Mental Health Disorders in Pregnancy and the Puerperium: A Comprehensive Review of Guidelines on Screening, Diagnosis, and Management.

Abstract

Importance: Mental health disorders are frequent, challenging, and potentially devastating complications during the antenatal and postnatal period with major impact on both women and their offspring, especially if left undiagnosed and untreated or managed in a suboptimal way.

Objective: The aim of this study was to review and compare the most recently published guidelines on the screening, diagnosis, and management of the most common mental health disorders in pregnancy and the puerperium.

Evidence acquisition: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the Center of Perinatal Excellence, and the National Institute for Health and Care Excellence on antenatal and postnatal mental health disorders was conducted.

Results: There is a consensus among the reviewed guidelines regarding the importance of a detailed personal and family history in the investigation of mental health disorders and the associated risk factors. Moreover, all the reviewed medical societies recommend universal antenatal and postnatal screening for depression and anxiety using validated screening tools, assessment of family violence exposure, and tobacco, alcohol, and illicit drug use, as well as evaluation of the woman's emotional well-being. They also agree that following a positive screening result, further assessment is required to set the diagnosis of a mental health condition based on specific criteria, whereas a positive self-harm question warrants urgent referral and management. Discrepancies were identified regarding the recommended screening tools, the frequency of screening, the algorithms that should be followed in case of positive screening, and the indications for pharmacological and psychological treatment. Regarding treatment, the reviewed guidelines recommend psychological interventions and pharmacological therapy based on the severity of the mental health disorders, suggesting selective serotonin reuptake inhibitors as first-line agents for depression and anxiety and agreeing that the lowest effective dose, a single-agent therapy, and a drug with the lowest risk profile should be preferred. Consistency also exists concerning the follow-up and monitoring of women treated for mental health disorders, as well as the management of women with preexisting mental illness.

Conclusions: Mental disorders during pregnancy and the puerperium are a sensitive, community-based issue that affects the parents' quality of life and interferes to the neonate's behavioral and emotional development. Therefore, it is of insurmountable importance to develop consistent international strategies for the early identification and the optimal management of this significant complication to improve the perinatal outcomes.