Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4

Purpose: To review evidence on the current understanding of mental health conditions in pregnancy and postpartum, with a focus on mood and anxiety disorders, and to outline guidelines for screening and diagnosis that are consistent with best available scientific evidence. The conditions or symptoms reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, suicidality, and postpartum psychosis. For information on psychopharmacologic treatment and management, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 5, "Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum" (1).

Target population: Pregnant or postpartum individuals with mental health conditions. Onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time.

Methods: This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal-fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.

Recommendations: This Clinical Practice Guideline includes recommendations on the screening and diagnosis of perinatal mental health conditions including depression, anxiety, bipolar disorder, acute postpartum psychosis, and the symptom of suicidality. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Similar articles

[No authors listed] [No authors listed] Obstet Gynecol. 2023 Jun 1;141(6):1262-1288. doi: 10.1097/AOG.0000000000005202. Obstet Gynecol. 2023. PMID: 37486661

[No authors listed] [No authors listed] Obstet Gynecol. 2023 Sep 1;142(3):745-759. doi: 10.1097/AOG.0000000000005300. Obstet Gynecol. 2023. PMID: 37590986

[No authors listed] [No authors listed] Obstet Gynecol. 2022 May 1;139(5):944-972. doi: 10.1097/AOG.0000000000004766. Obstet Gynecol. 2022. PMID: 35576364

Accortt EE, Wong MS. Accortt EE, et al. Obstet Gynecol Surv. 2017 Sep;72(9):553-568. doi: 10.1097/OGX.0000000000000477. Obstet Gynecol Surv. 2017. PMID: 28905985 Review.

Beck A, Hamel C, Thuku M, Esmaeilisaraji L, Bennett A, Shaver N, Skidmore B, Colman I, Grigoriadis S, Nicholls SG, Potter BK, Ritchie K, Vasa P, Shea BJ, Moher D, Little J, Stevens A. Beck A, et al. Syst Rev. 2022 Aug 22;11(1):176. doi: 10.1186/s13643-022-02022-2. Syst Rev. 2022. PMID: 35996176 Free PMC article. Review.

Cited by

Martínez Vázquez S, Perete AR, de la Torre-Luque A, Nakić Radoš S, Brekalo M, Amezcua-Prieto C, Caparros-Gonzalez RA. Martínez Vázquez S, et al. Healthcare (Basel). 2024 May 16;12(10):1032. doi: 10.3390/healthcare12101032. Healthcare (Basel). 2024. PMID: 38786442 Free PMC article.

[No authors listed] [No authors listed] Focus (Am Psychiatr Publ). 2024 Jan;22(1):77-78. doi: 10.1176/appi.focus.23021027. Epub 2024 Jan 12. Focus (Am Psychiatr Publ). 2024. PMID: 38694164 No abstract available.

Gopalan P, Spada ML, Shenai N, Kratzer I, Nichols N, Kucherer S, Chou S, Hovis E, Beck S, Glance J. Gopalan P, et al. Focus (Am Psychiatr Publ). 2024 Jan;22(1):35-43. doi: 10.1176/appi.focus.20230021. Epub 2024 Jan 12. Focus (Am Psychiatr Publ). 2024. PMID: 38694157

Weingarten SJ, Osborne LM. Weingarten SJ, et al. Focus (Am Psychiatr Publ). 2024 Jan;22(1):16-24. doi: 10.1176/appi.focus.20230023. Epub 2024 Jan 12. Focus (Am Psychiatr Publ). 2024. PMID: 38694149 Review.

Panelli DM, Miller HE, Simpson SL, Hurtado J, Shu CH, Boncompagni AC, Chueh J, Barwick F, Carvalho B, Sultan P, Aghaeepour N, Druzin ML. Panelli DM, et al. Obstet Gynecol. 2024 Jun 1;143(6):803-810. doi: 10.1097/AOG.0000000000005591. Epub 2024 Apr 25. Obstet Gynecol. 2024. PMID: 38663016

References

    1. Treatment and management of mental health conditions during pregnancy and postpartum. Clinical Practice Guideline No. 5. American College of Obstetricians and Gynecologists. Obstet Gynecol 2023;141:1262–88. doi: 10.1097/AOG.0000000000005202 - DOI
    1. Wisner KL, Sit DKY, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013;70:490–8. doi: 10.1001/jamapsychiatry.2013.87 - DOI
    1. Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis. J Clin Psychiatry 2019;80:18r12527. doi: 10.4088/JCP.18r12527 - DOI
    1. Masters GA, Hugunin J, Xu L, Ulbricht CM, Moore Simas TA, Ko JY, Byatt N. Prevalence of bipolar disorder in perinatal women: a systematic review and meta-analysis. J Clin Psychiatry 2022;83:21r14045. doi: 10.4088/JCP.21r14045 - DOI
    1. McKee K, Admon LK, Winkelman TNA, Muzik M, Hall S, Dalton VK, Zivin K. Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006–2015. BMC Womens Health 2020;20:150–6. doi: 10.1186/s12905-020-00996-6 - DOI