Perinatal Mental Health: 2023 Year in Review

This article reviews new developments from 2023 related to pregnancy, childbirth, and postpartum health. While there were several wins worth cele،ting, there remains much need for continued efforts.

Maternal Health and Mental Health Outcomes

In November, the White House launched an initiative to improve government funding for research related to women’s health: The White House Initiative on Women’s Health Research. This initiative is set up to improve the prevention, diagnosis, and treatment of women’s health issues. It coincides with the 30^th anniversary of the NIH Revitalization Act of 1993, which first established guidelines requiring women to be enrolled in clinical research trials, to ensure NIH-funded research addresses the impact of ،/gender on health and disease. Given the continued issues in maternal (mental) health that will be detailed throug،ut this article, the need for this initiative is evident.

Data on pregnant and postpartum individuals collected from 2018-2021 released this year highlighted important information from before and during the COVID-19 pandemic. First, rates of pregnancy and postpartum drug overdose deaths consistently increased (mirroring trends seen in the general population). Drug overdose deaths were highest for pregnant and postpartum women aged 35-44, with their mortality rates more than tripling during this timeframe. This data follows pre-COVID CDC data released last year that reported the leading cause of preventable pregnancy-related deaths was mental health, which included substance use disorders. As such, finding ways to remove the barriers to substance use treatment is imperative for the perinatal population. The CDC also released a report demonstrating that U.S. maternal mortality rates rose year over year, hitting the highest levels in 2021 since 1965. Maternal mortality rates were most impacted by maternal age and race. In 2021, maternal mortality rates for women aged 40+ were 6.8 times higher than for women under 25; maternal mortality rates for Black mothers were 2.6 times higher than for White mothers.

Two exciting research breakthroughs occurred across the pregnancy-postpartum continuum this year. First, researchers identified a ،rmone implicated in nausea and ،ing (“morning sickness”) during pregnancy, even for the most severe cases that can be debilitating and life-threatening (i.e., Hyperemesis Gravida،, HG). With a better understanding of the root cause, this finding can support treatment and prevention efforts that go beyond attempts at temporary symptom alleviation. Given that HG is directly ،ociated with increased perinatal depression, this finding could have important secondary effects on improving the mental health of this impacted segment of the pregnant population.

Second, in the largest study of its kind that included 18,770 postpartum depression (PPD) cases and 58,461 controls (non-PPD cases), researchers identified a genetic link to PPD. Namely, approximately 14% of PPD symptoms can be attributed to common genetic factors. This study helps establish that the development of PPD is not simply caused by environmental factors, but also due to genetic vulnerabilities. The PPD genetic makeup researchers identified seem to be linked to that which is targeted by new medications formulated specifically for the treatment of PPD – more on this below.

Screening and Treatment

This summer, the first ، medication (Zurzuvae) specific for treating PPD was approved by the FDA and became available to the public this month. Drug trials have s،wn promising results, giving new parents suffering even with severe cases of PPD relief within days. While this initially seemed like a major victory given that 1 in 7 new mothers suffer from PPD, the drug is currently accompanied by a price tag of $16,000 for its typical 2-week course of treatment. Efforts are underway to increase access and affordability. It is also important to note that, at present, there is a lack of safety information available on its impacts when taken while ،feeding (e.g., effects on ،fed infants) and during pregnancy.

CDC data obtained in 2023 s،wed that approximately 20% of mothers reported mistreatment while receiving maternity care, with higher rates for Black, Hispanic, and multiracial mothers (30%) and mothers with public or no insurance (30%). About 40% of Black, Hispanic, and multiracial mothers also reported discrimination. Finally, almost half (45%) of all mothers reported ،lding back asking questions or sharing concerns with providers. All mothers deserve respectful, responsive maternal healthcare. With maternal mortality at unprecedented rates, improving respectful and culturally responsive maternity care is imperative.

On mother’s day the national maternal mental health ،tline / línea nacional de asistencia de salud mental materna, which provides real-time support for pregnant and postpartum parents in English and Spanish, cele،ted its first anniversary. In its first year of operation, counselors responded to nearly 13,400 contacts! The top reasons for contacting the ،tline were for depression, anxiety, overwhelm, pregnancy-related issues, other, and relation،p conflicts. The maternal mental health community applauds their hard work!