American College of Obstetricians and Gynecologists Creates Perinatal Mental Health Clinical Practice Guidelines Using AHRQ Research

The American College of Obstetricians and Gynecologists (ACOG) relies on AHRQ’s Effective Health Care Program systematic reviews to inform a number of guidelines advising best treatment practices for its member physicians. In June 2023, ACOG released new clinical practice guidelines on pregnancy and postpartum mental health conditions that used AHRQ’s 2021 systematic review, Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Systematic Review of Perinatal Pharmacologic Interventions.

ACOG is a professional association of physicians specializing in obstetrics and gynecology. A nonprofit organization with more than 60,000 members, ACOG produces clinical practice guidelines for its member obstetrician-gynecologists and other clinicians.

According to recent CDC data, mental health conditions (including deaths from suicide and overdose/poisoning related to substance use disorders) are the leading cause of pregnancy-related death. Nearly a quarter (23 percent) of all maternal deaths can be attributed to mental health causes.

“Everyone—and particularly obstetrician-gynecologists—recognizes the incredible importance of addressing maternal mortality in the United States,” said Megan McReynolds, director of ACOG’s Clinical Practice Guidelines-Obstetrics. “There are significant disparities, and the current rates are unacceptable.”

To address mental health during and after pregnancy, ACOG recently released two guidelines. The first clinical practice guideline, Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum, outlines how obstetrician-gynecologists (OB/GYNs) can screen for and diagnose perinatal mental health conditions, including depression, anxiety, bipolar disorder, acute postpartum psychosis, and symptoms of suicidality.

The second ACOG clinical practice guideline, Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum, included the AHRQ Systematic Review. This guideline has 14 recommendations on treatment and management of perinatal depression, anxiety, bipolar disorders, and acute postpartum psychosis. Focusing on psychopharmacotherapy, this guideline also outlines specific steps for initial and followup treatment of perinatal mental health conditions.

ACOG has worked with AHRQ to develop systematic reviews on several topics over the years. These include maternal morbidity and mortality, hypertensive disorders in pregnancy, routine prenatal care, and headaches in pregnancy.

“We have a great working relationship with AHRQ,” McReynolds said. “ACOG members are involved and work with AHRQ on evidence reviews. The willingness to collaborate really helps our members and the patients they serve. Since many pregnant women and individuals are excluded from clinical trials, AHRQ’s reviews provide the most comprehensive information available.”

In addition to the perinatal mental health clinical practice guidelines, ACOG offers tools and resources to help OB/GYNs implement the guidelines into their practices. These additional resources (which also incorporated work based on the AHRQ Systematic Review) include the following:

• Perinatal Mental Health Toolkit.
• Addressing Perinatal Mental Health Conditions in Obstetric Settings eModule.
• Guide for Integrating Mental Health Care into Obstetric Practice.

McReynolds noted, “There has been a tremendous positive response to these guidelines, which shows that obstetrician-gynecologists want to improve care for their patients. At a 2023 ACOG annual meeting presentation on mental health in pregnancy, we had standing-room-only crowds.”