Critical Assessment of Observational Studies and Shared Decision Making in Perinatal Psychiatry

While mental health problems are common in pregnancy and the postpartum period, there remain a number of barriers to adequate evidence-based care. One important obstacle is the relative lack of evidence regarding the benefits and harms of treatment for perinatal mental disorders. Despite their limitations, observational studies and systematic reviews and meta-analyses of these continue to serve as the main source of evidence guiding treatment decisions. The importance of shared decision making in a field where risks exist in both the acceptance and refusal of treatment cannot be overstated. Therefore, it is critical that health-care providers not only know how to critically assess existing evidence, but base decisions on these assessments, women’s values and beliefs, and their clinical presentations.