Postnatal care model should be ‘reassessed’

The postnatal care model should be reassessed to include the mental health of both parents, a new study says today.

The systematic review and meta-analysis, led by UCL researchers, London, UK, and published in *JAMA Network Open*, says perinatal mood disorders could affect mothers and fathers simultaneously.

Researchers analysed 23 studies published between 1 January, 1990, and 8 June, 2021, with data from 29,286 couples who had low-risk pregnancies.

Mothers who experienced psychosocial factors, such as early life stressors, limited social support and exposure to intimate partner violence, were more at risk of developing a perinatal mood disorder.

However, for fathers, the main factors associated with an increased risk of perinatal mood disorder were lower levels of education, unemployment, low social support and marital distress.

Previous studies show a history of mood disorders increases the possibility of developing a common mental disorder in both parents, but a recent paper by members of the study team found up to 40% of new mothers do not get a postnatal check-up six to eight weeks after giving birth.

As there is no check up for men, the research team is calling for a change in postnatal care, adding it should also focus on social determinants and relationships between expectant parents to identify couples at risk.

Lead author Dr Kara Smythe, of UCL Institute of Epidemiology & Health, said: “In high-income countries such as the US and the UK, more than 80% of women and more than 70% of men become parents. Each year, more than 650,000 babies are born. Therefore, with prevalence rates of 2% to 3% for depression in both members of the parental dyad, the potential burden is considerable.

“Mood disorders in one parent may impact the other parent, and there is evidence that paternal depression leads to increased symptoms of depression in mothers during pregnancy and in the first six postpartum months.

“Parental perinatal mood disorders are associated with adverse pregnancy outcomes, impaired bonding with the newborn, and behavioural problems in their children. Co-occurrence of mood disorders in both parents may amplify these negative outcomes; however, prevalence data are lacking.

“This information is necessary to inform healthcare priority-setting and facilitate a move toward a family-centred model of care that better serves mother and fathers as they transition to parenthood.”

In the systematic review, 11% of new mothers in high-income countries were found to experience maternal depression during pregnancy and 13% after the baby is born.

This finding adds to an existing meta-analysis of 21 countries, which estimated 9.76% of fathers experienced paternal depression during pregnancy and 8.75% in the first postnatal year.

“Perinatal depression can follow a protracted course; most men and women who have depressive symptoms at four and eight weeks post-partum continue to have symptoms at six months post-partum, and some develop symptoms in the later postnatal period,” said Dr Smythe.

“Future research should determine the longitudinal course of perinatal mood disorders coexisting in both parents, which may change clinical practice. The focus on postnatal depression usually centres on the first 12 weeks post-partum, reflected in practice guidelines.

“However, our findings suggest that clinical attention to perinatal mood disorders may need to extend beyond the early postnatal period.”

Smythe KL, Petersen I, Schartau P. Prevalence of perinatal depression and anxiety in both parents: a systematic review and meta-analysis. *JAMA Network Open* 24 June 2022; doi: 10.1001/jamanetworkopen.2022.18969