Perinatal depression (PND) is any depressive episode that occurs during pregnancy or within a year of giving birth.

The AAP in its 2019 policy statement advocates that Pediatricians screen for postpartum depression (PPD) at one, two, four, and six months. More recent studies also advocate for screening at all inpatient admissions and ED visits for all infants under one.

It is estimated that between 12% and 15% of moms will have perinatal depression with studies suggesting that up to 25% of women who are in low-income socioeconomic status having perinatal depression.

The mother-infant dyad really is the responsibility of the pediatrician given the direct effect of maternal (and paternal) well-being on a child.

Screening tools for PPD include the Edinburgh Postpartum Depression Scale (EPDS) or the Patient Health Questionnaire (PHQ).

The EPDS is a ten question questionnaire and includes two questions related to anxiety. A score of 10 or more is suggestive of depression.

The PHQ works by asking two questions and if those are positive then a full nine PHQ is completed.

There are certain questions on both the EPDS and the PHQ that assess suicidality and elements of psychosis. If those are positive an immediate mental health referral and urgent care is needed.

Pediatricians should familiarize themselves with community resources to help address a positive depression screen .

The AAP recommends that a brief intervention be done when a positive screen is found. this may include:

promoting the strength of the mother-infant relationship

encouraging the mother and reassuring her regarding any feeding concerns

encouraging understanding and responding to the infant’s cues

promoting realistic expectations and prioritizing important things

encouraging social connections

A personal history of depression, a history of perinatal mood or anxiety disorder in a previous pregnancy, family history of depression, marital discord, family violence, isolation, difficult infant temperament, and young maternal age increase the risk of PND. In addition, the risk is also higher with multiple births, preterm birth, and a special needs infant.