep even when her infant is sleeping. Women with current depression or anxiety, a history of perinatal mood disorders, risk factors for perinatal mood disorders , or suicidal thoughts warrant particularly close monitoring, evaluation, and assessment. These women may benefit from evidence-based psychologic and psychosocial interventions and, in some cases, pharmacologic therapy to reduce the incidence and burden of perinatal depression

9)If there is concern that the patient suffers from mania or bipolar disorder, she should be referred to a psychiatrist before initiating medical therapy because antidepressant monotherapy may trigger mania or psychosis

10) Mania symptoms include inflated self-esteem or grandiosity, feeling rested after only 3 hours of sleep, or engaging in risky behaviors that worry her friends and family

After delivery

• Rest as much as can. Sleep when the baby is sleeping.
• Don’t try to do too much or to do everything by yourself. Ask the partner, family, and friends for help.
• Make time to go out, visit friends, or spend time alone with the partner.
• Talk about the feelings with the partner, supportive family members, and friends.
• Talk with other mothers so that it can learn from their experiences.
• Join a support group. Ask the doctor or nurse about groups in your area.
• Don’t make any major life changes right after giving birth. More major life changes in addition to a new baby can cause unneeded stress. Sometimes big changes can’t be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

It can also help to have a partner, a friend, or another caregiver who can help take care of the baby while you are depressed. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Tell a loved one and call your doctor right away.