WHO Releases New Guidance on Peripartum Mental Health

The World Health Organization released a guideline for providers on how they can best screen and treat mental health conditions during the perinatal period.

The 66 page guide, released September 19, 2022, offers an overview of how mental health can be integrated into common maternal healthcare. According to the guidelines, one in five women will experience a mental health condition during the perinatal period in low-income countries. About one in 10 will experience the same in high-income countries.

Jessica Vernon, MD is an OBGYN and director of the Perinatal Mental Health Program within the Department of Obstetrics & Gynecology at NYU Langone Health. Vernon said this guideline is important to bringing standard practices to a larger group of pregnant people.

"(The guidelines) are pretty much in line with what we have been saying," Vernon said. "This just brings it to a global scale and acknowledgment of the importance throughout the world."

The Importance of Peripartum Mental Health

Pregnancy can bring on life-changing alterations and cause a significant amount of stress, according to the guide. Depression, anxiety, and other mental health conditions can follow these important events, and some factors can increase a person's risk to the conditions.

"We know that mental health is very stigmatized to begin with, and especially in the peripartum period, when what we see on social media and society is that they're supposed to be happy and blissful," Vernon said.

According to the WHO guide, conditions wearing on a mother's mental health can result in worse pregnancy outcomes for both mother and infant. That is why it is vital to create a guideline to help those who suffer from any form of mental health issues.

"The World Health Organization also brings up a lot around stress and resiliency, which is very important, especially on a worldwide level where you're looking at a lot of people suffering from poverty, intimate partner violence, and gender-based discrimination," Vernon said.

She added that these factors of course do happen in places like the United States, but are more common in areas with less support and wealth.

However, mental health issues including perinatal mental health, have become more common in the years following the pandemic, Vernon said.

"It's been getting a lot more press, and awareness and a lot more efforts have been made towards promoting screening and treatment in the perinatal period," she said.

What the Guide Recommends

Vernon said the new guidelines described by the WHO are in line with what has been suggested by The American College of OBGYNs and the National Perinatal Task Force. The recommendations are for women to be screened for mental health conditions at least once during the peripartum period. Vernon described the peripartum period as "during pregnancy or within the first year postpartum."

"(We can start early) so we can pick up women with risk factors and implement preventative measures, instead of waiting until women are very symptomatic," she said.

Vernon said these screening tools are looking for a broad spectrum of mental health conditions. What was once called postpartum depression is now known as perinatal mood and anxiety disorders. The issues in this category can range from anxiety and depression to OCD, panic disorder, and psychosis.

"There are many things that as you progress through the pregnancy, providers should be on the lookout for and counseling their patients (on)," Vernon said.

After the screening period, the WHO suggests a "stepped-care approach." That means the intensity of intervention increases with the seriousness of the mental health condition.

"A lot of women with just mild symptoms may benefit from support groups, peer-to-peer connections, which are women who have lived experience with anxiety disorders who are trained to support other women," Vernon said.

She said further interventions such as therapy, medication, and mindfulness exercises can be added based on the situation. However, all of the treatment is based on what resources are available for a given area.

"We definitely try to refer to specialists who are more comfortable with (perinatal mental health) patients," Vernon said. "Of course, there is a lack of that which is why it's also important to educate more (general practitioners) to look out for the symptoms and diagnosis and be able to help give patients the support they need."