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Why This Topic Is Important
The emotional and behavioral health of women before, during, and after pregnancy is central to the well being of the entire family. Depression during pregnancy, if untreated, puts women at increased risk for preterm births and low birthweight when compared to women without depression (1). Other negative outcomes associated with depression around the time of pregnancy include problems with mother-infant attachment, poor physical and cognitive development, and emotional and behavioral difficulties in childhood and adolescence (2). Paternal depressive symptoms during this period also can affect children’s emotional and behavioral outcomes (2). Among mothers, symptoms of depression in the perinatal period are a strong predictor of depressive symptoms at four years postpartum (3).

Substance use around the time of pregnancy also can have serious adverse effects on mothers and children (4). Alcohol consumption, particularly binge drinking, is especially harmful during pregnancy and is associated with miscarriage, birth defects, stillbirth, sudden infant death syndrome, and a host of long-term physical, mental, and behavioral impairments, referred to as fetal alcohol spectrum disorders (4, 5). Tobacco use during pregnancy is linked to preterm birth, low birthweight, and disruptions in children’s intellectual and emotional development (4,5).

If a pregnancy is not planned before conception, pre-pregnancy risk behaviors can continue into the first weeks of pregnancy, before a woman realizes that she is pregnant. Public health initiatives increasingly are focusing on improving preconception health by targeting social and environmental factors that influence the health behaviors and health status of women entering pregnancy (6).
For more information on maternal emotional and behavioral health, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  Jarde, A, et al. (2016). Neonatal outcomes in women with untreated antenatal depression compared with women without depression: A systematic review and meta-analysis. JAMA Psychiatry, 73(8), 826-837. Retrieved from: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2526241

2.  Stein, A, et al. (2014). Effects of perinatal mental disorders on the fetus and child. The Lancet, 384(9956), 1800-1819. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61277-0/fulltext

3.  Woolhouse, H., et al. (2015). Maternal depression from early pregnancy to four years postpartum in a prospective pregnancy cohort study: Implications for primary health care. BJOG, 122(3), 312-321. Retrieved from: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.12837

4.  Mental Health America. (n.d.). Prevention and early intervention in mental health: Prenatal period to early childhood. Retrieved from: http://www.mentalhealthamerica.net/issues/prevention-and-early-intervention-mental-health-prenatal-period-early-childhood

5.  Maternal and Child Health Bureau. (2014). Child health USA 2014. U.S. Department of Health and Human Services. Retrieved from: https://mchb.hrsa.gov/chusa14/health-status-behaviors.html#hsbi

6.  Healthy People 2020. (n.d.). Maternal, infant, and child health. U.S. Department of Health and Human Services. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health
Policy Implications
Emotional and behavioral wellness before, during, and after pregnancy can have long-term effects on maternal and child health (1, 2). Depression and substance use around the time of pregnancy, for example, have been linked to negative birth outcomes and developmental deficits in children (1, 2). Policymakers have a role in helping to ensure that all women and couples have access to culturally and linguistically appropriate guidance and care—including mental health and substance abuse treatment if needed—before conception, during pregnancy, and after childbirth.

Policy and program options to promote perinatal emotional and behavioral health include:
  • Advancing prevention strategies that improve social and environmental conditions in which women live, acknowledge the history of trauma common among those with emotional and behavioral health conditions, and build individual and community resilience (3, 4)
  • Supporting evidence-based, culturally- and linguistically-appropriate public education and communication strategies to promote healthy behaviors across the lifespan for youth and adults, reduce stigma around perinatal emotional and behavioral problems, and provide resources to address mental health and substance abuse issues (4, 5)
  • Promoting a comprehensive approach to women’s health, including integration of the following into routine care: reproductive planning, screenings for substance use and depression using validated tools, and trauma-informed treatment for emotional and behavioral conditions (5, 6, 7)
  • Addressing barriers to mental and behavioral health care and fragmented delivery systems through improved collaboration between maternal health and mental health care providers, along with workforce development to ensure an adequate supply of culturally and linguistically diverse providers (4, 8)
  • Ensuring that funding and reimbursement mechanisms support implementation of evidence-based best practices for perinatal mental health and substance use screening, referral, and treatment in all prenatal and postpartum care and service settings (4, 5)
  • In alignment with the Affordable Care Act, supporting continued research on emotional and behavioral conditions before and after pregnancy; as part of this, expanding and improving existing perinatal data collection systems (5, 9)
For more policy information about perinatal emotional health, see kidsdata.org’s Research & Links section. Also see Policy Implications on kidsdata.org for Health Care, Prenatal Care, and Low Birthweight and Preterm Births.

Sources for this narrative:

1.  Mental Health America. (n.d.). Prevention and early intervention in mental health: Prenatal period to early childhood. Retrieved from: http://www.mentalhealthamerica.net/issues/prevention-and-early-intervention-mental-health-prenatal-period-early-childhood

2.  Maternal and Child Health Bureau. (2014). Child health USA 2014. U.S. Department of Health and Human Services. Retrieved from: https://mchb.hrsa.gov/chusa14/health-status-behaviors.html#hsbi

3.  Prevention Institute. (2017). Back to our roots: Catalyzing community action for mental health and wellbeing. Retrieved from: https://www.preventioninstitute.org/www.preventioninstitute.org/publications/back-to-our-roots

4.  California Task Force on the Status of Maternal Mental Health Care. (2017). California’s strategic plan: A catalyst for shifting statewide systems to improve care across California and beyond. Retrieved from: https://www.2020mom.org/ca-task-force-recommendations

5.  Secretary’s Advisory Committee on Infant Mortality. (2013). Final recommendations for a national strategy to reduce infant mortality. Health Resources and Services Administration. Retrieved from: https://www.hrsa.gov/advisory-committees/infant-mortality/reports.html

6.  Siu, A. L., & U.S. Preventive Services Task Force (2016). Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. JAMA, 315(4), 380-387. Retrieved from: https://jamanetwork.com/journals/jama/fullarticle/2484345

7.  Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed Approach.. Retrieved from: https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884

8.  Hoffman, M. C., & Wisner, K. L. (2017). Psychiatry and obstetrics: An imperative for collaboration. American Journal of Psychiatry, 174(3), 205-207. Retrieved from: https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.16111233

9.  Association of Maternal and Child Health Programs. (2015). Opportunities and strategies for improving preconception health through health reform: Advancing collective impact for improved health outcomes. Retrieved from: http://www.amchp.org/Transformation-Station/Documents/AMCHP Preconception Issue Brief.pdf
How Children Are Faring
In 2013-2015, prenatal symptoms of depression were at least as common as they were postpartum: Statewide, estimates of women with a birth who suffered depressive symptoms during pregnancy and those who suffered symptoms of depression in the months after pregnancy each were 14%. Across counties with data, however, there was substantial variation. Prenatal symptoms of depression ranged from 9% in San Mateo County to 20% in Stanislaus County in 2013-2015, while postpartum depressive symptoms were 10% in Yolo County and 19% in San Joaquin County.

African American/black and Hispanic/Latina mothers had higher rates of perinatal symptoms of depression when compared with other groups in California; e.g., depressive symptoms during pregnancy were nearly twice as common for African American/black (20%) and Hispanic/Latina (17%) women as they were for either Asian/Pacific Islander or white women (10%) in 2013-2015. Women with Medi-Cal for prenatal insurance coverage had higher rates of perinatal depressive symptoms (19% prenatal, 17% postpartum) when compared with privately insured mothers (8% prenatal, 10% postpartum). In general, estimates of prenatal and postpartum symptoms of depression were highest among women in families with income below the federal poverty guideline (21% and 18%, respectively), and declined as income increased.