Journal Article Annotations
2021, 4th Quarter

Women’s Mental Health

Annotations by Jyoti Sachdeva MD
December, 2021

Perinatal Planning Guide: Mitigating Perinatal Mood and Anxiety Disorders During the COVID-19 Pandemic.

PUBLICATION #1 — Women’s Mental Health

Perinatal Planning Guide: Mitigating Perinatal Mood and Anxiety Disorders During the COVID-19 Pandemic.

Leah C Susser, Victoria M Wilkins, Lauren H Sternberg

Abstract: Prim Care Companion CNS Disord. 2021 Sep 23;23(5):21nr02953. doi: 10.4088/PCC.21nr02953.

Women are at high risk for and more vulnerable to perinatal mood and anxiety disorders (PMADs) during the coronavirus disease 2019 (COVID-19) pandemic. While access to specialized perinatal mental health services is limited, clinicians with whom women have ongoing relationships are in a unique position to counsel about prevention of PMADs. These clinicians include primary care, obstetric, and general mental health clinicians. By providing a woman with practical guidance and psychoeducation for perinatal planning (eg, about sleep, exercise, nutrition, and the importance of social supports), clinicians can mitigate a woman’s risk of PMADs. This practical guidance must be modified to fit the social context of the COVID-19 pandemic. This guidance can prevent or attenuate unnecessary suffering on the part of the mother and have a long-lasting impact on her child. This review provides a perinatal planning guide that outlines important topics to discuss and problem solve with women in the context of the COVID-19 pandemic.

Annotation

The finding:
This narrative review provides guidance to clinicians to address women’s heightened risk of perinatal mood and anxiety disorders (PMAD) during the COVID-19 pandemic Several pandemic related factors increase women’s vulnerability to PMAD: the fear of contracting COVID-19 infection and its effect on her pregnancy and fetus; changes in social support due to isolation or lockdowns; and pandemic-related changes in work environment. Furthermore, lower socioeconomic status, increased life stress, financial difficulties, or being Black or Hispanic (communities disproportionately affected by covid) are additional contributing factors for PMAD. Despite the increasing prevalence of PMAD, very few women have access to evidence-based perinatal mental health care. Clinicians who have an ongoing relationship with these women—such as primary care providers, family practitioners, and obstetricians—are uniquely positioned to provide psychoeducation and practical guidance to prevent and manage PMAD. Besides educating women about symptoms, risk factors and treatment of PMAD, clinicians can help women with perinatal planning specifically focusing on ensuring availability of adequate social support. Clinicians can and should also help women develop a plan for optimizing sleep, nutrition, and exercise during the perinatal period.

Strength and weaknesses:
This article is a narrative review. The efficacy and generalizability of practical guidance to prevent and mitigate PMAD during Covid 19 pandemic is unclear. On the other hand, all the lifestyle modifications suggested are generally health promoting and carry little or no risk of harmful effects.

Relevance:
C-L Psychiatrists often treat women with PMAD in hospital or ambulatory settings. They can readily use the practical guidance offered here to optimize treatment and empower women who have little access to resources.