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abstract One in five pregnant or postpartum people has a diagnosed mood or anxiety disorder, which are the most common mental health illnesses that occur during the perinatal period. Untreated perinatal mental health conditions, encompassing pregnancy and the first five years of a childs life, carry a societal burden of $14 billion per year in the US. This overview article describes the prevalence of perinatal mental health conditions; the implications of those conditions; and associated barriers to screening, treatment, and bias associated with mental health conditions. We offer six policy opportunities designed to overcome the barriers and support overall sexual and reproductive health: extending Medicaid coverage through twelve months postpartum; redesigning care and reimbursement through co-location of services; establishing coverage for home visiting and peer support programs; enhancing telehealth policies that support access and coverage beyond the COVID-19 pandemic; enhancing data, research, and accountability; and enacting social and economic policies that support families.
Despite its high burden of morbidity, mortality, and economic cost, perinatal mental illness is poorly addressed by the US health care system. One in five pregnant or postpartum people has a diagnosed mood or anxiety disorder, which are the most common mental health conditions that occur during the perinatal period.1 This period brings with it increased vulnerabilities for depression, pharmacotherapy discontinuation, addiction recurrence, and overdose death postpartum.2-4 Many also suffer during this period from other mental health conditions that affect their well-being.
Perinatal mental illnesses contribute to adverse outcomes during pregnancy and postpartum, including pregnancy-related morbidity and mortality for the pregnant person. For example, perinatal anxiety in the last trimester of pregnancy can increase risk for preeclampsia, cesarean birth, and neonatal intensive care.5,6
The burden of perinatal mental illness is not limited either to the pregnant person or to the time immediately surrounding pregnancy. Perinatal depression can lead to fetal growth restriction and postnatal cognitive and emotional complications, including infant attachment barriers and poor cognition.7,8 Both at and well after childbirth, perinatal mental illness generally can lead to psychological and developmental disturbances in infants, children, and adolescents; preterm birth; and low birthweight.7,9,10
Untreated perinatal mental health conditions that occur during pregnancy and the first five years of a childs life carry a societal burden of $14 billion per year in the...