KKH implemented the screening programme for pregnant women receiving obstetric outpatient care at the hospital in December 2022. PHOTO: ST FILE

SINGAPORE – When Ms Nurdiana Rahmat, 38, discovered she was pregnant with her first child in March 2022, she was depressed and could not function for a few weeks.

Although the baby was planned, she had trouble coming to terms with the pregnancy.

“My biggest concern was how ambivalent I felt. I didn’t feel excited, like what most mothers would feel. I didn’t even know whether I wanted to continue the pregnancy or terminate it, and I just didn’t feel anything about both ideas,” said the arts manager at a local museum.

Her gynaecologist at KK Women’s and Children’s Hospital (KKH) referred her to the hospital’s women’s mental wellness services department for a psychiatric appointment. Her psychiatrist then worked with her through the complex emotions she was experiencing and helped her decide if keeping the pregnancy was for her.

“One of the things that I was worried about was whether my mental health issues would get passed on to my child. Going to therapy actually provided me with the tools to navigate this new life as a mother and how to lower the chances of my own child having mental health issues,” said Ms Nurdiana, who eventually decided to keep the child.

Ms Nurdiana Rahmat and her son Nuri Chiharu Jinnai. PHOTO: COURTESY OF NURDIANA RAHMAT

She gave birth to her son, Nuri Chiharu Jinnai, in November 2022. Ms Nurdiana continues to go for regular therapy sessions at KKH as she finds the sessions help her navigate motherhood.

To better support pregnant women’s mental health, KKH implemented the Psychological Resilience in Antenatal Management (Pram), a universal antenatal depression screening programme for pregnant women receiving obstetric outpatient care at the hospital, in December 2022.

Since then, more than 1,300 patients have undergone Pram screening, and over 8 per cent were found to have significant depressive symptoms, said Dr Chua Tze Ern, head and senior consultant of the women’s mental wellness service at the KKH Department of Psychological Medicine.

Under the programme, screening is conducted during an obstetric check-up in the second trimester, making the process convenient for the patient.

“Screening is conducted during the second trimester as it is a period of relative stability during pregnancy,” said Dr Chua.

“The first trimester may be complicated by events such as miscarriage or elective terminations, while the third trimester is generally a very busy time for expectant women as they make their final preparations for the baby’s arrival. In contrast, most women feel physically well during the second trimester, and it also allows time for intervention to take place prior  o the baby’s arrival.”

Screening is done using the Edinburgh Postnatal Depression Scale (EPDS) questionnaire, which measures symptoms of depression such as feelings of sadness, anxiety, being overwhelmed, inability to sleep and thoughts of self-harm.

The EPDS questionnaire is then scored. Patients with higher scores, indicating probable depression, are offered a psychiatric appointment, with individualised care as indicated. Those with borderline-high scores, indicating possible depression, are offered support and triaging by a clinical counsellor via phone.

Dr Chua said antenatal depression, if left untreated, is a major risk factor for postnatal depression, and the condition can also affect the foetus in many ways.

“An expectant woman suffering from clinical depression may not rest or eat properly, and may find it difficult to consistently attend antenatal classes. Some mothers may turn to unhealthy means of coping, such as smoking, drinking or substance abuse in order to cope with their emotional load, and this can have further implications on their health, well-being and relationships,” she said.

“Furthermore, antenatal depression often impairs a mother’s ability to form an attachment with her unborn child, which can affect her ability to prepare herself emotionally for motherhood. Antenatal depression has also been shown to be associated with increased risks of impaired foetal growth, altered foetal response to stress, and premature labour.”

Dr Chua said that during the Covid-19 pandemic, there was a 47 per cent increase in KKH patients who screened positive for postnatal depression. This indicated that more women might also need help for depression occurring during pregnancy.

“Including universal screening for antenatal depression into routine outpatient obstetric care acts as a safety net for all pregnant women. Being proactively asked about symptoms of depression helps women who may be embarrassed to ask for help or may not be aware that they are experiencing depression,” she said.

“It helps to reduce stigma by normalising the concept of mental health as a natural part of holistic healthcare. It also demonstrates that emotional health is important and that antenatal depression is a medical condition that their healthcare providers recognise and can offer treatment for.”

Dr Chua added that antenatal depression is highly treatable. A review of 118 patients who were treated for antenatal depression at the KKH Department of Psychological Medicine over a five year period between 2006 and 2010 found a very good prognostic outcome.

Eight in 10 patients, after a few months’ treatment, were discharged from outpatient care in a well and stable state. The prognosis was even better among those who had presented for depression for the very first time, with nine in 10 being discharged in a well and stable state.

“Awareness about the impact of mental wellness on maternal health and child development can empower women and their families to make lifestyle adjustments, starting even before pregnancy, to reduce their individual risk factors for perinatal depression, and give their babies the best start to life,” said Dr Chua.

Source: The Straits Times © SPH Media Limited. Reproduced with permission.