2025+亚太地区共识声明：围产期抑郁和焦虑
A B S T R A C T
Background: The perinatal period, from conception to one year postpartum, is a time of major physical and emotional change, with heightened risk for mental health disorders such as anxiety and depression-particularly in the Asia-Pacific region. Poor maternal mental health during this phase can lead to obstetric complications and adversely affect child development and neurodevelopment.
Method: Representatives Particular on 11 Asia-Pacific nations and/or jurisdictions developed a consensus statement on the perinatal mental health guidelines on depression and anxiety using the GRADE-ADOLOPMENT framework.Findings: These guidelines support all women of childbearing age, including those with special circum-stances-such as severe obstetric complications, adolescent pregnancies, or special needs-and their infants.Recommendations included special considerations for women who experienced severe maternal complications,personalized care for adolescents and women with unique needs, and attention to the mental health needs of
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infants. They focus on promoting optimal mental health for women experiencing depression and anxiety during the preconception, antenatal, and postnatal periods.
Interpretation: These guidelines, developed for maternal and child health practitioners in the Asia-Pacific, pro-mote a holistic approach-combining lifestyle changes, early screening, and tailored interventions-to improve perinatal mental health and enhance outcomes for mothers and children.
1. Introduction
The objective of the Asia-Pacific consensus statement on perinatal mental health guidelines on depression and anxiety was to provide guidance to professionals in maternal and child health services on addressing depression and anxiety, during the preconception, ante-partum and postpartum phases. The network of practitioners will include general practitioners, family physicians, obstetricians and gynaecologists, pediatricians, nurses, social workers and counsellors,psychiatrists, and other mental health professionals.
These recommendations apply to all childbearing women, regardless of their cultural background or socio-economic status, and take into account the needs of women with special circumstances, such as those with severe obstetric complications, adolescent pregnancies, or special needs such as neurodevelopmental disorders or learning disability, as well as their infants. Severe mental disorders, including schizophrenia and bipolar disorder, are excluded from these guidelines due to their lower prevalence and the need for specialized care.
All participating members are encouraged to adopt or adapt the guidelines to suit their local populations and integrate the recommen-dations into preconception, antenatal, and postnatal care frameworks.By embedding these guidelines into routine healthcare practices, pro-viders can deliver timely, opportunistic care and guidance, ensuring optimal outcomes for maternal and infant health. Recognizing the dif-ferences in resourcing and care processes among health services, these recommendations aim to guide maternal and child health practitioners in the Asia-Pacific region, contributing collectively to the improvement of perinatal mental health and its direct positive impact on child health and well-being(Duffy et al., 2024; World Health Organization, 2024).
2. Background
Perinatal mental health is a critical determinant of intergenerational mental health outcomes, with lasting impacts from infancy through adolescence, as demonstrated by meta-analytic evidence(Fan et al.,2024; Rogers et al., 2020). The impact of poor maternal mental health during this period extends beyond adverse obstetric outcomes(Ding et al.,2014), playing a critical role in shaping fetal development(Phua et al., 2020) and a child's brain development during the pre- and post-natal periods(Lewis et al.,2015). It affects brain structure,con-nectivity, and electrophysiology, influencing behavior, executive func-tions(e.g., working memory, attention, self-regulation), sensory processing, and language development(Phua et al., 2020; Borchers et al.,2021; Qiu et al.,2015). These combined effects can impede fetal growth(Diego et al., 2009; Henrichs et al., 2010), compromise school readiness(Glover, 2014; Law et al., 2021), and have lasting implications for societal outcomes.
A scoping review on maternal depression during pregnancy and the postpartum period in Southeast Asian countries reported antenatal depression prevalence ranging from 4.9% to 46.8%, while postnatal depression prevalence ranged from 4.4% to 57.7%. The review included 18 studies on antenatal depression across five countries,whereas depression prevalence was examined in 25 studies spanning eight countries, indicating a broader and higher prevalence for depres-sion prevalence(Hong and Buntup, 2023).
In a systematic review that included data from 34 countries, the pooled prevalence of any antepartany anxiety disorder was 15.2%,while the prevalence of antepartany anxiety symptoms was 22.9%.
Postnatally, the overall prevalence of anxiety symptoms between 1 and 24 weeks was 15.0%, while the prevalence of any anxiety disorder during this period was 9.9%, and generalized anxiety disorder occurred in 5.7%(Dennis et al.,2017).
3. Asia-Pacific regional status of perinatal mental health provision
There is varied information on perinatal mental health(PMH) from Asia-Pacific countries, and the available evidence from South and East Asia highlights an urgent need for intervention(Lemon et al., 2024).Proven models of PMH care exist in South and East Asia, such as Mother Baby Units in India and Sri Ianka(Chandra et al.,2015). Countries like Hong Kong, Singapore, Malaysia, and Taiwan integrate outpatient psy-chiatric services into public health systems, while Malaysia and Indonesia rely on consultation-liaison psychiatrists. Nepalese non-governmental organisations run programs like the SMILE Mother Project, but these are outside the public health system. Thailand man-dates antenatal depression screening but lacks standardized treatment and consistent outcome monitoring(Phoosuwan et al., 2018; Tang-charoensathien et al., 2018; The 2nd National Reproductive Health Development Policy and Strategy(2017-2026)). In East Asian countries like Japan, the 2017 revision of the Japanese Maternal and Child Health Act required the creation of Comprehensive Support Centers for Child-rearing Generations in every municipality across Japan(Japan Association of Obstetricians and Gynecologists). However, mental health support has become fragmented due to challenges in information sharing and collaboration between medical institutions and local gov-ernment agencies(Suzuki, 2024). Comparatively, in Australia, there is a range of private and public community-based specialised perinatal mental health services offering expert, multi-disciplinary management of perinatal mental health disorders in the community, with the provi-sion of parent-infant intervention and care for the father in some areas(TRANZCO P,2021), as well as a recently published national guidelines on perinatal mental health (COPE, 2023).
Despite the critical importance of perinatal mental health, recogni-tion and support vary significantly across many Asian countries. A 2011 Lancet commentary highlighted the"lack of attention and investment" in mental health, along with the incomplete implementation of policies(Maramis et al., 2011). Over a decade later, a scoping review of Southeast Asian nations reported that"maternal depression during pregnancy or the postpartum period still remains neglected," with no standard guidelines for maternal mental healthcare services(Hong and Buntup, 2023). While some South Asian and Southeast Asian countries have established frameworks, others face limitations due to cultural and infrastructural barriers. In Malaysia, midwives conduct regular perinatal home visits to provide early detection and basic healthcare, but they lack formal training in mental health. Obstetricians may offer psycho-education and informal supportive counselling(Raaj et al., 2023). In Indonesia, mothers receive at least four postnatal visits by community health workers, or kaders, who support, detect early signs, and make referrals within a task-sharing model, but there is limited capacity for specialized interventions(Rosmawati and Das, 2018). In Laos, village health volunteers provide primary healthcare, though male volunteers may struggle to engage pregnant women effectively(Toyama et al.,2021).
In Thailand, public hospitals offer free antenatal care, including depression screening, though the tool used-a two-question, non-
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specific questionnaire-is not validated for this purpose(Phoosuwan et al.,2020).In Vietnam, patients without private health insurance can only access specialist care through referrals from commune health centers, which have minimal capacity to screen for or manage mental health disorders(Abrams et al., 2016). In India, auxiliary nurse mid-wives provide perinatal care, yet over half lack adequate knowledge of perinatal mental health issues and cannot identify symptoms of severe mental illnesses. Additionally, there is a general lack of awareness about the importance of routine perinatal mental health screening among obstetricians and other healthcare workers(Poreddi et al., 2021). In Myanmar, postpartum depression has been reported at a relatively high prevalence of 31.8%. However, there are no standardized or specific guidelines for maternal mental healthcare services, and this critical area remains largely neglected(Myo et al., 2021). While in Vietnam,screening maternal wellbeing and distress using standardised validated routine especially during antenatal care is rarely performed in routine practice(Van Ngo et al., 2018).
Given these challenges, there is a clear regional need for compre-hensive guidelines to improve perinatal mental healthcare. Such guidelines should advocate for validated screening tools, well-structured screening programs, and sufficient training for mental health providers to ensure early detection and intervention for mothers with depression.
This manuscript builds on the ongoing work of the Asia-Pacific Perinatal Mental Health Guidelines on Depression and Anxiety Com-mittee, which aims to establish region-specific recommendations for both healthcare professionals and the general public. The objective is to unify and strengthen the Asia-Pacific region's commitment to support-ing optimal mental health for women experiencing depression and anxiety from preconception through the first year postpartum. The guidelines place a strong emphasis on lifestyle changes and community-based strategies that can be integrated into various healthcare settings,regardless of whether a formal maternal mental health care system is in place. This is in line with the recommendations for integrating task-shifted, non-specialist based, mental healthcare into the existing maternal healthcare programme, particularly in resource strapped communities, as a viable and sustainable cost-effective approach in addressing maternal mental health(Sivakumar et al.,2023;Jayasinghe et al.,2024).This report outlines the process and outcomes of devel-oping the Asia-Pacific Consensus Statement on Perinatal Mental Health Guidelines on Depression and Anxiety, with plans for a review and po-tential update in 2035.
4. Methods
4.1. Timeline and process
In June 2022, a core leadership workgroup was convened, consisting of psychiatrists specializing in perinatal mental health and clinical counsellors from KK Women's and Children's Hospital(KKH), National University Hospital, and the Institute of Mental Health in Singapore. A balanced perspective was ensured through contributions from a senior paediatricanneonatologist, obstetrician-nyaecognists, and a public health administrator.
Regular discussions were conducted to evaluate the evidence for Asia-Pacific guideline development, based on a literature review of the perinatal healthcare system in the Asia-Pacific region, and evidence conducted for the Singapore Perinatal Mental Health Guidelines on Depression and Anxiety(Chen et al., 2023). In January 2023, a consensus expert panel, including members experienced in local and regional perinatal mental healthcare delivery, was formed. Recom-mendations were finalized during a virtual meeting held on 18 February 2023. The timeline and development process are illustrated in Fig. 1.
4.2. Search strategy and selection criteria
The evidence reviews conducted for the development of the
 Asia Pacific Consensus Panel formed
January 2023
ADOLOPMENT of draft recommendations by core leadership group
Review of draft recommendations by Consensus Panel
February 2023
Finalized recommendations
Fig. 1. Timeline and process involved in development of the Asia Pacific consensus statement on the Perinatal Mental Health Guidelines on Depression& Anxiety.
Singapore Perinatal Mental Health Guidelines on Depression and Anxi-ety, utilizing the UK National Institute of Health and Care Excellence(NICE) guidelines on antenatal and postnatal mental health, as well as relevant literature published in MEDLINE, PubMed, and Google Scholar between 2002 and 2021, were integrated into the literature review to inform the development of the Asia-Pacific guidelines(Chen et al.,2023).
4.3. Limitations
Since only studies published in English were included, there is a slight possibility that research published in other languages within the Asia-Pacific region may have been overlooked. However, it is unlikely that such omissions would have significantly influenced the recom-mendations, given the broad representation of Asia-Pacific experts on the committee. Additionally, the use of the GRADE framework poses another limitation, as it tends to more readily downgrade evidence derived from epidemiological observational studies. Lastly, given the wide-ranging differences in cultural factors, health system variability,and resource constraints across the Asia-Pacific region, potential bar-riers and facilitators to implementing these guidelines in low-resource settings are numerous and cannot be addressed within the scope of this paper. Hence the guidelines aim to provide a framework for com-munities to adopt where possible considering local capabilities, with holistic approach highlighting support and lifestyle modifications rec-ommended as a first step.
4.4. Grading of evidence and recommendations
The Grading of Recommendations Assessment, Development, and Evaluation(GRADE) method was used to assess the quality of evidence and the strength of recommendations. Ratings from referenced guide-lines were also reviewed. To ensure a structured and transparent approach to healthcare decision-making, the GRADE-ADOLOPMENT framework was utilized(Balshem et al., 2011). This process involved defining the public health question, reviewing relevant resources,evaluating the evidence, and formulating healthcare recommendations
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(Schunemann et al., 2017). The workgroup used a combination of adoption(verbatim use), adaptation(contextual modifications) and unique development/addition, while ensuring regional appropriateness,in keeping with the process of“adoploment”. The GRADE framework is available in the supplementary materials of this manuscript.
The public health question was designed from the perspective of healthcare providers, aiming to ensuring optimal mental health for women with depression and anxiety during the preconception, antenatal and postnatal periods in the Asia-Pacific region. The conclusions drawn from assessments of all criteria supported the recommendations, with evidence rated as at least moderately certain.
4.5. Expert panel voting
The consensus panel comprised members of the Asia-Pacific Peri-natal Mental Health Guidelines on Depression and Anxiety. The number of representatives included 11 Asia-Pacific nations/jurdisities Australia, China, Hong Kong, India, Indonesia, Japan, South Korea,Malaysia, Sri Lanka, Thailand and Singapore. The consensus session was conducted virtually on 18th February 2023 at the Asia-Pacific Maternal and Child Health Conference and Integrated Platform for Research in Advancing Maternal and Child Health Outcomes(IPRAMHO) Interna-tional Meeting 2023. During the consensus process, each recommen-dation was presented to the panel and revised according to comments from the experts. This was followed by an online vote of“yes” or“no” to endorsing the recommendation. Each expert was allocated one vote per recommendation, and a consensus agreement was reached when 85%or of more of the votes were affirmative. All 15 reviewed recommendations received a majority agreement.
4.6. Role of funding source
Funding source is not involved in writing of the manuscript or the decision to submit it for publication.
4.7. Consensus statement
1. Increase awareness and provide advice on preconceptional mental health
(a) Provide advice on pregnancy planning
Supporting paragraph
There is a need to increase awareness about preconceptional mental health and to provide advice on pregnancy planning or contraception, as the situation requires. This is particularly important for women and adolescents with childbearing poten-tial(hereafter referred to as‘preconceptional women’) with a past or current depressive or anxiety disorder, as they are particularly vulnerable to the stress of an unplanned pregnancy.They are at risk of antenatal relapse, especially if they conceive unintentionally.
Having a previous history of depression or anxiety is a well-established risk factor for antenatal depression or anxiety(Biaggi et al.,2016) and unintended pregnancy is a risk factor associated with perinatal depression(Abajobir et al., 2016).Particularly, in low-income populations, the impact of depres-sion on women's use of contraception and degree of pregnancy planning calls for higher integration of mental health care into family planning services, as there is a greater risk of unplanned and ambivalent pregnancy(Catalao et al., 2023).
(b) Provide preconceptional counselling on impact of maternal mental illness and treatment
Supporting paragraph
Preconceptional women with a severe depressive or anxiety disorder should be advised about how their condition and its treatment might affect them and their baby in case of pregnancy(McCloskey et al., 2021). Such advice should be tailored to their
individual needs and illness pattern so they can make informed decisions about family planning and pregnancy.
2. Optimize preconceptional mental health
(a) Have a holistic approach to preconceptional mental health Supporting paragraph
Other than psychotropic medication, non-pharmacological approaches such as psychological therapies, social stressor intervention and strengthening the couple relationship also contribute to optimal preconceptional mental health and can help minimize required doses of psychotropic medication.Identifying healthy women at risk along with appropriate referral for social and psychological interventions during the preconception visit might prevent the emergence of anxiety and depressive disorders during pregnancy and postpartum(Frieder et al.,2008). A systematic review and meta-analysis found that interventions specifically targeting women of reproductive age suffering from a psychiatric condition show that group-counelling and interventions leading to empowerment of women show a trend towards lowering of depression(Lassi et al.,2014), whilst coping skills training significantly lower depres-sion levels, with lasting benefits at the 1-yr follow-up(Rychtarik and McGillicuddy, 2005). Addressing any couple conflicts is particularly important as strong couple relationship could ameliorate the risk of depression perinatally(Westdahl et al.,2007).
(b) Make lifestyle adjustments to optimise preconceptional mental health Supporting paragraph
Healthy lifestyle adjustments are recommended for pre-conceptional women with pre-existing depressive or anxiety disorders(van Lee et al., 2020). These recommendations should be personalized to meet individual needs and may involve adopting a whole foods-based diet, managing weight, quitting smoking, avoiding alcohol, and taking folate supplements to support both maternal mental health and fetal development.Engaging in physical activity, regular exercise, and mindfulness practices can further help alleviate symptoms of depression and anxiety while enhancing overall well-being(Dennis et al.,2022).Nutritional deficiencies among women in low-income countries can be prevalent, particularly among women with mental illness,soietary supplements of iron and folic acid are recommended preconception(Nanjundaswamy et al., 2022).
(c)Evaluate medication use in consideration of childbearing
Supporting paragraph
As far as possible, clinicians should select medication that maximises fetal safety for preconceptional women who may require long-term psychotropic treatment. Sodium valproate(a mood stabilizer), in particular, is a well-known teratogen, and its use should be restricted to when there are no other effective or tolerable alternatives(Shakespeare and Sisodiya, 2020). As maternal mental health state tends to remain consistent from conception to pregnancy, minimum effective doses of psy-chotropic medication should be used. Any medication cessation should be carefully discussed. The use of valproate in pregnancy has been extensively studied, but more so in women with epi-lepsy. In a recent review published in the Cochrane Library of Systematic Review(Weston et al., 2016), the known risk asso-ciated with sodium valproate exposure was clear across com-parisons with a pooled prevalence of 9.8%(95% CI 8.1-11.9)from cohort data and 9.7%(95% CI 7.1-13.4) from routine health record studies. The risk of spinal, skeletal, cardiac, and facial malformations was found to be elevated across nearly all comparisons with other monotherapy mood stabilizers, with absolute risk differences ranging between 5% and 9%. Identi-fying depressive and anxiety disorders before pregnancy pro-vides an opportunity to discuss treatment options and, if necessary, transition to a regimen that is safer for pregnancy.
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Ensuring the woman achieves and maintains a euthymic state during pregnancy is critical for reducing the risk of adverse outcomes for both the mother and the fetus(Frieder et al., 2008).The recommendation to discuss carefully medication adjust-ments and cessation is important for women with a history of mood or anxiety disorder, as they should be informed about the high risk of relapse(50-75%) when discontinuing maintenance medication(Cohen et al., 2004).
3. Provide screening and assessment for antenatal depression/anxiety
(a) Screen for antenatal depression/ anxiety
Supporting paragraph
Although international estimates vary, evidence from Singapore indicates that antenatal depression is more prevalent than postnatal depression(Chee et al., 2005). Across the Asia-Pacific region, both antenatal and postnatal depression are common; however, pooled data from a systematic review and meta-analysis of studies in low- and middle-income countries,including those in East Asia and the Pacific, found a higher prevalence of antenatal depression(26.3%) compared with postnatal depression(23.1%)(Roddy Mitchell et al., 2023).These findings underscore the importance of screening for depression during pregnancy, as antenatal depression not only affects maternal well-being and increases the risk of persistent depressive symptoms into the postpartum period, but is also associated with adverse obstetric outcomes and is a significant risk factor for postnatal depression(Norhayati et al., 2015).Obstetric visits provide an ideal opportunity for screening,facilitating timely intervention before delivery(Marcus et al.,2003). Appropriate screening instruments for antenatal depres-sion include the two-item Patient Health Questionnaire(PHQ-2)(Marcus et al.,2003) and Edinburgh Postnatal Depression Scale(EPDS)(Cox et al., 1987). While there is no robust evidence supporting a specific screening instrument for antenatal anxiety,the two-item Generalized Anxiety Disorder(GAD-2)(Kroenke et al.,2007) may be used in conjunction with clinical assessment.
(b)Assess for antenatal depression/ anxiety for women with positive screens
Supporting paragraph
Clinical diagnoses should be based on diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5)(DSM; currently in its fifth edition, text revi-sion)(American Psychiatric Association, 2013) or International Classification of Diseases(ICD-11)(World Health Organization,2019). Clinicians should assess for risk of harm(to self and others, including baby) and consider holistic aspects of care such as other psychiatric co-morbidities, medical and obstetric health,interpersonal relationships, care of older children, financial and occupational stressors, lifestyle practices and maternal bonding and anxiety
4. Optimize care, treatment and support for antenatal depression and anxiety
a. Provide a holistic approach to care for patients with antenatal depression/ anxiety
Supporting paragraph
Care providers should coordinate care and provide patients with information on potential benefits and side effects of treat-ment and consequences of untreated illness(such as poor maternal health, lower quality of life, difficulties with social re-lationships, poor mother-infant bonding, and poor overall devel-opment of the infant)(Slomian et al., 2019), to enable informed collaborative decision-making about intervention(Donker et al.,2009). Care providers are encouraged to give lifestyle advice on diet, sleep, physical activity, smoking and social support, as these measures help prevent and reduce antenatal depressive symptoms(van Lee et al., 2020). Non-pharmacological interventions such as supportive counselling,psychological therapy and group therapy
may be beneficial(Bowen et al., 2014). An example of an evidence-based approach, the Thinking Healthy Programme(THP), a low-intensity psychosocial intervention for perinatal depression successfully implemented in low-resource settings, has been endorsed by WHO(Sikander et al., 2019; World Health Or-ganization, 2015).
b. Optimise medication advice and use in antenatal depression/ anxiety Supporting paragraph
Clinicians should prescribe antidepressants for pa-tients with moderate to severe illness or at risk of clinically sig-nificant relapse, with good informed consent after weighing the impact of illness and medication on both mother and fetus, pre-vious response to treatment, stage of pregnancy and patient preference(Yonkers et al., 2009). Although selective serotonin reuptake inhibitors may be considered, clinicians should be aware of the risk of fetal septal defects, particularly with Paroxetine, and should provide this information to patients and discuss the rele-vant risks and benefits(Molenaar et al., 2018). Good prescribing practices include using lowest effective doses aiming for symptom remission, divided over the day if necessary, avoiding first-trimester use if possible, and frequent regular reviews(UK National Institute of Health and Care Excellence Guidelines on Antenatal and postnatal mental health, 2014).
c. Monitor and facilitate support for women receiving care for antenatal depression/anxiety
Supporting paragraph
Care providers should monitor patients regularly for symptom progression and treatment response(UK National Institute of Health and Care Excellence Guidelines on Antenatal and postnatal mental health, 2014), and consider referral to tertiary perinatal psychiatric services or women with severe illness, or with illness not responding to treatment. Encouraging social and emotional support from their partners(Dunkel Schetter, 2011) and family can help reduce mood symptoms(Spoozak et al., 2009).
5. Provide screening for postnatal depression/ anxiety
(a) Screen for postnatal depression/ anxiety
Supporting paragraph
Obstetric visits(McKinney et al., 2018) and routine well-child visits to the paediatric or primary healthcare provider are opportune times for maternal screening(Earls, 2010). Screening is particularly important for women with risk factors for postnatal depression/ anxiety. These include antenatal depression/ anxiety,recent stressful life events and inadequate social support(Beck,2001). Appropriate screening instruments for postnatal depression include the PHQ-2(Kroenke et al., 2003) and EPDS(Cox et al.,1987). While there is no robust evidence supporting a specific screening instrument for postnatal anxiety, the GAD-2 may be used in conjunction with clinical assessment(Kroenke et al., 2007).
(b) Assess for postnatal depression and anxiety
Supporting paragraph
Clinical assessments should follow the diagnostic guidelines out-lined in the DSM-5-TR(American Psychiatric Association, 2013) or ICD-11(World Health Organization, 2019). Practitioners should evaluate any potential risks, including harm to the individual, others,or the infant, and adopt a comprehensive approach to care. This includes considering co-existing psychiatric conditions, overall medical and obstetric health, relationship dynamics, responsibilities for other children, financial and work-related pressures, lifestyle habits, and the mother's bonding with her baby.
6. Optimize care, treatment and support for postnatal depression and anxiety
(a) Provide a Holistic approach to care for patients with postnatal depression/anxiety
Supporting paragraph
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Care providers should coordinate care and provide patients with information on potential benefits and side effects of treatment and consequences of untreated illness(such as poor maternal health, lower quality of life, difficulties with social relationships, poor mother-infant bonding, and poor overall development of the infant)(Slomian et al.,2019), to enable informed, collaborative decision-making about inter-vention(Donker et al., 2009). Care providers are encouraged to give lifestyle advice on healthy eating, physical activity and sleep hygiene(Austin et al., 2017). Non-pharmacological measures such as supportive counselling, cognitive-behavioural therapy and interpersonal psycho-therapy should be considered(Austin et al., 2017; UK National Institute of Health and Care Excellence, 2020), as should interventions to improve mother-baby bonding, if indicated(UK National Institute of Health and Care Excellence, 2014).
(b) Optimise medication advice and use in postnatal depression/ anxiety
Supporting paragraph
Patients should be counselled on risks and benefits of psychotropic medications, including potential consequences of untreated illness and adverse side effects of antidepressants. They should be supported in their decision about breastfeeding. Clinicians should be aware that an-tidepressant use is not an absolute contraindication to breastfeeding(Brown et al., 2021).
(C) Monitor and facilitate support for women receiving care for postnatal depression/anxiety
Supporting paragraph
Care providers should monitor patients regularly for symptom pro-gression and treatment response(UK National Institute of Health and Care Excellence Guidelines on Antenatal and postnatal mental health,2014), and consider referral to tertiary perinatal psychiatric services for women with severe illness, or with illness not responding to treatment.Encouraging social and emotional support from their partners and family can help reduce mood symptoms(De Sousa Machado et al.,2020).
7. Address Mental Health Following Severe Maternal Events and those with mental health needs.
Supporting paragraph
The risks of depression, anxiety and post-traumatic stress dis-order are higher in women who have had a severe obstetric complication such as massive haemorrhage, hypertensive crises,eclamptic seizures, sepsis, thrombotic events, cardiovascular failure, stillbirth or intrauterine death(Furuta et al., 2014).Support should be provided for these women as well as their healthcare providers, who might experience emotional effects of severe adverse events. Additional support, such as counselling,may be warranted where clinically indicated. There should also be a strong emphasis on the need for heightened awareness of postpartum psychosis, particularly within the first month post-partum when the risks of suicide and infanictide are greatest. This is especially important for individuals with a prior history of postpartum psychosis or a family history of bipolar disorder(Perry et al.,2021). Early identification and appropriate referral are critical to ensuring timely intervention and safeguarding the wellbeing of both mother and infant(Morton et al.,2021).
8. Customise Perinatal Mental Health Support for Adolescents and Vulnerable Populations
Supporting paragraph
Care delivery should be tailored to address the needs of vulnerable mothers(D'Angelo et al., 2020) and adolescents, as they may have higher risks of perinatal depression(Siegel and Brandon, 2014). Additional effort to provide information and support, for example through use of simple language and patient repetition, may mitigate the development of perinatal depression and anxiety.
9. Enhance higher caregiving quality for perinatal and infant mental health needs
Supporting paragraph
Maternal mental health can influence maternal attunement and sensitivity to infant needs(Rifkin-Graboi et al., 2015) and maternal mind-misdedness(Bigelow et al., 2018), which in turn are related to quality of caregiving and subsequently infant neurodevelopment. Even in the presence of depression/ anxiety,mothers are encouraged to spend quality time with their babies by following baby's cues and keeping mindful of baby's needs.Consciously staying present, watching and wondering about the baby can improve maternal reflective capacity(Bakermans-Kranenburg et al., 2003). In contrast, reduced maternal attunement, reduced child responsiveness to mother and restricted growth and development are red flags for dyadic dysfunction(Tsang et al., 2019). In postnatal primary care, it is important that concerns about mother-infant attachment are addressed alongside the treatment of any maternal mental health issues. Interventions may include individual or group therapy,with the aim of supporting the developing parent-infant rela-tionship and promoting optimal outcomes for both mother and child(de de Camps Meschino et al.,2016;Irvine et al.,2021).10. Integrate the above recommendations into the healthcare framework.
10. Integrate the above recommendations into the healthcare framework.
Supporting paragraph
The healthcare sector should work towards embedding these rec-ommendations across the preconception, antenatal, and postnatal stages within the existing healthcare system, making use of every opportunity to deliver care and guidance for optimal outcomes. Recognizing that healthcare services may differ in resources and care delivery, these guidelines are designed to support maternal and child health pro-fessionals in Singapore as part of a coordinated approach to enhancing perinatal mental health, ultimately benefiting child development and well-being(Ministry of Health, 2022).
Alongside the release of these recommendations, efforts have commenced to raise public awareness and provide education, along with strengthening continuing medical education for the primary care network. Looking ahead, plans include conducting surveys among healthcare providers and the general population to assess the uptake of these guidelines and determine whether clinical practices have evolved in line with the proposed recommendations.
5. Conclusion
The Asia-Pacific region is susceptible to worsening healthcare burden and mortality caused by perinatal mental health conditions that are still underrecognized and undertreated. The World Health Organi-zation(WHO) advocates for mental health and social care services in community-based settings that are evidence-based, cost-effective, and grounded in human rights, emphasizing early identification and treat-ment of maternal mental health disorders(World Health Organization,2024). These guidelines offer the latest evidence-based recommenda-tions on raising awareness, providing advice on perinatal mental health,conducting screening and assessment, and optimizing care and treat-ment. We hope that with these recommendations, authorities of nations in the Asia-Pacific region will support the development of programmes in a collective effort to improving perinatal mental health with direct benefits on child health and well-being.
Summary
Statement 1
Increase awareness and provide advice on preconceptional mental health
(a) Provide advice on pregnancy planning
(b) Provide preconceptional counselling on impact of maternal mental illness and treatment
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Statement 2
Optimize preconceptional mental health
a) Have a holistic approach to preconceptional mental health
b) Make lifestyle adjustments to optimise preconception mental health
c) Evaluate medication use in consideration of childbearing
Statement 3
Provide screening and assessment for antenatal depression/anxiety
(a) Screen for antenatal depression/ anxiety
(b) Assess for antenatal depression/ anxiety for women with positive screens
Statement 4
Optimize care, treatment and support for antenatal depression and anxiety
(a) Provide a holistic approach to care for patients with antenatal depression/ anxiety
(b) Optimise Medication advice and use in antenatal depression/anxiety
(c) Monitor and facilitate support for women receiving care for antenatal depression/anxiety
Statement 5
Provide screening for postnatal depression/ anxiety
(a) Screen for postnatal depression/ anxiety
(b) Assess for postnatal depression and anxiety
Statement 6
Optimize care, treatment and support for postnatal depression and anxiety
(a) Provide a Holistic approach to care for patients with postnatal depression/repression/ anxiety
(b) Optimise Medication advice and use in postnatal l depression/anxiety
(c) Monitor and facilitate support for women receiving care for postnatal depression/anxiety
Statement 7
Address Mental Health Following Severe Maternal Events and those with mental health needs.
Statement 8
Customise Perinatal Mental Health Support for Adsolescents and Vulnerable Populations
Statement 9
Enhance higher caregiving quality for perinatal and infant mental health needs
Statement 10
Integrate the above recommendations into the healthcare framework.
Contributors
All authors contributed to the conceptualisation, literature review,methodology, and review& editing of the manuscript. QPL provided the original draft of the manuscript. All authors approved the final version of the manuscript. Members of the committee contributed to the liter-ature review, consensus process and approval of the revised recommendations.
CRediT authorship contribution statement
Sachith Mettananda: Writing-review& editing. Dittakarn Bor-iboinhirsunarn: Writing- review& editing. Endang Retno Surja-ningrum: Writing-review& editing. Ganeshan Muniswaran: Writing- review& editing. Miland Shah: Writing- review& editing. Tze-Ern Chua: Writing-review& editing, Writing- original draft. Pui-wah Hui: Writing-review& editing. Prabha S Chandra: Writing-review&editing. Chen Yu Helen: Writing-review& editing, Conceptualization.Phaik Ling Quah: Writing-review& editing, Writing-original draft.Kok Hian Tan: Writing- review& editing, Conceptualization. Anne Bust: Writing-review & editing.
Ethical approval
Not applicable.
Funding
Funded by Integrated platform for research in advancing metabolic health outcomes of women and children
Declaration of Competing Interest
The authors declare that they have no competing financial interests or personal relationships that could be perceived to have influenced the work reported in this paper.
Acknowledgements
Funded by Integrated platform for research in advancing metabolic health outcomes of women and children(NMRC/CG/C008A/2017_KKH).
Appendix A. Supporting information
Supplementary data associated with this article can be found in the online version at doi:10.1016/j.ajp.2025.104720.
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