Pregnancy stock photo

New recommendations call for clinicians to do more to prevent depression among pregnant women and new mothers. Identifying at-risk patients and referring them to counseling could prevent a cascade of health issues down the line. Photo courtesy of MorgueFile

MANKATO — Newly released recommendations call for clinicians to earlier identify depression risks in pregnant women and new mothers.

The U.S. Preventive Services Task Force released the new guidelines Tuesday. The panel’s evidence-based mandates guide clinical practices across the country.

The change is aimed at preventing depression among pregnant women and new mothers by connecting them to counseling sooner.

Dr. Graham King, family medicine physician at Mayo Clinic Health System in Mankato, said he’s hopeful the new recommendations will result in healthier outcomes for at-risk women.

“I think we’re going to catch things earlier,” he said. “It’s like any other disease; the earlier it’s caught, the easier to treat and better outcomes.”

The task force previously called for screenings and then counseling after individuals are identified as having depression symptoms. The latest guidelines specifically focus on perinatal depression, meaning depression before, during or after pregnancy. The goal would be to identify depressive symptoms sooner to prevent the women from developing depression in the first place.

About 1 in 7 women experience perinatal depression, according to research included in the task force's recommendation. The disorder can lead to a host of negative health effects for both the mother and infant, including increased risk for a preterm birth and low birth weights.

“My hope is this would become standard practice because not only does it affect the woman who’s pregnant, it affects the unborn child,” said Heidi Rimstad, behavioral health provider at Open Door Health Center, in reaction to the guidelines.

The task force based its recommendation on 50 studies involving pregnant and postpartum women who received preventive interventions. The combined studies indicated a 39 percent reduction in perinatal depression likelihood when the women received counseling interventions.

Risk factors would typically be identified in primary care by a physician or registered nurse. King said this would typically come in the first eight to 12 weeks of a pregnancy.

A patient's previous history with depression or their ongoing use of medication to treat it would be among the more clearly identifiable indicators prompting counseling. It's more tricky when those factors aren't present, but clinicians would look for signs during checkups and conversations with patients.

“So many things are happening in a woman's body when she’s pregnant," King said. "Sometimes there’s no way to tell other than having those conversations during those prenatal visits."

Socioeconomic factors also influence which women are more at risk for perinatal depression. The task force's recommendation statement released in the JAMA medical journal found women entering low-income, young or single parenthood could be at greater risk for maternal depression.

Effective counseling interventions include cognitive behavioral or interpersonal therapy. The former uses techniques like goal-setting to address and manage negative thoughts, while the latter focuses on treating the interpersonal issues likely contributing to the disorder. Both King and Rimstad named local support groups for mothers as a possible aspect of treatment.

Rimstad added the guidelines ideally will shift counseling's role in treatment to where it should've been all along, as a preventive option rather than a reactive care strategy. For women struggling during what's so often portrayed as a cheerful period in their lives, the change could help serve them better.

“Pregnancy in mainstream life is this joyous celebratory occasion, and if the woman is not feeling like their response is what it's supposed to be, it can be really shaming,” she said.

Follow Brian Arola @BrianArolaMFP.

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