Perinatal / Postpartum Research
Evidence suggests the prevalence of perinatal mental illness has increased in recent years.
- More children were exposed to maternal mental illness, from 22% in 2005-07 to 25% in 2015-17.
- This could be due to increased awareness and/or detection of PMH problems and thus better care, including among different populations.
- However, it also probably reflects a real increase, as population surveys show similar findings of an increase of common mental disorders in young women.
A self-report of depression in pregnancy was 51% more common among young mothers today than among their mothers 25 years ago.
- Young pregnant women report they are living in circumstances different from their mothers, including a faster pace of life, technology and social media use, isolation and insecure employment.
- Another study estimates more pregnant women under age 25 (45%) experience depression and anxiety, compared with women ages 25 years or more (15.5%).
Other studies conclude the following:
- Self‐reported anxiety symptoms are very common and increase across the trimesters of pregnancy.
- 10‐20% of pregnant women with prior depression seem to experience a depressive relapse.
- For each woman requiring psychiatric admission following birth, 2.5 require outpatient treatment and 12 receive medication in primary care.
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- Therefore, “common mental disorders”—mild to moderate depression and anxiety—represent a significant component of treatment needed in the postnatal period.
- There is an increased rate of disorders requiring outpatient, postnatal care and/or medication, particularly for depression and OCD.
- Prevalence of admission is higher in low‐ to middle‐income countries than in high‐income countries.
Evidence for postpartum triggering is less clear.
- It may be due to under‐detection and/or under‐treatment of these disorders during pregnancy.
- Possibly it is also due to women being less likely to receive treatment during pregnancy than postnatally.
- For more severe mental illness, the early postnatal period carries a high risk for new and recurrent episodes, with 1-2 women in 1,000 requiring hospitalization in the first months after birth.
- Women were 22 times more likely to have a psychiatric admission in the month following birth than in the pre‐pregnancy period.
- While true for women with and without prior psychiatric illness, the risk was greater for those women with a pre‐existing, severe mood disorder.
- Recent data from the UK found suicide to be the leading non-obstetric cause of maternal death.
- 20% of women with pre‐existing bipolar disorder experience prominent manic episodes in the postnatal period.
- In contrast, during pregnancy, 1 in 5 women experience a relapse with a predominance of depressive and mixed episodes.
- Perinatal eating disorders are relatively rare. There is a history of an eating disorder in 15% of pregnant women, who may need support with re‐emerging symptoms precipitated by pregnancy or postpartum.
- Alcohol is a major factor in causing problems in pregnancy, including malformation of the embryo.
- A recent study estimated 1 in 10 women use alcohol in pregnancy, with 1 in 67 having a child with fetal alcohol syndrome.
- A recent UK study showed more substance misuse and poor maternity and mental healthcare among women who died in the perinatal period.
Fathers’ mental health has recently gained greater attention.
- Evidence suggests an unmet treatment need for paternal depression and anxiety.
- Growing evidence shows the adverse effects of untreated paternal mental illness on mothers’ mental health and on adverse child emotional and behavioral outcomes.
- This can also include child maltreatment, particularly when children are exposed to a combination of parental mental illness, parental substance misuse and conflict between the parents.
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