BIGG

Perinatal mental health conditions: a national clinical guideline

Ano de publicação: 2023

It is well recognised that perinatal mood disorders are common conditions affecting pregnancy and the postnatal period, and are associated with significant maternal, fetal and infant morbidity and mortality.1 Inequality in maternal morbidity and mortality is recognised across a number of socioeconomic indicators, with Black women and those from minority ethnic groups being at significantly greater risk of maternal death.2 Maternal suicide remains the leading cause of maternal death, with an increase in suicide amongst teenage mothers in the United Kingdom (UK).2 Women/birthing parents, their partners, fathers and families in Scotland are emerging from a unique time in history, namely the global COVID-19 pandemic, the recovery from which has coincided with marked rising costs of living and increasing socioeconomic pressures. Risk factors for mental illness, such as domestic violence, caring responsibilities and financial vulnerability, increased during the pandemic. At the height of the pandemic, women and birthing parents were restricted in the support they received during labour and in the early postnatal period. The early parenting experience was significantly affected by restrictions on social contact and guidance, such as mask wearing, and loss of other natural peer support networks.3-6 The longer-term impact of these changing circumstances on the experience of mothers, parents, infants and families remains to be fully understood, particularly with the effect of birth trauma in future pregnancies, and infant emotional, social and cognitive development. There is increasing recognition of the needs of infants, the parent-infant relationship and fathers, partners and other caregivers, including the value of family-focused approaches. Early and timely intervention to ensure these conditions are assessed and treated appropriately is important to improve outcomes and support recovery. The majority of women/birthing parents their infants and families will have their needs met by universal services including maternity, health visiting, primary care and voluntary sector services. A smaller proportion of women/birthing parents, infants and families with more complex needs will require additional input from specialist services, such as community perinatal mental health services, maternity and neonatal psychological interventions or infant mental health services in Scotland. Perinatal mental illnesses range from adjustment disorders to postpartum psychosis. Prevalence rates may be underestimated, as not all those who experience them present to secondary care. A study in South London estimated prevalence of those presenting with depression, anxiety disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders or self harm of 45.1% in pregnant women under the age of 25 and 15.5% in pregnant women aged 25 or over.7-9 Prevalence of perinatal mental illness is rising in the UK, particularly amongst younger cohorts of women, with higher numbers of children living with maternal mental illness.10 Rates are higher amongst parents of children experiencing greater socioeconomic disadvantage, with the highest incidence reported amongst mothers of infants 0–3 months.10 This suggests that demand for perinatal mental health services is likely to continue to rise over time in Scotland.