Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Define perinatal depression 2. Discuss the risk factors associated with preinatal depression
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Perinatal depression is defined as major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery. It is very common, affecting approximately 9% of women in pregnancy and 10% during the postpartum period.
USPSTF (2019) recommends that
…clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions (Grade B Guidance)
Moderate net benefit
Note: Definition of Grade B Guidance
The USPSTF recommends the service | There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
Suggestions for Practice: Offer or provide this service
Recommendation based on ‘convincing evidence’
Counseling interventions (e.g., cognitive behavioral therapy and interpersonal therapy) are effective in the prevention of perinatal depression
ACOG recommendations include the following
ObGyns and other obstetric care providers should screen patients “at least once during the perinatal period for depression and anxiety symptoms”
ObGyns and other OB providers should “complete a full assessment of mood and emotional well-being” during the comprehensive postpartum visit for every patient
Use a validated screening tool to identify the presence of depression or anxiety
Screening alone has potential for clinical benefit
In the context of a positive screening test, follow up with appropriate medical interventions and referrals provides maximal benefit
The USPSTF recommends routine depression screening in the general adult population, including pregnant and postpartum women (Grade B – The USPSTF recommends the service; there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial)
Gauge depression by paying attention to flat affect, noting unusual anxiety or tearfulness in addition to using a screening instrument
Antepartum Depression Risk Factors:
STRENGTH OF ASSOCIATION
Medium – Large
Negative life events
Medium – Large
Poor relationship quality
History of depression
Small – Medium
Lack of social support
Small – Medium
Postpartum Depression Risk Factors:
Depression during pregnancy
Anxiety during pregnancy
Experiencing stressful life events during pregnancy or the early postpartum period
Traumatic birth experience
Preterm birth/infant admission to neonatal intensive care
Low levels of social support
Previous history of depression
Left untreated, the results of depression can be devastating for both the child and the mother. Proactive screening is necessary because often depression can go unnoticed. Changes in libido, mood and sleep may incorrectly be attributed to the pregnancy or the birth of the child rather than underlying depression
Anxiety and insomnia can be significant indicators of depression
Women with a history or with common risk factors for depression are more likely to be affected by perinatal depression and extra caution is warranted
Management including evaluation and close follow up are required for women with
Current depression or anxiety
History of perinatal mood disorders
Risk factors for perinatal mood disorders
The Edinburgh post-natal depression scale (EPDS) and the PHQ-9 screening tool (see ‘Learn More – Primary Sources’ below)
Are validated for use in the primary care setting
Take a relatively short time to complete
EPDS: Sensitivity 59-100% | Specificity 49-100%
PHQ-9: Sensitivity 75% | Specificity 90%
Other screening tools, unlike the EPDS, include constitutional symptoms
Constitutional symptoms such as altered sleep patterns are associated with pregnancy/postpartum period in general, and therefore can reduce screening specificity
Systems should be in place to ensure follow up, diagnosis and treatment
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
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