Q&A: How physicians can better support pregnant patients’ mental health

Key takeaways:

• Maternal mental health care improves outcomes for mothers and their children.
• Physicians should arm themselves with resources for their pregnant patients to get help with mental health concerns.

As a child and adolescent psychiatrist, Shama Rathi, MD, spent her time treating children for mental health issues, but she discovered that most of what she was seeing started with a lack of mental health care for their mothers.

“A common thread throughout my experience was that maternal mental health is really underserved,” Rathi told Healio. “My work was focused on stressed family units, specifically stressed moms, and so much of what I was seeing downstream in kids could be traced back much earlier.”

In 2021, Rathi partnered with Sipra Laddha, MD, to create LunaJoy, a telehealth company that provides mental health services, counseling and medication management for women, with a goal of filling the gap in maternal mental health care.

Healio spoke with Rathi about the importance of maternal mental health and how physicians can better support their patients during and after pregnancy.

Healio: Why is maternal mental health important?

Rathi: Maternal mental health is not only important for the well-being of a mom, but also for the healthy development of their babies. Those early years of a child’s life are critical for brain development, and maternal mental health plays a huge role in cognitive, social and emotional development and a mother’s ability to bond with her baby. If a mom is struggling with depression and anxiety, it can potentially lead to insecure attachment, which can then predispose the child to mental health issues.

I think maternal mental health often exists in a vacuum. We talk about it without seeing how mom is often the primary caregiver, and this can influence the psychological and emotional environment in the household.

Healio: What is currently missing from the health care system for postpartum women?

Rathi: This answer is constantly evolving. If you had asked me a year ago, I would have said education and awareness. In September 2022, the CDC released a report indicating that our maternal mortality rates are rising, and 80% of pregnancy-related deaths are preventable. The No. 1 cause is mental health, with suicides and overdoses leading the way.

Now, due to regulatory tailwinds, we are doing much more screening — not only postpartum, but also during pregnancy. There is a lot of focus around screening, but we don't know what to do with the results. It is overwhelming many of our OB/GYN colleagues, hospital systems, clinics and payers, because 40% of women are testing positive. One hospital system we are talking to in California has 9,000 positive screens sitting in their system without any actionable steps. The infrastructure is what is missing.

Healio: What is LunaJoy doing to try to fill these gaps?

Rathi: We screen, we care navigate and we provide in-network services. While there are many incredible solutions that do just one aspect (soley screen, care navigate or only provide subscription-based therapy or coaching). But you take this very fragmented and siloed system and inadvertently fragment it a little bit more, and women are getting screened, finding out they are positive and not knowing what to do with it. They might get therapy, but then they have to go somewhere else for medications, if they can even get in. Or they may get medications, but have limited options for therapy.

We created LunaJoy to bring all of this under one umbrella. We partner with OB/GYNs to use our technology to screen, then we reach out directly to the women who are symptomatic, and if warranted, schedule an appointment on our platform that is in-network with their insurance, and then we close the feedback loop with the OB/GYNs.

I think we are picking folks up much earlier. When we screen at only the 6 weeks postpartum visits, we are really missing the boat. A lot of what's happening postpartum had earlier signs and symptoms during pregnancy. Earlier screening allows us to engage patients when they're less symptomatic, which also means that they're more likely to engage in services, which ultimately leads to better outcomes.

Healio: How can psychiatrists and mental health providers better support women during and after pregnancy?

Rathi: A majority of our referrals come from psychiatrists and providers who do not feel comfortable treating this population. Managing psychiatric medications during pregnancy is not straightforward and unfortunately there can be limited exposure to this population during traditional medical training programs. We have had patients come in who were doing well with their mood stabilizer, but were then taken off the medication when they became pregnant, and then they decompensated. One of the biggest things that we can do as providers is enhance awareness of how to support women, and just as importantly, know how to get these patients into care.

Healio: How can obstetricians and family practice physicians support their pregnant patients’ mental health?

Rathi: Awareness and education about resources and behavioral health integration is really important. OB providers are already overwhelmed; they only have 15 minutes to not only check on the medical health of the mother but also the medical health of the baby. We are expecting them to do it all, and there simply is not much time left to manage mental health issues.

We are here to help bridge this gap and take this burden off of our OB colleagues — we will get patients connected to care with us if we are in-network or offer them other resources to support patients along their journey. Unfortunately, for patients, their families and their OB providers, these mental health issues, if not addressed, can be associated with higher C-section rates, preterm births and poor maternal and neonatal outcomes.

Healio: What changes do you hope to see in this field over the next 10 years?

Rathi: The mental health field in general is very reactive: Things have to get worse for someone around you to notice, and then you finally, maybe, get into care. In 10 years, my hope is that we are having more preventive conversations about mental health. There is so much data around the fact that even women being provided six to eight sessions of anticipatory guidance can be preventive for years against postpartum depression.

Specific to this population is issues with insurance. Six to seven out of 10 births in this country are financed by Medicaid. Historically, we have really been missing most of these women because most of these solutions are not geared for Medicaid. There are a lot of social determinants of health and a lot of barriers to care. In creating these solutions and innovating in the maternal mental health space, it is imperative that we keep some of this in mind. I hope in 10 years that we will have more comprehensive solutions.

References:

• Four in 5 pregnancy-related deaths in the U.S. are preventable. https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html. Published Sept. 19, 2022. Accessed July 9, 2024.
• LunaJoy. Hellolunajoy.com. Accessed July 12,2024.
• Roubinov DS, et al. J Consult Clin Psychol. 2022;doi:10.1037/ccp0000776.

For more information:

Shama Rathi, MD, can be reached at shama@hellolunajoy.com.