Screen for Postpartum Depression Before Delivery, Expert Advises


SAN FRANCISCO — Screen pregnant women to identify those who are at increased risk for postpartum depression, and plan home visits by a nurse with the at-risk group 10–14 days after delivery, Dr. Andrea J. Singer said at the Perspectives in Women's Health conference sponsored by OB.GYN. NEWS.

“Don't wait for the 6-week postpartum visit” in this at-risk group, advised Dr. Singer, director of women's primary care at Georgetown University Medical Center, Washington.

Approximately one in every eight pregnant women will develop postpartum depression, which generally appears within 3–4 months after delivery and affects roughly 560,000 U.S. women per year. Check a patient's history for clues to postpartum depression risk, she said.

Half of pregnant women with a history of postpartum depression will develop it again, she noted. Consider prophylactic therapy in this group, starting at the end of the third trimester or immediately following delivery.

One-third of women with major depression during pregnancy develop postpartum depression, as do one-fourth of women with a history of major depression before pregnancy.

Stressful events during pregnancy or the postpartum period, a history of mood disorder in a first-degree relative, or conflicts with the baby's father or the woman's primary partner increase risk for postpartum depression. Women with shorter time intervals between pregnancies (who have other young children at home) or who deliver low-birth-weight infants or infants with frequent health problems also are at higher risk.

At the least, ask each mother to complete the Edinburgh Postnatal Depression Scale at the first postpartum visit, she urged. Any woman whose total score is greater than 10 or who indicates that “the thought of harming myself has occurred to me” on the questionnaire is likely to be depressed and needs an assessment.

Dr. Singer is on the speakers' bureau of Pfizer, which makes the antidepressant drug sertraline.

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