[Editor’s Note: Dr. Ann Anderson Berry is a faculty member of University of Nebraska Medical Center and Medical Director of the Nebraska Perinatal Quality Improvement Collaborative (NPQIC). She testified on behalf of NPQIC and Children’s Hospital and Medical Center before the Nebraska Legislature’s Health and Human Services Committee in support of LB905 which recommends maternal depression screenings for women prenatally and postnatally, and at well-child checkups during their baby’s first year. This guest blog post is adapted from her written testimony.]

Maternal depression is common among women in Nebraska, impacting 18% of women during pregnancy and up to 12% of women in the post-partum period.1 The impact of perinatal depression is significant with short- and long-term effects on the mother, infant and partner, and long-term impacts on child development through early adolescence. A large body of medical research shows that infants of mothers with untreated depression are at risk for early breastfeeding cessation, developmental delays, decreased family well-being, delayed infant feeding and development and infant attachment problems.2-4 Later in childhood, children are at risk for attention deficit hyperactivity disorder (ADHD) and associated school performance and behavior issues.5 Additional information indicates that perinatal depression may increase risk for child abuse.6

Maternal depression increased during pandemic
An added impact for families in 2020-2022 has been the COVID-19 pandemic. Preliminary data and research on the impact of the pandemic on rates of perinatal depression show increases in postpartum depression to 33%.7 Having 1 in 3 mothers suffering from depression will have a profound impact on our children over the next one to five years.

It is well documented that perinatal and postpartum depression places families, from all walks of life, at risk throughout the first decade of life. Maternal major depressive disorders can lead to suicide and is one of the most common causes of maternal mortality in the U.S. Additionally, depression and anxiety in the perinatal period has been shown to decrease breastfeeding success for these mother-infant pairs. Decreased breastmilk in the diet is associated with more infections, missed days of work and higher health care costs than for those infants that are exclusively breastfed. As one of a handful of states that has not hard-wired postnatal depression screening, Nebraska simply can and must do better. This easy and freely available screen should be given to all mothers at the proposed times to recognize symptoms and refer mothers to treatment in a timely manner leading to improved neurodevelopmental outcomes for her infant.

Exhaustion, inability to process information
In my hospital-based neonatal intensive care unit we have been screening mothers and their partners for years. Perinatal depression presents as a mother who is so exhausted that she can’t get up from the cot in her baby’s room to change a diaper or sooth her baby when its crying despite urging by the nurses. Depression manifests as inability to eat and drink enough to keep up an adequate milk supply for the baby. Maternal depression often means not being able to answer the phone when the doctor calls or to have a conversation or process the medical information given to you. Maternal depression leaves you at home in bed, unable to come to the NICU to read, talk and sing to your baby to help with their growth and brain development. Depression leads to increased conflict between partners at the infant’s bedside and beyond. Maternal depression makes it difficult to remember to take your hypertension medications from your complicated delivery, leading to risk of stroke, hemorrhage, seizures, emergency room visits and rehospitalizations or worse. Depression leads to thoughts of self-harm even when you know you have everything to live for in your new baby. I see these situations on a regular basis. I have screened mothers who did not recognize as depressed and found them to be actively suicidal, needing to go the emergency room. And, most importantly, I have seen these same women and families improve and regain their ability to be amazing parents. Treatment isn’t an easy fix, but it helps, and I have so many families who are thankful that we screened, referred and cared enough to make this part of our standard of care.

Supporting maternal depression screenings will have an important impact on Nebraska babies and their families. Thank you to Senator Walz for introducing LB905. Together Nebraska’s Perinatal collaborative will continue to work so that Nebraska will be a state where a great life starts with healthy moms and healthy babies.

See current legislative status of LB905

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1 Centers for Disease Control and Prevention. (2021, July 2). Prevalence of Selected Maternal and Child Health Indicators for Nebraska, Pregnancy Risk Assessment Monitoring System (PRAMS), 2016–2019. https://www.cdc.gov/prams/prams-data/mch-indicators/states/pdf/2019/Nebraska_PRAMS_Prevalence-of-Selected-Indicators_2016-2019_508.pdf
2 Bick DE, MacArthur C, Lancashire RJ. What influences the uptake and early cessation of breast feeding? Midwifery. 1998 Dec;14(4):242-7. doi: 10.1016/s0266-6138(98)90096-1. PMID: 10076319.
3 Hasselmann MH, Werneck GL, Silva CV. Symptoms of postpartum depression and early interruption of exclusive breastfeeding in the first two months of life. Cad Saude Publica. 2008;24 Suppl 2:S341-52. doi: 10.1590/s0102-311×2008001400019. PMID: 18670714.
4 McPeak KE, Sandrock D, Spector ND, Pattishall AE. Important determinants of newborn health: postpartum depression, teen parenting, and breast-feeding. Curr Opin Pediatr. 2015 Feb;27(1):138-44. doi: 10.1097/MOP.0000000000000185. PMID: 25564189.
5 Nidey NL, Momany AM, Strathearn L, Carter KD, Wehby GL, Bao W, Xu G, Scheiber FA, Tabb K, Froehlich TE, Ryckman K. Association between perinatal depression and risk of attention deficit hyperactivity disorder among children: a retrospective cohort study. Ann Epidemiol. 2021 Jun 26;63:1-6. doi: 10.1016/j.annepidem.2021.06.005. Epub ahead of print. PMID: 34186179.
6 Obikane E, Baba T, Shinozaki T, Obata S, Nakanishi S, Murata C, Ushio E, Suzuki Y, Shirakawa N, Honda M, Sasaki N, Nishi D, O’Mahen H, Kawakami N. Internet-based behavioural activation to improve depressive symptoms and prevent child abuse in postnatal women (SmartMama): a protocol for a pragmatic randomized controlled trial. BMC Pregnancy Childbirth. 2021 Apr 20;21(1):314. doi: 10.1186/s12884-021-03767-9. PMID: 33879065; PMCID: PMC8057289.
7 Gustafsson HC, Young AS, Doyle O, Nagel BJ, Mackiewicz Seghete K, Nigg JT, Sullivan EL, Graham AM. Trajectories of perinatal depressive symptoms in the context of the COVID-19 pandemic. Child Dev. 2021 Aug 27. doi: 10.1111/cdev.13656. Epub ahead of print. PMID: 34448493.

 

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