Untreated perinatal mental and substance use disorders are linked to high-risk pregnancy and adverse outcomes for the birthing parent and child. Often, pregnant persons often do not receive adequate mental health care (Rafferty et al., 2019), and mental health practitioners receive little training in treating this population (Osborne et al., 2015). By understanding the current gaps and needs of pregnant and breastfeeding persons, alongside mental health practitioners, the quality of care for pregnant and breastfeeding persons and their babies can be improved.

Understanding the factors associated with these gaps is critical to improving the quality of care for pregnant persons and their offspring. To address these gaps, the CDC Foundation awarded a cooperative agreement to the American Psychiatric Association (APA) to conduct a needs assessment to identify practices and barriers in treating perinatal mental and substance use disorders. The initiative was informed by a 21-member advisory panel comprised of representatives from the APA, American Psychological Association, American Association of Nurse Practitioners, American Counseling Association, and National Association of Social Workers.

APA used an integrative, multimodal approach that analyzed existing research as well as the experiences of pregnant and postpartum individuals with mental health and substance use disorders. Insights into training gaps and practice barriers were solicited from training directors as well as physician and non-physician mental health practitioners. The results of these investigations informed the development of this toolkit, which includes eight factsheets for clinicians and patients, a white paper, and a four-part webinar series covering this understudied and underserved area of mental health. The white paper and 4-part webinar series covers:

• Epidemiology and biology of perinatal mental and substance use disorders,
• Pharmacological and non-pharmacological interventions,
• Recommendations for training curricula for mental health professionals,
• Considerations for certain vulnerable populations.

White Paper

Perinatal Mental and Substance Use Disorders (.pdf)

The white paper discusses the epidemiology and etiology of perinatal mental and substance use disorders and describes the impact of these conditions on maternal and fetal, and child outcomes. The paper also discusses the clinical management of perinatal mental and substance use disorders, makes screening recommendations, and describes the pharmacological and nonpharmacological treatment options. The unique mental healthcare needs of vulnerable and underserved groups are highlighted, and tailored interventions are included. The paper addresses current gaps in training across the continuum of behavioral healthcare provider training programs, highlights the consequences of limited education and training, reviews the education and training opportunities, and makes recommendations to improve the training and education of practitioners across the behavioral healthcare spectrum.

Webinars

Epidemiology, Etiology, and Adverse Outcomes of Perinatal Mental and Substance Use Disorders

This webinar discusses the epidemiology and etiology of perinatal mental and substance use disorders and describes the impact of these conditions on maternal and fetal, and child outcomes.

Clinical Management of Perinatal Mental and Substance Use Disorders

This webinar discusses the importance of preventing perinatal mental and substance use disorders and the risk associated with not treating these conditions, highlights the importance of screening, and recommends available screening tools for specific conditions. It also describes the available pharmacological and nonpharmacological treatment options and alternative care approaches for perinatal mental and substance use disorders.

Training Gaps in Perinatal Mental Healthcare

This webinar addresses training and education gaps across the continuum of behavioral healthcare provider training programs and their impact on the mental healthcare of the perinatal population. The webinar also informs about available educational resources and training opportunities in each behavioral healthcare domain. It makes recommendations to improve the education and training of behavioral healthcare practitioners that treat perinatal persons.

Perinatal Mental Health and Substance Use Disorders – Vulnerable & Underserved Populations

This webinar discusses the unique mental healthcare needs of vulnerable & underserved populations, including 1) adolescents; 2) sexual and gender minority persons; 3) incarcerated individuals; 4) refugees and immigrants; 5) persons experiencing infertility; 4) persons who experience pregnancy loss; and 6) persons experiencing intimate partner violence. The webinar also highlights the disparities in mental health care access and describes the screening requirements and tailored treatment approaches for this group.

Fact Sheets

The following documents offer facts and resources about mental health and pregnant persons, organized by the intended audience.

Resources for Persons Considering Pregnancy, Currently Pregnant, or Postpartum

• Preparing for your Medical Appointments (.pdf)
• Persons with Mental Health and Substance Use Conditions Who are Planning to Become Pregnant (.pdf)
• Pregnant Persons with Mental Health and Substance Use Conditions (.pdf)
• Persons Who Develop Mental Health or Substance Use Conditions Within a Year of Giving Birth (.pdf)

Resources for Prescribing Practitioners

• Persons Who Want to Get Pregnant (.pdf)
• Pregnant and Postpartum Persons (.pdf)

Resources for Non-prescribing Practitioners

• Persons Who Want to Get Pregnant (.pdf)
• Pregnant and Postpartum Persons (.pdf)

Advisory Panel

Psychiatry

References

• Osborne, L. M., Hermann, A., Burt, V., Driscoll, K., Fitelson, E., Meltzer-Brody, S., Barzilay, E. M., Yang, S. N., & Miller, L. (2015). Reproductive Psychiatry: The Gap Between Clinical Need and Education. Am J Psychiatry, 172(10), 946-948. https://doi.org/10.1176/appi.ajp.2015.15060837
• Rafferty, J., Mattson, G., Earls, M. F., & Yogman, M. W. (2019). Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice. Pediatrics, 143(1). https://doi.org/10.1542/peds.2018-3260

This project is partially supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) grant #NU38OT000288. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of, nor an endorsement by, HHS/CDC or the CDC Foundation.