Weingarten, S. J., & Osborne, L. M. (2024). Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders. Focus (American Psychiatric Publishing), 22(1), 16-24. https://doi.org/10.1176/appi.focus.20230023
Weingarten SJ, Osborne LM. Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders. Focus (American Psychiatric Publishing). 2024;22(1):16-24. doi:10.1176/appi.focus.20230023
Weingarten, Sarah J., and Lauren M. Osborne. "Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders." Focus (American Psychiatric Publishing), vol. 22, no. 1, 2024, pp. 16-24.
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RRM Academy Synopsis
Perinatal mood and anxiety disorders top childbirth complications
A 2024 narrative review for general psychiatrists reports that mood and anxiety disorders affect 1 out of every 5 to 7 birthing individuals in pregnancy or the first year after birth. The authors outline how to screen for them, assess suicide risk, and choose treatment.
Key Findings
Among birthing individuals, the authors report one in every five to seven are affected by these disorders, which are present in pregnancy or up to 12 months postpartum.
In 2017–2019 Maternal Mortality Review Committee data reported by the CDC, 80% of pregnancy-related deaths were preventable. Mental health conditions, including suicide and overdose, accounted for 23% of all pregnancy-related deaths.
Screening during pregnancy and again postpartum is recommended by the USPSTF, the American Academy of Pediatrics, and ACOG, the American College of Obstetricians and Gynecologists.
Postpartum psychosis occurs in about one to two of every 1,000 births, so universal screening is not recommended; bipolar disorder is one of its strongest risk factors.
For mild to moderate depression in pregnancy and after birth, ACOG recently recommended psychotherapy as first-line treatment; the review calls SSRIs generally accepted first-line medications for perinatal mood and anxiety disorders.
Interpretation
Two Weill Cornell Medicine physicians wrote this narrative review for general psychiatrists, laying out screening tools, suicide risk assessment, and treatment choices for perinatal mood and anxiety disorders. The authors describe the obstetric risks they list, such as preeclampsia and preterm birth, as associations. The authors note that research on pregnant people who do not identify as women is scarce.
RRM Context
The review asks for a gynecologic history that includes mood changes linked to the menstrual cycle and to using or stopping hormonal contraception, a suppressive medication. Restorative reproductive medicine reads these patterns as clues to how the reproductive system is working. Cycle charting can record them alongside the cycle. The review also says these disorders can affect the patient, the fetus, and the entire family unit.
Our editorial summary of this paper, not the article's abstract.
Abstract
Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth. When poorly controlled, they are associated with worse obstetric outcomes, such as higher rates of preterm birth and unplanned cesarean delivery. They are also associated with suicide, a leading cause of perinatal maternal death. This article provides an overview of evidence-based recommendations for screening, assessment, and management of PMADs, including suicide risk assessment and management and pharmacological and nonpharmacological treatment options compatible with pregnancy and lactation. Although specialized reproductive psychiatrists can provide expert guidance for the management of PMADs, their scarcity means that most patients will not have access to this expert care and instead will seek guidance from general psychiatrists. This article provides a clinical guide for generalists that is based on the best current evidence, including recently released treatment guidelines.
