Perinatal Mental Health a key issue in Health Affairs’ https://www.healthaffairs.org October issue. Alan Weil Health Affairs Editor-in-Chief said, “Perinatal mental health conditions are diagnosed in one of every five pregnant or postpartum woman.”
Jennifer Moore, Founding Executive Director, Institute for Medicaid Innovation and Health Affairs and coauthors described the prevalence of perinatal mental health conditions, the implications of the conditions, associated barriers to screening and treatment, and offered recommendations for robust and integrated perinatal mental health care.
As reported the estimated $14 billion per year cost associated with untreated perinatal mental health conditions is likely an underestimation. Policy actions are needed such as extending Medicaid coverage, support for co-location of services, provide evidence-based community centered models of care, enhance telehealth policies post pandemic, enhance data, research, and support for families dealing with depression
The briefing featured a discussion with Representative Lauren Underwood (IL), the Co-Founder and Co-Chair of the Black Maternal Health Caucus and lead sponsor of the Black Maternal Health Momnibus Act of 2021. She discussed how the legislation builds on existing maternal health legislation to address the clinical and non-clinical drivers of the maternal health crisis in the U.S.
Ellen-Marie Whelan, Chief, Population Health Officer CDC, wants to see robust funding to help pregnant and new moms receive quality care, use surveillance systems to monitor trends and investigate health issues, improve health among low income mothers, extend Medicaid coverage to mothers after giving birth, and use screening to deal with depression affecting new moms.
David Goodman, Team Lead, Maternal Mortality Prevention Team, Division of Reproductive Health at CDC discussed Prevention of Pregnancy-Related Mental Health Deaths: data from 14 U.S, 2008-2017.
As he explained, the Maternal Mortality Review Committee (MMRC) reports that deaths occurring 43-365 days after the end of pregnancy are determined to be preventable. Researchers say opportunities identified by MMRC are to prevent pregnancy related mental health deaths by coordinating care, increasing screenings, assessments, and education for patients and clinicians, provide public access to treatment and services for SUDs, plus provide help for other mental health conditions.
After analyzing hospital data, Clare Brown, Assistant Professor, College of Public Health, University of Arkansas for Medical Sciences and colleagues, found people giving birth who have at least one mental health disorder are at more than 50% greater risk of severe maternal morbidity. They also incur hospitalization costs associated with delivery at 9% higher than those with no mental health disorders, 16% higher for individuals with trauma or stress related disorders, 80% higher for those with bipolar disorders, and 88% higher for those with trauma or a stress related disorder.
Shannon D. Simonovich, Assistant Professor, Department of Nursing, DePaul College of Science and Health, and co-authors updated a 2010 meta-analysis and found that pregnant people with depression are 1.46 times more likely to give birth preterm and more likely to deliver a low birthweight infant than people without depression.
From the viewpoint of a black mother, Jasmine Getrouw-Moore PhD Student, University of North Carolina at Greensboro, reinforced the idea that it is very important to address Social Determinants of Health in terms of living conditions.
Also, suggestions by Sayida Peprah, Executive Director, Diversity Uplifts, Inc. discussed the need to reimagine perinatal by focusing on system issues not just personal issues but to address discriminatory treatments affected by SDOH, address care models affecting the whole person, community, and listen to leaders in policy .
Kara Zivin, Professor of Psychiatry and Obstetrics and Gynecology, University of Michigan Medical School talked about how dealing with perinatal mental illness nearly ended her life. She reported that eleven years ago with a fear of pregnancy and new motherhood, she experienced serious depression and anxiety during pregnancy and trauma after she delivered her baby.
She feels that it is essential to support mothers and babies and make it possible for them to stay together especially in the hospital, but most importantly, expand information on mental illness not only during pregnancy but beyond to enable both the mother and baby to move forward and have a happy productive life together.