New Recommendations for Maternal Depression
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Each year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression -- depression that occurs during pregnancy or in the first year after birth -- the most under-diagnosed obstetric complication in the United States, according to a report released today by the American Academy of Pediatrics (AAP).
Postpartum depression in mothers negatively affects parenting skills and can also alter judgment when it comes to child safety and health issues. It also puts an infant at risk for failure to thrive, attachment disorder and development delays in many areas, including language acquisition, according to the report.
Maternal depression in infancy can also cause a child's increased production of the hormone cortisol at preschool age, which has been linked to anxiety, social wariness and withdrawal. Behavior problems, depression and other mood disorders in childhood and adolescence can also occur more frequently in children of mothers with major depression, the study reports. And, the longer the mother's depression goes untreated, the less responsive her child will be to intervention targeted to preventing developmental problems.
"Addressing maternal depression in a timely and proactive fashion is essential to ensure healthy early brain and child development and readiness to succeed," write the authors.
An estimated 5 to 25 percent of pregnant and postpartum women have from depression, though studies show as many as 40 to 60 percent of low-income mothers and pregnant and parenting teenagers are afflicted, the study reports. And the risk of perinatal depression is increased when there is a family history of depression, alcohol abuse or a personal history of depression.
There are different forms of maternal depression, ranging from "maternity blues" to postpartum depression to postpartum psychosis, the authors note.
Maternity blues is said to affect 50 to 80 percent of new mothers and occurs in the first few days after delivery, with symptoms that include crying, worrying, sadness, anxiety and mood swings. These symptoms usually stop within two weeks after delivery and do not impair function. This type of depression can be treated effectively with reassurance and emotional support, the researchers report.
In contrast, postpartum depression occurs in 13 to 20 percent of women after birth, and produces symptoms that meet the diagnostic criteria for depression -- which is not the case with the maternity blues.
Postpartum psychosis is a serious condition that affects about 1 to 3 mothers out of 1,000 and most often occurs in the first four weeks after delivery. These mothers are severely impaired and may experience paranoia, mood shifts, hallucinations, delusions and suicidal and homicidal thoughts -- which necessitate immediate medical attention and usually hospitalization.
In addressing the problem of maternal depression, the AAP has recognized that the child's primary care provider (PCP) has a unique opportunity to identify the condition and work with families to improve mental health outcomes. The PCP is likely the first medical professional to see the baby and mother after birth, and therefore has very early access and regular, continued access through child care and follow-up visits. The child's PCP can screen for the mother's depression and help her access resources -- family support, therapy or emergency services.
In addition, the AAP recommends that obstetricians advise patients to visit the pediatric practice during the prenatal period, so a relationship with parents can be established early and the pediatrician can be better prepared to address any depression symptoms that may occur after delivery.