Improving Perinatal Outcomes by Providing Preconception Care for Women with a History of Depression

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Improving Perinatal Outcomes by Providing
Preconception Care for Women with a History of
Depression

• Jennifer M. Wilen, MPH
• Wisconsin Association for Perinatal Care
• Perinatal Foundation
• www.perinatalweb.org

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You Cant Tell by LookingTM that a woman is
depressed
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Wisconsin Association for Perinatal Care

• 35-year old, non-profit organization
• Largest perinatal association in the nation
• Has a Preconception Prenatal Care Committee,
  founded in 1986
• Works collaboratively with sister organization,
  the Perinatal Foundation
• Together, WAPC and the PF have been working to
  infuse depression counseling into preconception
  care since 1999

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Women with Depression

• Depression affects 10-15 of women
• Women are three times more likely to experience
  depression during pregnancy or postpartum
• Up to 28 of women living in poverty experience
  perinatal depression

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Symptoms of Depression

• Sleep or appetite disturbances
• Loss of interest pleasure
• Feelings of being overwhelmed
• Depressed mood/tearfulness
• Hopelessness

• Guilt
• Anxiety or nervousness
• Loss of concentration
• Low energy
• Self-injury
• Suicide

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• A previous history of depression, either
  preconceptionally or during the perinatal period,
  is the strongest predictor that a woman will
  suffer from an episode of major depression during
  pregnancy or postpartum.

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Consequences of Perinatal Depression

• Womans relationships with others are affected
• Poor infant weight gain and sleep problems
• Woman less attentive to infant cues and hygiene
• Maternal-infant bonding is affected
• Prenatal care recommendations may not be followed
  
• Infant behavior problems and risk for depression
  later in life
• Suicide or infanticide

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What can be done about depression
preconceptionally?

• Talk to women with a history depression prior to
  conception or in the interconception period
• Counseling about depression should become a
  routine part of preconception care
• Treat depression just as you would any other
  chronic disease
• All health care providers who have contact with
  women in the preconception period can talk with
  them about depression

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Women with Depression Information Sheet

• Developed in 1999
• Low-literacy
• Free, easily accessible
• Currently used by thousands of providers across
  the nation
• Part of a series of information sheets that
  address the relationship between pregnancy and
  chronic illness
• Answers four questions

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Have you, your parents, grandparents or brothers
and sisters had a history of - Depression? -
Other emotional problems? - Being hospitalized
for psychiatric reasons? - Suicide?
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Benefits of Preconception Counseling for Women
with Depression

• Woman and her partner can make informed decisions
  about planning for a family

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There was a kind of comfort knowing I was on
Paxil before and it didnt hurt my baby.
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Benefits of Preconception Counseling for Women
with Depression

• A plan of action can be developed

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Benefits of Preconception Counseling for Women
with Depression

• If a woman is taking antidepressant medications,
  those medications can be changed or the dose
  lowered if necessary.

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I think the lived experience of postpartum
depression truly helped me identify when I needed
help after the second pregnancy. I knew how
depression presented in me. The recurring
thoughts and nightmares about death and dying
were my trigger to get in to my therapist.
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Benefits of Preconception Counseling for Women
with Depression

• May be more likely to recognize signs symptoms
  of depression

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Benefits of Preconception Counseling for Women
with Depression

• May be more likely to seek and access treatment
  earlier
• The earlier treatment is sought, the better the
  outcomes

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Part of what made it so bad was the lack of
possibility that it could exist.
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Benefits of Preconception Counseling for Women
with Depression

• Anticipating the potential interplay between
  depression and pregnancy is itself an
  intervention that can lead to better perinatal
  outcomes

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Conclusions

• Further research is needed
• The major challenge lies in convincing health
  care providers to pay attention to womens mental
  health and to screen for depression
  preconceptionally

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• Pregnancy and motherhood are not magical for
  women suffering with depression
• www.perinatalweb.org