New guidelines to support mental health of women during pregnancy and after birth

More than three in five women reported that they had not received any mental health assessments or advice from their doctor. PHOTO: ISTOCKPHOTO

SINGAPORE – KK Women’s and Children’s Hospital (KKH), which saw cases of post-natal depression shoot up during the Covid-19 pandemic, has come up with a set of clinical guidelines for women that emphasise the importance of screening.

This will help ensure that mental health conditions in pregnant women and mothers who have just given birth can be quickly detected and treated.

KKH said it registered a 47 per cent rise in cases of post-natal depression between April 2021 and March 2022, compared with April 2019 to March 2020.

Before the Covid-19 pandemic, post-natal depression affected one in 14 women in Singapore, and antenatal depression impacted one in eight women.

From 2017 to 2021, citizen births averaged 32,200 a year, marking a drop from the 2012 to 2016 average of 32,900. 

A survey by KKH, involving about 600 pregnant women and women who had just given birth, found that only one in six would seek professional help if they experienced symptoms of depression.

More than three in five women reported that they had not received any mental health assessments or advice from their doctor.

Senior Minister of State for Health Janil Puthucheary, who unveiled Singapore’s first set of perinatal mental health guidelines on Friday, said the survey results highlight the need to equip women and their families with the know-how to recognise changes in their mental well-being, identify basic signs and symptoms of conditions such as anxiety and depression, and encourage them to seek help.

The launch was held at the Asia Pacific Maternal and Child Health Conference and the KKH-led Integrated Platform For Research In Advancing Maternal And Child Health Outcomes (Ipramho) international meeting at the hospital.

A second KKH survey, which involved more than 50 obstetricians and gynaecologists, found that more than 90 per cent of patients rarely reported mental health concerns or symptoms during or after pregnancy.

Furthermore, more than half the doctors admitted they seldom initiated discussions about mental health with their patients. Most were not confident or only “somewhat” confident about providing advice on perinatal mental health. 

The two surveys were conducted between September and November 2022 as part of the development of the guidelines.

Apart from screening, the guidelines include providing mental health information and tips on lifestyle behavioural interventions targeting sleep, diet and physical activity for pregnant patients with depression or anxiety.

“The key to preventing these negative effects is early screening, prompt attention for anxiety and depression, preferably even before the woman is pregnant,” said Professor Helen Chen, head and senior consultant at KKH’s department of psychological medicine and chairman of the workgroup for the guidelines.

With the guidelines, KKH also hopes to push for greater awareness of maternal mental health that goes beyond the usual four to six weeks after birth when clinicians are on the lookout for post-natal depression, she added.

In Singapore, where confinement nannies are commonly hired in the first month after birth, some mothers develop post-natal depression after that period when the help ends, Prof Chen noted.

“We want to make sure that women are screened for post-natal depression, particularly in the first three months after birth” and preferably throughout the first year after birth, she said. 

Post-natal depression impacts not just the mother but also the child. Mothers who are mentally vulnerable are unable to function normally or bond with their infants and, in severe cases, may be at risk of suicide, said Prof Chen.

Noting that women with post-natal depression and anxiety often worry about not being a good enough mother, she added: “A lot of it comes with the sense of low mood that they have and the loss of interest and joy in doing what they like to do.”

In his speech, Dr Janil said a local study, Growing Up In Singapore Towards Healthy Outcomes, has found that perinatal depression and anxiety experienced by the mother impacts the child’s neurodevelopment.

The perinatal mental health guidelines are part of a series by Ipramho aimed at transforming national health in Singapore.

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