Skip to main content
SpringerLink
Log in

Perinatal Depression and Psychiatric Considerations

  • Chapter
  • First Online:
Twin and Higher-order Pregnancies

  • 653 Accesses

Abstract

Perinatal depression (PND) is one of the most common complications of pregnancy. Estimates of prevalence range from 10% to 20%. The perinatal period is associated with complex and unique biological, socio-environmental, and psychological changes for each woman. PND is a burdensome disorder with a profound intrusive impact on the (expectant) mother (to be), her (unborn) child, but also the supporting system. PND is heterogeneous in presentation with likely multifactorial etiologies for each woman. Apart from psychosocial factors, researchers investigated potential underlying endocrinological, immunological, and (epi)genetic factors associated with PND. The Edinburgh Postnatal Depression Scale (EPDS) is the gold standard for detection. The main goals of treating PND are to reduce maternal psychiatric symptoms and to support maternal–child attachment. A stepped-care approach is advocated, in which mild to moderate symptoms should be treated with psychotherapeutic interventions, whereas women with severe symptoms or women who do not respond to nonpharmacological treatment, pharmacological treatment can be suggested. A weighted decision should be made.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Zeanah C. Handbook of infant mental health. 4th ed. New York & London: The Guilford Press; 2019.

    Google Scholar 

  2. Roseboom T. De eerste 1000 dagen – Het fundamentele belang van een goed begin vanuit biologisch, medisch en maatschappelijk perspectief. Utrecht: de Tijdstroom; 2018.

    Google Scholar 

  3. Van den Bergh BRH, van den Heuvel MI, Lahti M, Braeken M, de Rooij SR, Entringer S, et al. Prenatal developmental origins of behavior and mental health: the influence of maternal stress in pregnancy. Neurosci Biobehav Rev. 2017;S0149-7634(16):30734–5.

    Google Scholar 

  4. Benute GR, Nozzella DC, Prohaska C, Liao A, de Lucia MC, Zugaib M. Twin pregnancies: evaluation of major depression, stress, and social support. Twin Res Hum Genet. 2013;16(2):629–33.

    Article  PubMed  Google Scholar 

  5. Fisher J, Stocky A. Maternal perinatal mental health and multiple births: implications for practice. Twin Res. 2003;6(6):506–13.

    Article  PubMed  Google Scholar 

  6. Kendig S, Keats JP, Hoffman MC, Kay LB, Miller ES, Simas TAM, et al. Consensus bundle on maternal mental health: perinatal depression and anxiety. J Midwifery Womens Health. 2017;62(2):232–9.

    Article  PubMed  Google Scholar 

  7. Wisner KL, Sit DK, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiat. 2013;70(5):490–8.

    Article  Google Scholar 

  8. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071–83.

    Article  PubMed  Google Scholar 

  9. Kimmel MC, Bauer A, Meltzer-Brody S. Toward a framework for best practices and research guidelines for perinatal depression research. J Neurosci Res. 2019;98(7):1255–67.

    Article  PubMed  Google Scholar 

  10. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384(9956):1775–88.

    Article  PubMed  Google Scholar 

  11. Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017;219:86–92.

    Article  CAS  PubMed  Google Scholar 

  12. Heron J, O’Connor TG, Evans J, Golding J, Glover V, Team AS. The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord. 2004;80(1):65–73.

    Article  PubMed  Google Scholar 

  13. Atif N, Lovell K, Rahman A. Maternal mental health: the missing “m” in the global maternal and child health agenda. Semin Perinatol. 2015;39(5):345–52.

    Article  PubMed  Google Scholar 

  14. Ross LE, McQueen K, Vigod S, Dennis CL. Risk for postpartum depression associated with assisted reproductive technologies and multiple births: a systematic review. Hum Reprod Update. 2011;17(1):96–106.

    Article  PubMed  Google Scholar 

  15. van den Akker O, Postavaru GI, Purewal S. Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis. Reprod Biomed Online. 2016;33(1):1–14.

    Article  PubMed  Google Scholar 

  16. American Psychiatric Publishing. Diagnostic and statistical manual of mental disorders. 4th ed. Arlington: American Psychiatric Publishing; 2000.

    Google Scholar 

  17. American Psychiatric Publishing. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  18. Prevention CfDCa. International classification of diseases, 11th revision, clinical modification (ICD-11-CM). Geneva: WHO; 2019.

    Google Scholar 

  19. O’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):3–12.

    Article  PubMed  Google Scholar 

  20. Sharma V, Mazmanian D. The DSM-5 peripartum specifier: prospects and pitfalls. Arch Womens Ment Health. 2014;17(2):171–3.

    Article  PubMed  Google Scholar 

  21. Martini J, Bauer M, Lewitzka U, Voss C, Pfennig A, Ritter D, et al. Predictors and outcomes of suicidal ideation during peripartum period. J Affect Disord. 2019;257:518–26.

    Article  PubMed  Google Scholar 

  22. Khalifeh H, Hunt IM, Appleby L, Howard LM. Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year findings from a UK national inquiry. Lancet Psychiatry. 2016;3(3):233–42.

    Article  PubMed  Google Scholar 

  23. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health. 2005;8(2):77–87.

    Article  CAS  PubMed  Google Scholar 

  24. Gressier F, Guillard V, Cazas O, Falissard B, et al. Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J Psychiatr Res. 2017;84:284–91.

    Article  PubMed  Google Scholar 

  25. Consortium PDATCaTP. Heterogeneity of postpartum depression: a latent class analysis. Lancet Psychiatry. 2015;2(1):59–67.

    Article  Google Scholar 

  26. Putnam KT, Wilcox M, Robertson-Blackmore E, Sharkey K, Bergink V, Munk-Olsen T, et al. Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium. Lancet Psychiatry. 2017;4(6):477–85.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Vliegen N, Casalin S, Luyten P. The course of postpartum depression: a review of longitudinal studies. Harv Rev Psychiatry. 2014;22(1):1–22.

    Article  PubMed  Google Scholar 

  28. Boekhorst MGBM, Beerthuizen A, Van Son M, Bergink V, Pop VJM. Psychometric aspects of the Tilburg pregnancy distress scale: data from the HAPPY study. Arch Womens Ment Health. 2019;23(2):215–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Torres A, Gelabert E, Roca A, Navarro P, Plaza A, Subirà S, et al. Course of a major postpartum depressive episode: a prospective 2 years naturalistic follow-up study. J Affect Disord. 2019;245:965–70.

    Article  PubMed  Google Scholar 

  30. Cooper PJ, Murray L. Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. Br J Psychiatry. 1995;166(2):191–5.

    Article  CAS  PubMed  Google Scholar 

  31. Wisner KL, Perel JM, Peindl KS, Hanusa BH. Timing of depression recurrence in the first year after birth. J Affect Disord. 2004;78(3):249–52.

    Article  PubMed  Google Scholar 

  32. Pop V, van Son M, Wijnen H, Spek V, Denollet J, Bergink V. Increase of depressive symptomatology during pregnancy over 25 years’ time in four population based cohorts. J Affect Disord. 2019;259:175–9.

    Article  PubMed  Google Scholar 

  33. Marcus SM, Heringhausen JE. Depression in childbearing women: when depression complicates pregnancy. Prim Care. 2009;36(1):151–65, ix.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Vigod SN, Wilson CA, Howard LM. Depression in pregnancy. BMJ. 2016;352:i1547.

    Article  PubMed  Google Scholar 

  35. Howard LM, Piot P, Stein A. No health without perinatal mental health. Lancet. 2014;384(9956):1723–4.

    Article  PubMed  Google Scholar 

  36. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. 2010;202(1):5–14.

    Article  PubMed  PubMed Central  Google Scholar 

  37. O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379–407.

    Article  PubMed  Google Scholar 

  38. Choi Y, Bishai D, Minkovitz CS. Multiple births are a risk factor for postpartum maternal depressive symptoms. Pediatrics. 2009;123(4):1147–54.

    Article  PubMed  Google Scholar 

  39. McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 2017;31(5):519–52.

    Article  PubMed  Google Scholar 

  40. Milgrom J, Gemmill A, editors. Identifying perinatal depression and anxiety: evidence-based practice in screening, psychosocial assessment and management. Chichester: Wiley; 2015.

    Google Scholar 

  41. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.

    Article  CAS  Google Scholar 

  42. Bergink V, Kooistra L, et al. Validation of the Edinburgh Depression Scale during pregnancy. J Psychosom Res. 2011;70(4):385–9.

    Article  PubMed  Google Scholar 

  43. Meltzer-Brody S, Howard LM, Bergink V, Vigod S, Jones I, Munk-Olsen T, et al. Postpartum psychiatric disorders. Nat Rev Dis Primers. 2018;4:18022.

    Article  PubMed  Google Scholar 

  44. Figueiredo FP, Parada AP, de Araujo LF, Silva WA, Del-Ben CM. The influence of genetic factors on peripartum depression: a systematic review. J Affect Disord. 2015;172:265–73.

    Article  PubMed  Google Scholar 

  45. Serati M, Redaelli M, Buoli M, Altamura AC. Perinatal major depression biomarkers: a systematic review. J Affect Disord. 2016;193:391–404.

    Article  CAS  PubMed  Google Scholar 

  46. Meaney S, Corcoran P, O’Donoghue K. Death of one twin during the perinatal period: an interpretative phenomenological analysis. J Palliat Med. 2017;20(3):290–3.

    Article  PubMed  Google Scholar 

  47. Muzik M, Bocknek EL, Broderick A, Richardson P, Rosenblum KL, Thelen K, et al. Mother-infant bonding impairment across the first 6 months postpartum: the primacy of psychopathology in women with childhood abuse and neglect histories. Arch Womens Ment Health. 2013;16(1):29–38.

    Article  PubMed  Google Scholar 

  48. Shonkoff J, Philips D. From neurons to neighborhoods: the science of early childhood development. Washington, DC: National Academies Press; 2000.

    Google Scholar 

  49. Kimmel M, Clive M, Gispen F, Guintivano J, Brown T, Cox O, et al. Oxytocin receptor DNA methylation in postpartum depression. Psychoneuroendocrinology. 2016;69:150–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Molenaar NM, Kamperman AM, Boyce P, Bergink V. Guidelines on treatment of perinatal depression with antidepressants: an international review. Aust N Z J Psychiatry. 2018;52(4):320–7.

    Article  PubMed  PubMed Central  Google Scholar 

  51. O’Connor E, Senger CA, Henninger ML, Coppola E, Gaynes BN. Interventions to prevent perinatal depression: evidence report and systematic review for the US preventive services task force. JAMA. 2019;321(6):588–601.

    Article  PubMed  Google Scholar 

  52. Letourneau NL, Dennis CL, Cosic N, Linder J. The effect of perinatal depression treatment for mothers on parenting and child development: a systematic review. Depress Anxiety. 2017;34(10):928–66.

    Article  PubMed  Google Scholar 

  53. Sockol LE. A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. J Affect Disord. 2018;232:316–28.

    Article  PubMed  Google Scholar 

  54. van Ravesteyn LM, Lambregtse-van den Berg MP, Hoogendijk WJ, Kamperman AM. Interventions to treat mental disorders during pregnancy: a systematic review and multiple treatment meta-analysis. PLoS One. 2017;12(3):e0173397.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Sockol LE. A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord. 2015;177:7–21.

    Article  PubMed  Google Scholar 

  56. Lever Taylor B, Cavanagh K, Strauss C. The effectiveness of mindfulness-based interventions in the perinatal period: a systematic review and meta-analysis. PLoS One. 2016;11(5):e0155720.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Damkier P, Christensen LS, Broe A. Patterns and predictors for prescription of psychotropics and mood-stabilizing antiepileptics during pregnancy in Denmark 2000-2016. Br J Clin Pharmacol. 2018;84(11):2651–62.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Sadler TW. Selective serotonin reuptake inhibitors (SSRIs) and heart defects: potential mechanisms for the observed associations. Reprod Toxicol. 2011;32(4):484–9.

    Article  CAS  PubMed  Google Scholar 

  59. Bérard A, Zhao JP, Sheehy O. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ Open. 2017;7(1):e013372.

    Article  PubMed  PubMed Central  Google Scholar 

  60. NICE. Antenatal and postnatal Mental Health. The NICE guideline on clinical management and service guidance – Updated edition: The Royal Psychological Society and the Royal College of Psychiatrists (National Institute for Health and Care Excellence – National Collaborating Centre for Mental Health); 2018.

    Google Scholar 

  61. Huybrechts KF, Palmsten K, Avorn J, Cohen LS, Holmes LB, Franklin JM, et al. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med. 2014;370(25):2397–407.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Furu K, Kieler H, Haglund B, Engeland A, Selmer R, Stephansson O, et al. Selective serotonin reuptake inhibitors and venlafaxine in early pregnancy and risk of birth defects: population based cohort study and sibling design. BMJ. 2015;350:h1798.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Klinger G, Frankenthal D, Merlob P, Diamond G, Sirota L, Levinson-Castiel R, et al. Long-term outcome following selective serotonin reuptake inhibitor induced neonatal abstinence syndrome. J Perinatol. 2011;31(9):615–20.

    Article  CAS  PubMed  Google Scholar 

  64. Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med. 2006;160(2):173–6.

    Article  PubMed  Google Scholar 

  65. Masarwa R, Bar-Oz B, Gorelik E, Reif S, Perlman A, Matok I. Prenatal exposure to selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors and risk for persistent pulmonary hypertension of the newborn: a systematic review, meta-analysis, and network meta-analysis. Am J Obstet Gynecol. 2019;220(1):57, e1–e13.

    Article  PubMed  Google Scholar 

Key Reading

  • Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071–83.

    Article  PubMed  Google Scholar 

  • Kimmel MC, Bauer A, Meltzer-Brody S. Toward a framework for best practices and research guidelines for perinatal depression research. J Neurosci Res. 2019;98(7):1255–67.

    Article  PubMed  Google Scholar 

  • McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 2017;31(5):519–52.

    Article  PubMed  Google Scholar 

  • Meltzer-Brody S, Howard LM, Bergink V, Vigod S, Jones I, Munk-Olsen T, Honikman S, Milgrom J. Postpartum psychiatric disorders. Nat Rev Dis Primers. 2018;4:18022.

    Article  PubMed  Google Scholar 

  • Ross LE, McQueen K, Vigod S, Dennis CL. Risk for postpartum depression associated with assisted reproductive technologies and multiple births: a systematic review. Hum Reprod Update. 2011;17(1):96–106.

    Article  PubMed  Google Scholar 

  • Van den Akker O, Postavaru GI, Purewal S. Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis. Reprod Biomed Online. 2016;33(1):1–14.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Adult Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium

    Femke Vanwetswinkel

  2. Department of Neuroscience, Department of Adult Psychiatry, KU Leuven – University Psychiatric Center KU Leuven, Leuven, Belgium

    Titia Hompes

Authors
  1. Femke Vanwetswinkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Titia Hompes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Titia Hompes .

Editor information

Editors and Affiliations

  1. Fetal Medicine Unit, St George’s University Hospitals, NHS Foundation Trust, London, UK

    Asma Khalil

  2. Department of Obstetrics & Gynaecology, University Hospitals Leuven, Leuven, Belgium

    Liesbeth Lewi

  3. Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands

    Enrico Lopriore

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Vanwetswinkel, F., Hompes, T. (2021). Perinatal Depression and Psychiatric Considerations. In: Khalil, A., Lewi, L., Lopriore, E. (eds) Twin and Higher-order Pregnancies. Springer, Cham. https://doi.org/10.1007/978-3-030-47652-6_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-47652-6_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47651-9

  • Online ISBN: 978-3-030-47652-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation