Doctor Jennifer Payne, MD, Psychiatrist, UVA, talks about a new study that identifies which women might be at highest risk for postpartum depression.
Interview conducted by Ivanhoe Broadcast News in May 2022.
WHY IS IT IMPORTANT TO IDENTIFY AHEAD OF TIME MOMS WHO COULD BE AT HIGHEST RISK FOR POSTPARTUM DEPRESSION?
DR PAYNE: It’s incredibly important to know who’s at risk for postpartum depression. Postpartum depression has been shown to have effects on the baby’s IQ and language development, as well as behavioral issues and so treating mom for postpartum depression is important to minimize those risks. If we can identify who’s at risk before the postpartum time period, then we can intervene immediately during the postpartum time period and potentially prevent onset.
TELL ME A LITTLE BIT ABOUT HOW YOU AND YOUR COLLEAGUES CAME UP WITH THE INFORMATION. DID YOU LOOK AT A LARGE SAMPLE OF WOMEN? WAS IT A SURVEY? HOW DID YOU GO ABOUT GATHERING THAT?
DR PAYNE: I have a couple different studies, but I think the one that we’re talking about today is one in which I partnered with the mobile phone app, Flo Health. Flo allows women to track their menstrual cycles, but also track their pregnancies and one of the things that Flo does, once a woman has delivered her child, it will send them automatically a survey about their mood in the immediate postpartum time period. I was able to partner with them and access data on over a million pregnancies from 138 countries, and we were able to look at certain risk factors to see what was associated with reporting postpartum depressive symptoms.
YOU SAID IMMEDIATELY AFTER PREGNANCY, WHAT WAS THE TIMEFRAME?
DR PAYNE: They release it about 60 days after delivery, but it can vary from individual to individual.
THIS IS A VERY LARGE SAMPLE, ONE MILLION PREGNANCIES, 138 COUNTRIES?
DR PAYNE: Yes.
TELL ME WHAT YOU FOUND IN STUDYING THE DATA?
DR PAYNE: We found pretty definitively that twin pregnancies have a higher rate of postpartum depressive symptoms, that moms who are young have a higher rate of postpartum depressive symptoms, and first pregnancies are also associated with more postpartum depressive symptoms. We also found that, in women over the age of 40 who had twin pregnancies, that they had an incredibly high rate.
WHAT WAS THE RATE?
DR PAYNE: I believe it was 15 percent.
DOCTOR PAYNE, IS THERE ANY HYPOTHESIS AS TO WHY THESE WOMEN WOULD BE STRUGGLING THE MOST?
DR PAYNE: Well, my guess would be that, by the time you’re 40, you’re pretty set in your ways, and so having a baby come into your life, and not just one baby but two, is probably pretty disturbing. Also, many of these women may have struggled to get pregnant and therefore may be at higher risk because of the long road they took to get pregnant.
WHEN YOU HAVE THIS INFORMATION AND YOU KNOW WHO MIGHT BE AT HIGHEST RISK, WHAT CAN PRACTITIONERS DO? WHAT SHOULD WOMEN DO?
DR PAYNE: Practitioners taking care of pregnant and postpartum women should be screening women for postpartum depression. Postpartum depression is actually the most common complication of giving birth and we screen about 40 percent of women for it. In contrast, gestational diabetes happens to about six percent of all pregnancies, and we have a screening rate of about 99%. So, we really need to get better at screening for postpartum depression. Then once a woman is identified as having postpartum depression, we really need to get on top of treatment.
WHAT’S THE DANGER OF HAVING A WOMAN WITH DEPRESSION DURING THIS PERIOD?
DR PAYNE: Well, suicide is one danger. Suicide accounts for 20 percent of all postpartum deaths and is a preventable cause of death in women. There are also dangers to the pregnancy itself. So, if a woman’s depressed during pregnancy, she has a higher chance of having pre-eclampsia, preterm birth, low birth weight, C-section, and gestational diabetes. Being depressed during pregnancy is not healthy for either the mom or the baby, and then if a mom is depressed in the postpartum time period and she doesn’t get treated, that can have effects on the baby’s IQ and language development.
WHAT KIND OF TREATMENTS ARE AVAILABLE?
DR PAYNE: Well, there are all kinds. A lot of different types of therapies can be helpful and have been shown to be helpful. In addition, antidepressant medications are available. We also have a new class of medications that are specifically targeting and FDA approved for postpartum depression.
WOMEN WHO ARE TRYING TO GET PREGNANT AND DURING PREGNANCY MAY BE HESITANT TO TAKE AS MUCH AS AN ASPIRIN, LET ALONE AN ANTIDEPRESSANT, WHAT DO YOU SAY TO TWO WOMEN, FIRST OF ALL, WHO MAY HAVE BEEN ON ANTIDEPRESSANTS PRIOR TO GETTING PREGNANT?
DR PAYNE: I generally advise women to, obviously, talk to their doctors but in general, we don’t advise going off psychiatric medications for pregnancy. There are a few medications that you can’t take during pregnancy, but most have really been shown to be fairly safe during pregnancy, and there is a robust literature on the negative effects of depression and anxiety disorders during pregnancy. When you really weigh the risks and the benefits, staying on medication and staying psychiatrically well during pregnancy is really important.
YOU HAD MENTIONED THE 20 PERCENT SUICIDE RATE. SO THERE ID, OF COURSE, THE DANGER TO THE MOM. WHAT ABOUT DANGER TO THE BABY OR MOM POTENTIALLY HARMING THE CHILD?
DR PAYNE: Absolutely. Every now and then, we have a terrible tragedy where mom did not get identified as being depressed and she becomes so ill that she takes her own life and/or her baby’s. Again, these are preventable deaths and really, it’s not that hard to screen people for postpartum depression.
DOCTOR PAYNE, HOW OFTEN DOES THAT HAPPEN? WHAT PERCENTAGE?
DR PAYNE: I’m not sure of the percentage. I believe, in postpartum psychosis, the incidence of infanticide is about 4 percent. I’m not sure we have a comparable statistic for postpartum depression.
POSTPARTUM PSYCHOSIS IS DIFFERENT THAN POSTPARTUM DEPRESSION?
DR PAYNE: Yes, postpartum psychosis is considered a psychiatric emergency and really requires hospitalization. It’s very different from postpartum depression and is quite scary in general.
YOU TALKED ABOUT OLDER MOMS OF TWINS. WERE THERE ANY OTHER CATEGORIES OF WOMEN THAT WERE HIGHER RISK? SOMETHING THAT SORT OF SURPRISED YOU?
DR PAYNE: So young moms, late teen age, early 20s had a higher rate. Interestingly, there’s been a question in the literature as to whether having a boy pregnancy versus a girl pregnancy could result in a difference in postpartum depression. We did not find clinically significant difference between boy pregnancies and girl pregnancies.
WHAT ABOUT FIRST PREGNANCIES?
DR PAYNE: First pregnancies have higher rates as well.
HOW MUCH OF IT, DOCTOR PAYNE, IS HORMONAL? HOW MUCH OF IT IS JUST THOSE EXTERNAL FACTORS, AS YOU MENTIONED, ALL OF THE CHANGE, ALL OF THE PRESSURE? IS IT A COMBINATION OF BOTH THAT’S CONTRIBUTING TO POSTPARTUM DEPRESSION?
DR PAYNE: It is in general. I mean, we know that there’s that genetic basis for postpartum depression, it runs in families. We also know that women who develop postpartum depression often have a mood sensitivity to the hormonal fluctuations they go through after delivery. We also know that psychosocial stressors play a role in many women developing postpartum depression. So it’s a combination of factors.
YOU HAD MENTIONED THE SCREENING, ARE THERE STATES WHERE THIS SCREENING IS MANDATORY? IS IT NOT CONSISTENT? I KNOW YOU MENTIONED 99 PERCENT OF WOMEN GET THE DIABETES SCREENING BUT MUCH LESS FOR DEPRESSION.
DR PAYNE: Four states have mandated screening. One of the problems is that, if you screen, then you have to have a place to send a woman to get treatment and that is very difficult in many, many places and so many hospitals and OBGYN practices aren’t screening because they can’t handle the issue, they can’t refer a woman to a psychiatrist or other mental health provider. During the pandemic, mental health care has suffered in that we’ve been overwhelmed. There’s been a mental health crisis and so people are literally booked for months at a time.
AT WHAT POINT, WHAT SYMPTOMS WOULD YOU RECOMMEND THAT WOMEN, YOU KNOW, START THE CONVERSATION WITH SOMEONE, START TO ADVOCATE FOR THEMSELVES PERHAPS?
DR PAYNE: Postpartum depression is really like any other depressive episode. People will complain of feeling low, their mood is sad, sometimes they have crying spells. Anxiety can play a big role in postpartum depression. Not being able to sleep when the baby is sleeping, worrying about is the baby still breathing in the middle of the night- all of these symptoms can be present. Really people need to seek treatment when their functioning is impacted. So, if mom is not able to take care of herself, shower, take care of the dishes in the sink or get herself out of bed that’s when people really need to be reaching out.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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