The importance of screenings for pregnant women and new mothers.

May 7, 2024 | Dr. Joel L. Young

Between 11%-20% of women develop postpartum depression after giving birth, and 20% suffer from mental health disorders during their pregnancy. Moreover, as many as 80% of women also experience a low-grade and short-lived form of depression shortly after childbirth. This makes mental health issues the most common complication associated with pregnancy, far outpacing better known issues like gestational diabetes, postpartum hemorrhage, premature birth, and pre-eclampsia. So why aren’t all pregnant women given a mandated mental health screening?

Many doctors do not check for these very common issues. And the toll this decision exacts is hard to quantify. Mental health issues can impede a woman's ability to bond with and care for her baby, to assert her needs to her medical provider, and to safely return to work.

Postpartum mental health issues can lead to a more severe condition called postpartum psychosis. Postpartum psychosis was allegedly behind Andrea Yates's famed killing of her children. Yates horrified the nation when she confessed to the drowning of her five young children in the bathtub of their home in 2001.

Yates, who was 37 years old at the time of the drowning, suffered from severe postpartum depression, postpartum psychosis, and schizophrenia. Women suffering from postpartum psychosis may not know right from wrong or truth from fiction, and may mistakenly harm their children in an attempt to protect them or themselves.

Now, the United States Preventative Services Task Force, an association that helps set health care policy, has ruled that a prenatal mental health screening tool should be used on all pregnant women. The ruling could ensure that the screening is covered by insurance providers. If you are pregnant, the partner of a pregnant woman, or are considering becoming pregnant, here's what you need to know about pre and postnatal mental health:

Why do some pregnant women experience mental health issues?

It's easy to write off pregnant women's mental health concerns as hormonal in nature, but the picture is rarely so simple. Most women who develop mental health symptoms during pregnancy have a previous history of mental illness, suggesting that a complex cocktail of hormones, anxiety about becoming a parent, and life circumstances combine to contribute to mental health issues.

A number of factors increase a woman's vulnerability to prenatal and postpartum mental health issues, and awareness of these risk factors can help medical providers intervene early and productively advocate for their patients. Research consistently shows that women may experience mental health issues when:

-The pregnancy is unplanned.

-They are in financial distress.

-Their partner is uninvolved, unhelpful, or abusive.

-They do not have adequate social support.

-They are concerned about childcare.

-They suffer health issues during the pregnancy.

-They suffer a traumatic childbirth, such as an unwanted cesarean section, or there are serious complications, such as a baby born prematurely.

-They stop using psychiatric medications during pregnancy.

Prenatal mental health treatment options

Research is conflicted on the safety of some mental health treatments during pregnancy. One recent study linked antidepressant use during pregnancy to a slight increase in the risk of autism; a second found no such increase. We do know that, left untreated, some mental health disorders can lead to women making poor choices that compromise not only their own health but that of their baby's. These choices include drinking or using recreational drugs.

Thus every doctor must weigh the relative costs and benefits of treatment. They must be aware of the signs and symptoms of mental illness among their patients. In a severely depressed woman, the benefits of antidepressants will often outweigh the risks. In addition to medication, care and counseling, other treatments include:

-Finding more prenatal support.

-Enrolling in a support group for pregnant women or women with mental health disorders.

-Therapy, particularly therapy targeted to the specific challenges pregnant women face.

-Exercise, which is almost always safe during pregnancy.

Postnatal mental health treatment options

After giving birth, women who want to breastfeed may be concerned about the effects of psychiatric medication on their new baby. In consultation with a certified lactation consultant, a psychiatrist, and a primary care provider, women can weigh the merits of each treatment option. Telling women not to breastfeed is not a viable option, since breastfeeding offers a plethora of benefits to both mother and baby. Moreover, constraining a woman's choices can disempower her, increasing her risk of psychological distress.

In addition to medication, ongoing postnatal support, therapy, and medical care are vital to the recovery from and prevention of postpartum difficulties. Women at a high risk of mental health issues should get regular screenings, and doctors should treat mental health issues as health concerns, not personal failings. Women who are shamed for mental health disorders, or who worry that their babies will be taken from them, are less likely to report their symptoms to their doctors, further causing more potential harm to Mom and Baby.

References:

1. Antidepressants and autism. (n.d.). Retrieved from https://www.sciencebasedmedicine.org/antidepressants-and-autism/
2. Belluck, P. (2016, January 26). Panel calls for depression screenings during and after pregnancy. Retrieved from http://www.nytimes.com/2016/01/27/health/post-partum-depression-test-epd...
3. Postpartum psychiatric disorders. (n.d.). Retrieved from https://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-...
4. Psychiatric disorders during pregnancy. (n.d.). Retrieved from https://womensmentalhealth.org/specialty-clinics/psychiatric-disorders-d…
5. Helling, Steve.  “Andrea Yates, Who Drowned Her 5 Kids in a Tub in 2001, Annually Declines Release from Mental Hospital.” PEOPLE.com, Meredith Corporation, 5 Apr. 2022, Retrieved from https://people.com/crime/andrea-yates-who-drowned-kids-in-bathtub-in-2001-annually-declines-release-from-mental-hospital/.