If you ask people what they think the most common medical complication is during and after childbirth, you probably won’t hear mental health issues. Yet perinatal mood and anxiety disorders (PMADs) — including prenatal and postpartum depression and anxiety — top the list, affecting at least one in seven women. In addition to the substantial human toll of these conditions, they come with a hefty price tag, especially because women who have them often go untreated.

Mathematica’s analysis, released today in conjunction with national Maternal Mental Health Week, estimated the national economic costs of these disorders. When following the mother-child pair from pregnancy through five years postpartum, the estimated cost is $14.2 billion for births in 2017, or an average of $32,000 for every mother-child pair affected but not treated. The California Health Care Foundation, the Perigee Fund, and the Zoma Foundation funded this study. In addition to national results, state-specific details are available for California, Colorado, and Washington.

To assess the economic impact of not treating these disorders, Mathematica calculated costs incurred over six years, which included pregnancy through five years after the birth of a child. A little more than half (53%) of the costs, or $7.5 billion, occur in the first year (conception through birth).

“We conducted the most comprehensive analysis yet of the economic burden of perinatal mood and anxiety disorders in the United States,” said Kara Zivin, a senior researcher at Mathematica and the study director. “In addition to health consequences for mothers and children, these conditions are particularly burdensome in terms of maternal productivity loss and increased social services costs.”

Tallying the Toll on Families and Society

Of the $14.2 billion, about 60% of the costs relate to maternal outcomes, and the remaining 40% relate to child outcomes. The most costly components include productivity loss because of an increased likelihood of work presenteeism (that is, mothers might be less productive or more likely to make mistakes at work), absenteeism (that is, mothers missing work), and unemployment ($4.7 billion, or 33% of total costs); preterm birth ($3.3 billion, or 23% of total costs); and maternal health expenditures ($2.9 billion, or 20% of total costs).

When comparing only medical costs of other perinatal conditions, PMADs cost more than $17,000 per mother over six years, whereas postpartum hemorrhage (bleeding) and gestational diabetes (diabetes during pregnancy) each cost up to $3,300 per mother and take place only during pregnancy and childbirth.

“This is a call to action,” said Becca Graves, executive director of the Perigee Fund. “We must screen and treat pregnant women and new parents for these serious and incredibly common illnesses and prevent the onset where we can.”

Close-Up on Costs in California

Untreated PMADs take an economic toll on California’s economy. We estimate that the total societal cost of these conditions in California is $2.4 billion for all births in 2017, when following the mother-child pair from pregnancy through five years postpartum. The three leading individual costs are productivity losses ($816 million), maternal health expenditures ($481 million), and preterm births ($468 million).

Maternal Health Conditions: Common, Yet Undertreated

Although treatment for them is effective and beneficial for mothers and children, PMADs are often ineffectively treated or not treated at all. In fact, according to the recent Listening to Mothers in California survey, only half of perinatal women diagnosed with depressive symptoms receive any treatment.

“Given how common and detrimental these conditions are, it is important for the health care system to consistently support mothers from pregnancy through the first five years postpartum, which will in turn improve the well-being of their children,” said Stephanie Teleki, director of learning and impact at the California Health Care Foundation.

Mothers with untreated PMADs are more likely to deliver preterm and have a cesarean delivery than those without these disorders, which increases health care costs for both delivery and care of premature infants and makes it harder for mothers to return to work. In addition, children of mothers with PMADs have a higher risk of behavioral and developmental disorders themselves, including attention-deficit/hyperactivity disorder, depression, anxiety, and behavioral or conduct disorders such as oppositional defiant disorder.

Professional organizations such as the American College of Obstetricians and Gynecologists; the American Academy of Pediatrics; the American Psychological Association; the Association of Women’s Health, Obstetric and Neonatal Nurses; and the U.S. Preventive Services Task Force recognize the need to act, including by consistently screening for and effectively treating PMADs.

“Helping women and their families access effective and affordable treatment for these disorders will ultimately lessen the overall burden and costs on society, and more importantly, support mothers and infants to thrive,” said Rebecca Alderfer, senior program consultant at the ZOMA Foundation.

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