Postpartum Depression: On the Verge of a Global Crisis

Postpartum Depression: On the Verge of a Global Crisis

December 12, 2024

A transformative approach to postpartum care is essential for combating maternal mortality.

rates increasing

Increasing Maternal Mortality Rate

Postpartum depression (PPD) is a serious mental health condition that requires prompt attention and treatment to support the well-being of both mothers and their newborns. According to the American College of Obstetrics and Gynecology (ACOG), at least 40% of women do not seek postpartum care. Meanwhile, PPD affects 3 out of 20 new mothers.1 When left untreated, maternal depression can lead to immediate and significant consequences. Often, women experiencing PPD  feel isolated, not only due to guilt or helplessness but also because of the diminished ability to feel gratification in the mothering role.2

The US Centers for Disease Control and Prevention (CDC) found that between 2000 and 2017, the maternal mortality rate increased by more than 25% in the US.3 This is seen as the highest rate among developed countries, with mental health conditions as the leading cause.4 In 2021, the maternal mortality rate was 32.9 deaths per 100 000 live births. This, additionally, represents a significant increase from 23.8 in 2020 and 20.1 in 2019.5

Early Detection in Pregnancy

The CDC conducted a study in May of 2024 where maternal mortality review committees (MMRCs) reviewed deaths during or within 1 year of the end of pregnancy. They used clinical and non-clinical information to understand the circumstances around each death, determine if it was pregnancy-related, and recommend actions to prevent future deaths. Mental health conditions were the number one cause of pregnancy-related deaths in the US. Of those deaths, 80% were determined to be preventable. Among the 1018 deaths studied, 971 were by suicide.6    

Due to the unique stressors experienced during the postpartum period, identifying and addressing depression in this period can be extremely difficult.7 Approaching postpartum care more comprehensively rather than in single, isolated visits allows healthcare providers to address urgent maternal needs and provide adequate support across the postpartum phase.8 Currently, the ACOG recommends a postpartum evaluation within the first 3 weeks of delivery and ongoing support across the next 12 weeks, as opposed to a single 6-week postpartum visit.7 Importantly, ongoing care should be provided and tailored to each woman's individual needs following her initial assessment, and a comprehensive postpartum visit should occur no later than 12 weeks after birth.1,9

Prioritizing mental health during pregnancy allows for early intervention and ongoing support as needed and is essential to improve maternal survival.2 Prompt treatment of PPD can lead to faster symptom recovery, earlier return to daily activities, and reduced risk of chronic depression for new mothers.10

Summary

Globally, PPD is a critical issue, and as we see by the alarming rise in maternal mortality rates in the US, PPD can have detrimental effects on mothers.3,5 Prioritizing mental health during pregnancy is crucial, as mental health conditions are reported as the number one cause of maternal and pregnancy-related death.6 Early intervention with a provider can create an opportunity to uncover warning signs and prevent serious and preventable medical problems. By redefining postpartum care as an ongoing process, ACOG aims to optimize the health of women and infants, providing services and support tailored to each woman's needs throughout the critical weeks following birth.

References:

  1. ACOG Committee Opinion No. 736: Optimizing Postpartum Care. Obstet Gynecol. 2018;131(5):e140-e150. doi:10.1097/AOG.0000000000002633
  2. Fitelson E, Kim S, Baker AS, Leight K. Treatment of postpartum depression: clinical, psychological and pharmacological options. Int J Womens Health. 2010;3:1-14. doi:10.2147/IJWH.S6938
  3. Hoyert D. Maternal mortality rates in the United States, 2020. National Center for Health Statistics. December 2022. Accessed November 18, 2024. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm
  4. Joseph KS, Sarka Lisonkova, Boutin A, et al. Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance? Am J Obstet Gynecol. 2024;230(4). doi:10.1016/j.ajog.2023.12.038
  5. Hoyert D. Maternal mortality rates in the United States, 2021. Centers for Disease Control and Prevention. March 16, 2023. Accessed November 18, 2024. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm
  6. Pregnancy-related deaths: data from maternal mortality review committees in 36 U.S. States, 2017–2019. Center for Disease Control and Prevention. May 30, 2024. Accessed November 18, 2024. https://www.cdc.gov/maternal-mortality/php/data-research/mmrc-2017-2019.html
  7. Leight K, Fitelson E, Kim S, Baker A. Treatment of post-partum depression: a review of clinical, psychological and pharmacological options. Int J Womens Health. 2010;3(3):1-14. doi: 0.2147/ijwh.s6938
  8. Almond P. Postnatal depression: a global public health perspective. Perspect Public Health. 2009;129(5):221-227. doi:10.1177/1757913909343882
  9. ACOG redesigns postpartum care. The American College of Obstetricians and Gynecologists. April 23, 2018. https://www.acog.org/news/news-releases/2018/04/acog-redesigns-postpartum-care
  10. Fitzgerald L, McNab S, Njau P, et al. Beyond survival: prioritizing the unmet mental health needs of pregnant and postpartum women and their caregivers. PLOS Glob Public Health. 2024;4(2):e0002782. doi:10.1371/journal.pgph.0002782