Perinatal depression can have long-term health implications for parents and children if left untreated
Maternal depression can affect a baby’s health before and after birth, and it is one of the most common – and costly – obstetric complications in the United States when left undiagnosed and untreated, according to a report released by the American Academy of Pediatrics.
In its updated policy statement, “Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice,” the AAP renews its call for physicians to screen women for depression during and after pregnancy and details the health implications for children.
The policy statement and an accompanying technical report will be published in the January 2019 issue of Pediatrics and can be accessed here. The reports update guidance offered in a 2010 clinical report by AAP.
“When we are able to help a mother deal with her mental health, we are essentially reaching the whole family,” said Marian Earls, MD, FAAP, a lead author of the report, which was developed by the AAP Committee on Psychosocial Aspects of Child and Family Health. “We hope to create a protective buffer for the baby while strengthening family relationships and wellbeing.”
An estimated 50 percent of women who are depressed during and after pregnancy are undiagnosed and untreated, according to research cited in the report. When left untreated, perinatal depression can hinder bonding and healthy attachment, distort perception of the infant’s behavior and impair the mother’s attention to and judgment concerning safety.
Perinatal depression has typically referred to a period of time when symptoms appear anytime during pregnancy or within four weeks of delivery. More recently, some professional organizations have expanded the time period to include the full 12 months following delivery. The report finds that an estimated 15 to 20 percent of new mothers are affected by perinatal depression, an umbrella term that includes forms of prenatal and postpartum depression.
Emerging research also has begun to examine the importance and influence of a father’s emotional state on a child’s early development and well-being. “Fathers also experience a high rate of postpartum depression and need to be supported, identified and referred for treatment,” said Michael Yogman, MD, FAAP, a coauthor.
AAP recommends that mothers are screened for depression once during pregnancy, and that pediatricians screen mothers during the infant’s well visits at 1, 2, 4 and 6 months of age. Pediatricians are also encouraged to work with prenatal health providers to identify systems of support for the patients and identify community resources.
“We know that postpartum depression can be a form of toxic stress that can affect an infant’s brain development and cause problems with family relationships, breastfeeding and the child’s medical treatment,” said Jason Rafferty, MD, MPH, EdM, FAAP, a coauthor. “Pediatricians are in a unique position to help identify parents in need of extra support.”
Many factors play into risk of perinatal depression, including family and personal history, substance use, marital discord, family violence, isolation, poverty, difficult infant temperament, young maternal age and chronic illness. Risk is also higher for teen mothers, mothers with multiple births and preterm births, as well as those undergoing stressful transitions, such as returning to work.
“We have made strides in the past 10 years in education and screening parents for depression,” Dr. Earls said. “But more work needs to be done, in tackling the stigma associated with mental illness and steering families to the right support.”