Depression and Pregnancy

Definition

Antenatal depression: major or minor depressive episode that occurs during pregnancy

Postpartum depression: major or minor depressive episode that occurs during the 12 months following the birth of a child¹

• Of note, postpartum psychosis is a distinct condition characterized by hallucinations, delusions, and/or disorganized thoughts that usually begin within 2 weeks of childbirth
• Differentiate postpartum depression from “baby blues”: short crying spells, irritability, poor sleep, nervousness, and emotional reactivity that resolve within 10 days and are not considered a depressive disorder¹

Prevalence

Antenatal depression:

• Approximately 14.5% of women develop major or minor depression at some point during pregnancy (between conception and birth)²
• Associated with a high risk of postpartum depression³

Postpartum depression:

• Approximately 14.5% of women develop major or minor depression during the first 3 months following birth²
• 14% of Maryland mothers reported symptoms of postpartum depression, and 8% reported receiving a diagnosis of postpartum depression ^4,5
• Postpartum depression affected mothers of all races, ethnicities, and ages
• The biggest risk factor for postpartum depression is a personal history of depression (including previous postpartum depression, antenatal depression, or major depressive disorder)

“Baby blues” affect 40-80% of women⁶

Health Impact

Perinatal depression is associated with:

•  decreased prenatal care visits⁷
• alcohol, tobacco, and drug use during pregnancy⁷
• intimate partner violence^8,9
• decreased rate of initiation of breastfeeding¹⁰
•  increased risk of poor mother-infant bonding, infant growth and developmental delays, and anxiety and depressive symptoms later in the infant’s life¹
•  increased risk of suicide¹¹

Perinatal depression may also be associated with adverse pregnancy outcomes such as low birth weight and preterm delivery, but the exact relationship is still controversial¹⁰

Screening

• The Edinburgh Postnatal Depression Scale (EPDS) may be used to screen women during pregnancy or in the postpartum period, and women should ideally be screened by 6 weeks postpartum: http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf
• The general screening tools for depression may also be used

What if screen is positive?

• Many women with mild or moderate depression may be managed with non-pharmacologic options such as lifestyle modifications, counseling, and support groups
• Resource phone number for women with perinatal depression: 1-800-PPD-MOMS (24-hour helpline)
• The Maternal and Child Health Bureau created a brochure: About Postpartum Depression (Also available in 6 languages – Chinese, French, Korean, Russian, Spanish, Vietnamese.)  The brochures can be ordered by completing the MCH Publications Order Form.
• Psychotherapy in an individual or group setting is effective for mild to moderate postpartum depression¹
• Medication combined with psychotherapy is effective for moderate to severe postpartum depression¹
•  Electroconvulsive therapy (ECT) is another treatment option
• The risks and benefits of antidepressant use vs. untreated depression must be weighed individually for each patient, since untreated maternal depression can have a negative effect on the fetus or newborn¹²

1. Hirst KP, Moutier CY. Postpartum major depression. Am Fam Physician. 2010 Oct 15; 82(8):926-33.
2. Gaynes BN, Gavin N, Meltzer-Brody S, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ). 2005 Feb; (119):1-8.
3. Larsson C, SydsjöG, Josefsson A. Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms. Obstet Gynecol. 2004; 104(3):459.
4. Maryland Department of Health and Mental Hygiene. Maryland PRAMS Report 2004-2008 Births. Available at http://phpa.dhmh.maryland.gov/mch/Documents/PRAMS_2004_2008_Report.pdf. Accessed on November 24, 2014.
5. Maryland Department of Health and Mental Hygiene. Maryland PRAMS Report 2009-2011 Births. Available at http://phpa.dhmh.maryland.gov/mch/Documents/PRAMS_Phase_6_Report_Web_040213.pdf. Accessed on November 24, 2014.
6. Roy-Byrne PP. Postpartum blues and unipolar depression: Epidemiology, clinical features, assessment, and diagnosis. In: UpToDate, Solomon D (Ed), UpToDate, Waltham, MA. (Accessed on December 4, 2014.)
7. Bonari L, Pinto N, Ahn E, et al. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004; 49(11):726.
8. Martin SL, Li Y, Casanueva C, et al. Intimate partner violence and women's depression before and during pregnancy. Violence Against Women. 2006 Mar; 12(3):221-39.
9. Ludermir AB, Lewis G, Valongueiro SA, de Araújo TV, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet. 2010 Sep 11; 376(9744):903-10.
10. Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013; 74(4):e321.
11. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health. 2005; 8(2):77.
12. Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006 Feb 1; 295(5):499-507.

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12/2014