Maternal Mental Health: An Underserved Market

Hello!

It’s been a while, but I’m back providing insights and highlighting innovation, startups and underserved markets. Hope you enjoy following along ~ grateful to have you in my community as colleagues, partners, clients and friends!

As this issue aligns with March Women’s History Month, I’d like to shine a light on maternal mental health and share the story of LunaJoy, an integrated platform for women’s mental health at every phase of life.

My hope is this email creates awareness, shift mindsets and further enables action and funding for this underserved market of maternal mental health. If you enjoy reading, please consider sharing with others in your network.

Ok, let’s dive in!

~ Alison 

Maternal mental health refers to a mother’s overall emotional and mental well-being, during and after pregnancy.  

Maternal mental health is also referred to as perinatal mental health, the latter is commonly used by clinicians. Throughout this article, I’ll use these terms interchangeably.

Pregnancy and caring for a newborn baby is typically a joyous and exciting time, but with this new transition, hormonal fluctuations and reduced sleep, it can also be an emotionally difficult time.

During pregnancy, hormonal changes, particularly in estrogen and progesterone, “occur that affect neurotransmitters in the brain, creating shifts in mood and emotional stability. These hormonal changes can contribute to the development or exacerbation of mental health disorders such as anxiety and depression.”¹

This NIH article goes into depth on the neuroendocrine aspects of pregnancy and postpartum depression, highlighting the fluctuating role of estradiol, progesterone, oxytocin, cortisol and thyroid hormones in postpartum syndromes. “For instance, Mothers adapt to lower lowers of estradiol postpartum to help in lactation. But decreased estradiol levels can interfere with mothers’ natural defense against depression.”²

Perinatal mental health is described as perinatal mood and anxiety disorders (PMADs) and can appear gradually or suddenly during from conception through baby’s first year. The two most common perinatal mental health disorders are postpartum anxiety and postpartum depression. 3

Perinatal Mood Anxiety Disorder is different than ‘baby blues’, where ‘baby blues’ is defined as worry, sadness and tiredness that is mild, temporary and occurs in the first two weeks after having a baby, as hormones fluctuate. Up to 85% of women experience ‘baby blues’. ⁴ 

Perinatal mental health disorders are those with symptoms lasting for more than 2 weeks after giving birth.

There are also factors that enable a greater risk of mothers developing perinatal mental health disorders, such as the below: (aamc)

• Personal history or family history of anxiety or depression: “Those with bipolar disorders, depression or anxiety are 30% to 35% more likely to have postpartum depression.”

• Genetics and biological factors

• Sleep deprivation

• Stress and lack of support system

• Trauma including birth trauma

• Poor socioeconomic status

• Environmental factors

Perinatal mental health is common and treatable, however, it is going undiagnosed and untreated at high rates, where nearly 75% of women never obtain treatment.

Lack of treatment is due to many reasons including lack of screening, maternal care deserts, stigma and shame. Not getting treatment can progress to even worse symptoms and mental health conditions.

The prevalence of postpartum depression is 17% among pregnant people, however, new mothers of color experience postpartum mood disorders at twice the rate (38 percent) of white mothers in the U.S., and up to half of them do not receive any support or treatment. 

Of all pregnancy-related deaths, the most frequent underlying cause was mental health conditions at 22.7%, higher than other health causes, and largely preventable with treatment.

Depression that occurs during pregnancy could lead to complications for both mother and baby, such as “slower fetal development, low birth weight, preterm labor, preterm birth, maternal anemia and diabetes, hypertensive disorders (including preeclampsia), cesarean section….” There also a appears to be a higher risk of having a child with autism spectrum disorder (ASD) than women who are not affected regardless of antidepressant use.”⁵ 

However, with treatment, most women will resolve symptoms. Treatment for perinatal mental health includes the following or combination thereof:

• Therapy: Cognitive Behavioral Therapy or Interpersonal Therapy

• Medication: Antidepressants such as selective serotonin reuptake inhibitors (SSRIs)

• Alternative Therapies like acupuncture and massage

• Lifestyle adjustments including eating more nutritious foods, meditation, exercise, sleep and managing stress

While in Atlanta for business, I had the pleasure of meeting Dr. Sipra Laddha, co-founder of LunaJoy, learning about her story and journey in co-founding LunaJoy.

LunaJoy provides accessible, holistic and comprehensive mental health solutions for women at every phase of life, including puberty, pregnancy and menopause. LunaJoy’s behavioral health integration platform is an end-to-end solution, consisting of virtual coaching, therapy and medication personalized to your genetics.

LunaJoy seeks to close the gap between medical and behavioral health, enabling preventive care with earlier screening, detection and access to services. The team wants to provide women the support they need earlier to prevent high need later.

Dr. Laddha is a board certified adult psychiatrist, specializing in perinatal psychiatry. She comes from a line of physicians - her Dad, Mother and Brother are all physicians. Previous to co-founding LunaJoy, Dr. Laddha was working in Emory’s perinatal psychiatry area with expecting and new mothers, helping them through perinatal mood disorders (perinatal anxiety and depression). During her work at Emory, Dr. Laddha became pregnant with twins and during her pregnancy she experienced both perinatal and postpartum anxiety. She remembers talking with family and friends, one of whom was her sister-in-law, Dr. Shama Rathi, about what she was feeling and realized she needed help.

Based on her own pregnancy and physician experience, Dr. Laddha knew more needed to be done for women. She teamed up with Dr. Shama Rathi, also a board certified psychiatrist, and the two co-founded LunaJoy in April 2021.

Traditionally, OBGYNs are not incentivized to screen patients for maternal mental health.  With this understanding, LunaJoy launched a training course for primary care providers and OBGYNs, to better understand their care journey. The goal was to understand the patient experience and incorporate OBGYNs to screen patients for perinatal mental health - if a positive screening, then refer patients to LunaJoy to receive treatment.

After founding LunaJoy in 2021, the team was accepted into Y Combinator cohort for Jan-March 2022 and raised $2.5M in oversubscribed seed round, backed by Goodwater Capital, Asymmetry Ventures and Emmeline Ventures.

In the two years since, LunaJoy has experienced impressive traction growing their OBGYN partners and clinical therapists on the platform, enabling nationwide virtual coaching, expanding medication management and therapy across numerous U.S. states and securing insurance contracts with Cigna, Aetna, Humana and Magellan.

LunaJoy is continuing on their growth path. If you’d like to support LunaJoy’s mission in women’s mental health, below are ways you can contribute:

• Providing awareness and connections to OBGYNs and health system leaders in your network

• Connecting to in-depth knowledge stakeholders, such as doctors and entrepreneurs

The market size of maternal mental health is large, growing significantly and creating an economic burden in health and societal costs.

Market drivers of growth include: increased incidence of postpartum depression, rise in awareness programs, improved practices on maternal mental health and government funding to reduce maternal mortality. ⁶

As mental health conditions continue to increase in the U.S., this becomes a risk factor that could later affect women during or after pregnancy.

Economic Burden

Health and societal consequences for mother and child include lower work productivity, more preterm births, greater health challenges, among other. “The average cost per affected mother-child…was about $31,800.“ ⁷

Perinatal mood and anxiety disorders have not received the attention they deserve by policymakers and healthcare payers in prior years largely “because of the lack of published evidence on costs of untreated PMADs.” ⁷ This NIH study published in 2020 is the first to provide a comprehensive economic burden of PMADs in the United States.

While maternal mental health is a large market, affecting 1 in 5 women in the U.S. and posing devastating consequences, there is currently no medical standard of care.

And symptoms may go unnoticed at doctor appointments.

“The American College of Obstetricians and Gynecologists recommends screening at least three times during the perinatal period, but many physicians still don't provide it. In fact, fewer than 20% of perinatal patients report being asked about their mental health, according to an analysis of insurer data.” ⁸ 

And behavioral specialists are not necessarily equipped with training specific to perinatal mental health.

Furthermore, 7 million American women live in maternal care deserts or have limited maternity care services. In America, there are 1,119 U.S. counties that do not have one single OB-GYN.  

These further impact maternal mental health with lack of access to care and screening for maternal mental health.

Even if a mother had access to screening performed by a doctor, there are still challenges to obtaining maternal mental health care, including:

• Shortage of behavioral health professionals and long wait lists

• Affordability of care

Below are continual opportunity areas that will help in identifying, screening and treating maternal mental health disorders.

• Training OBGYNs in screening patients for PMADs

• Educating and training primary care doctors to recognize symptoms of perinatal anxiety and depression

• Extending Medicaid coverage from 60 days to 12 months postpartum. As of April 2023, 31 states and D.C. have extended Medicaid postpartum coverage to 12 months.

• Artificial Intelligence to provide risk stratification for women, so women can get help faster

In recent years there has been more policy action, highlighting these key timings below. As more data and research is amassed, my hope is continued funding and innovations in maternal mental health.

If you or a woman you know is struggling with maternal mental health, please seek help.  

• National Maternal Mental Health hotline, 1-833-TLC-MAMA, established in 2021 for free, confidential, 24/7 support before, during and after pregnancy. 

• Postpartum Support International (PSI) is dedicated to helping families suffering from postpartum depression, anxiety, and distress.

Thank you for reading!  ❤️  

Research Sources:

• ¹ Transformations Care Network

• ² NIH

• ³ 2020Mom.Org

• ⁴ CDC

• ⁵ NIH

• ⁶ Grandview Research 

• ⁷ NIH

• ⁸ 2020Mom