The devastating consequences of maternal mental distress could be addressed by developing an early universal screening tool specifically for Aotearoa New Zealand mothers.
It’s one of several findings in a new evidence brief Perinatal mental distress: An under-recognised concern written by Chloe Wilkinson, Sir Peter Gluckman and Dr Felicia Low at Koi Tū: The Centre for Informed Futures.
The brief suggests the prevalence of and detrimental consequences from maternal mental distress during and soon after pregnancy warrant the introduction of a screening programme.
Caught in advance, high rates of mental distress in new mothers and consequent intergenerational effects in children stemming from perinatal mental difficulties could be reduced.
Research Fellow Dr Low, who leads Koi Tū’s work on maternal and infant health, says maternal mental health is critically important but under-recognised, and needs greater priority within Aotearoa New Zealand’s public policy frameworks.
“At least 15% of New Zealand women are affected by mental distress during the perinatal period from conception and pregnancy to a year after birth. Among women of Māori, Asian and Pacific ethnicity, the rate can reach one in three.”
“Yet, current screening tools and practices may not be able to adequately identify these women. We therefore need to consider developing a screening tool customised to New Zealand’s diverse ethnic makeup, encompassing a wide range of cultural world views and concepts of wellbeing,” Dr Low says.
The consequences both for the woman and her baby can be serious. Depression can produce disabling effects on mood and daily functioning, lead to adverse pregnancy outcomes and result in suicide, which is the largest single cause of death for New Zealand women during and in the six weeks following pregnancy.
Some mothers’ thoughts may turn to harming their baby. And in the longer term, children who were not able to bond with their distressed mothers may go on to have mood disorders.
Depression during pregnancy is also associated with altered fetal brain development, potentially resulting in behavioural difficulties with lifelong negative consequences.
Research Assistant Chloe Wilkinson says a woman’s risk of developing perinatal distress is probably determined by the interaction of biological factors with her wider social and environmental context.
“The same psychosocial risk factors common to mental distress in the general population — low income, lack of social support or a difficult family environment — are implicated in the development of perinatal distress. But the risk and any biological propensity can be exacerbated by pregnancy-related factors, such as unplanned or complicated pregnancy, birth difficulty and infant temperament.”
“Although there is more to understand, it is clear that perinatal distress is more than simply a social or hormonal issue, and the distress many women experience after giving birth must not be dismissed as the expected minor and temporary ‘baby blues’.”
Even if the condition is unrecognised until after birth, it usually starts before or during pregnancy, implying that early intervention is paramount. If distress can be detected and managed during pregnancy, that helps prevent it worsening after birth.
Dr Low says that highlights the benefit of universal screening, which should start with the first lead maternity carer visit, be repeated mid-pregnancy and again postnatally, and be supported by appropriately resourced maternal mental health services.
“Such a tool should use the term ‘perinatal distress’ rather than ‘postnatal depression’ to reflect the fact that symptoms are not limited to depression and may present at any time during pregnancy.”
Dr Low and Ms Wilkinson say spreading word of the high prevalence of perinatal distress will reduce stigma and make it easier for women to seek help. Partners, wider family, whānau, healthcare providers and women themselves need to be made more aware of the condition, so that it can be managed to the benefit of mothers and babies.