Estimated read time: 6-7 minutes
As Americans celebrate the moms in our lives, health professionals here in Utah are increasing their commitment to improving the treatment and understanding of the mental health challenges experienced by women during and after a pregnancy.
Every year In the United States, it is estimated that more than 400,000 babies are born to individuals who are depressed. Postpartum depression often goes undiagnosed and untreated, according to the most recent statistics gathered nationally and locally. Research has confirmed an alarming trend. Maternal mental illness is now considered to be the leading cause of pregnancy-related deaths in the U.S.
Nationally, one in five women suffer from perinatal and postpartum mood disorders. Here in Utah, statistics show this is about more than psychological struggles. From 2015 to 2016, 75% of pregnancy-related deaths in the state were associated with a mental health condition—and many of them were preventable.
"Until 2022, in 14 states including Utah, suicide and overdose were the two most common reasons women died in the first year postpartum," according to Jamie Hales, LCSW, clinical manager at Huntsman Mental Health Institute (HMHI) and co-chair of the board for Postpartum Support International Utah.
In March, the state extended comprehensive Medicaid coverage to postpartum women from 60 days to a full 12 months. Motherhood certainly doesn't end at delivery and it doesn't end 60 days after a baby is born. The effort to expand Utah's Medicaid coverage was supported by lawmakers in the State Senate and House of Representatives during the 2023 session.
"This is something that Utahns are actually paying attention to," said Utah State Representative Rosemary Lesser, MD, who is an OB/GYN. "When I would be caring for women under Medicaid, we would be scrambling to accomplish our health care goals by 60 days."
Applying for Medicaid is not easy. But it can be well worth the effort. The federal poverty level for an individual is $14,580. Today, the average U.S. birth costs between $10,000 and $16,000. It is not difficult to see why women dealing with postpartum mental health issues can often struggle to get the long-term care they so desperately need.
As a result of the federal government's approval of Utah's expanded Medicaid coverage, an additional 4,000 women in the state will now be eligible for an entire year of postpartum coverage. Medicaid currently covers 41% of all births in the United States, and with the approval of Utah's plan, 691,000 women across 45 states, the District of Columbia, and the U.S. Virgin Islands will have a longer lifeline to postpartum care.
U.S. Secretary of Health and Human Services Xavier Becerra applauded Utah and the state's medical community for getting behind this critical program. "With this step, thousands of women in Utah will now have the security and peace of mind that continuous coverage provides, during one of the most important times in a new parent's life," he said.
If left untreated, postpartum mood disorders can negatively affect the critical period in which women recover from childbirth, address any complications from their delivery, bond with their newborn, and make the transition from obstetric to primary care. This is why the conversations surrounding postpartum depression are vital. Women here in Utah will now benefit from greater access to health care professionals in the postpartum period.
These conversations can clear the way for individual women to make choices about their treatment. "We can talk about everything from conservative options like improving sleep and diet, getting outside, and doing some form of exercise," said Lauren Gimbel, MD. "We can also talk about therapy, and for some individuals, we talk about medications." Gimbel provides obstetrics and gynecology care to patients at University of Utah Health. She is also the clinical obstetrical lead of perinatal mental health at U of U Health in collaboration with HMHI.
Gimbel added that the most effective form of treatment is normally using all these strategies, with a combination of therapy and medications being the most effective. Medication is another area where there has been significant progress over the past year. In August 2023, the Food and Drug Administration approved Zuranolone (Zurzuvae), the first oral drug for postpartum depression, and it became available for prescription in December.
The once-daily pill is taken for 14 days at home and acts much quicker than other antidepressants. Typically, antidepressants can take two to four weeks to show improvement in symptoms, and some patients simply do not want to use traditional antidepressants. "For some patients, the main advantage of Zuranolone may be that it works faster," Gimbel said.
Providers and their patients voiced concerns after Sage Therapeutics, the developer of Zuranolone, announced the wholesale cost of a 14-day treatment would be $15,900. However, as of March 1, 2024, Zuranolone is covered under Utah Medicaid's list of prior authorized drugs. As far as private insurance plans, a health care professional can explain that you need Zuranolone and request an exception, even if the drug is not currently listed as covered.
Gimbel hopes researchers will now take the time to study the long-term response to Zuranolone by women currently on the drug. During FDA trials, patients were only studied for 45 days. "Anytime someone is treated with an antidepressant and has good results, we really try to make sure they have that stability anywhere from 6 to 12 months once their mood is stable," she said. "This decreases the chances of reoccurrence."
The message sent through all this work by caring people at both the state and federal level is simple: Mothers matter.
With broader access to care, new interventions, and insurance coverage through every stage of pregnancy, the goal of healthier, happier parents and babies can be realized here in Utah and across the country.
If you or someone you know may be struggling with perinatal/maternal mental health issues, you can learn more about programs addressing maternal mental health and find a provider through the Huntsman Mental Health Institute. For a list of local agencies and support groups available, visit Postpartum Support International Utah.
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