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.
Clinical Actions:
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
ACOG recommendations include the following
Antepartum Depression Risk Factors:
FACTOR | STRENGTH OF ASSOCIATION |
Maternal anxiety | Medium – Large |
Negative life events | Medium – Large |
Unintended pregnancy | Medium |
Medicaid (US) | Medium |
Poor relationship quality | Medium |
History of depression | Medium |
Domestic violence | Small – Medium |
Lack of social support | Small – Medium |
Smoking | Small |
Lower income | Small |
Lower education | Small |
Postpartum Depression Risk Factors:
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
ACOG Committee Opinion 757: Screening for Perinatal Depression
USPSTF Recommendation Statement (JAMA): Interventions to Prevent Perinatal Depression
USPSTF Perinatal Depression: Preventive Interventions (2019)
Edinburgh Postnatal Depression Scale
PHQ-9 Screening Tool (University of Michigan)
Risk factors for depressive symptoms during pregnancy: a systematic review
Risk factors in pregnancy for post-traumatic stress and depression after childbirth
USPSTF: Final Recommendation Statement: Depression in Adults – Screening
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