How often should a pregnant woman with a family history of major depressive disorder be screened for symptoms of depression and anxiety during the perinatal period, according to the American College of Obstetricians and Gynecologists (ACOG)?

Perinatal Depression and Anxiety Screening Recommendations

According to the American College of Obstetricians and Gynecologists (ACOG), women should be screened at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool (option A). 1, 2

Screening Recommendations and Timing

ACOG's specific recommendations include:

• Minimum requirement: Screen at least once during the perinatal period 1, 2
• Optimal practice: Screen during both pregnancy and at the comprehensive postpartum visit 1, 2
• If screening was performed during pregnancy, additional screening should occur during the comprehensive postpartum visit 1, 2

Risk Factors and Considerations

For this 35-year-old pregnant patient with a family history of major depressive disorder, several factors warrant attention:

• Family history of depression is a significant risk factor that increases her vulnerability to perinatal mood disorders 3
• Perinatal depression affects approximately one in seven women (14%) 1, 2
• Approximately 14% of pregnant and postpartum women screen positive for depression, with about 6% experiencing severe depression 4

Screening Tools and Implementation

Several validated screening instruments can be used:

• Edinburgh Postnatal Depression Scale
• Patient Health Questionnaire-9 (PHQ-9)
• Hospital Anxiety and Depression Scale
• GAD-7 for anxiety symptoms 5

Benefits of Screening

• Early identification allows for timely intervention
• Evidence shows screening alone can have clinical benefits 1, 2
• Maximum benefit occurs when screening leads to treatment initiation or appropriate referrals 1, 2
• Successful implementation of universal screening programs has shown 96% screening rates with appropriate follow-up care 4

Follow-up and Treatment Considerations

When positive screens are identified:

1. Complete a full assessment of mood and emotional well-being
2. Be prepared to initiate medical therapy when indicated
3. Refer to appropriate behavioral health resources
4. Consider stepped care approach beginning with psychotherapy for mild-moderate symptoms 5
5. Consider pharmacotherapy for moderate-severe symptoms 5

Common Pitfalls to Avoid

• Inadequate follow-up: Many screening programs struggle with follow-up for positive screens 3
• Missing screening opportunities: Women who miss postpartum checkups may still be reached at well-child visits (97.3% attendance) 6
• Focusing only on depression: Anxiety disorders are also prevalent in women (approximately 40% lifetime prevalence) and should be included in screening 3

While ACOG recommends screening at least once during the perinatal period, the evidence suggests that more frequent screening may be beneficial, particularly for high-risk women like this patient with a family history of major depressive disorder.