Maternal Mental Health Outcomes Research Articles

Treatment for substance use disorder in mothers of young children: A systematic review of maternal substance use and child mental health outcomes.

Substance use disorders (SUD) in mothers of young children can negatively impact the family unit and promote the intergenerational cycle of mental health disorders. This systematic review aims to: 1) provide an overview of substance use treatments for mothers of young children (from birth to 5years old); 2) synthesize findings on maternal substance use and child/maternal mental health outcomes; and 3) identify key treatment components. Database searches in Medline, PsycINFO, PubMED, and PsycARTICLES were conducted on May 7th, 2024. A total of 14, 916 articles were identified following duplicate removal. Articles were screened following PRISMA guidelines. Eight articles (n=900) met inclusion criteria. Outcomes of interest included maternal substance use, child/maternal mental health, and treatment components. All studies indicated maternal substance use treatments were at least as, or more, effective in improving maternal substance use and child/maternal mental health outcomes compared to controls. Treatment components included: mother/family mental health, basic needs, parenting skills, occupation/education, operant conditioning, crisis management, and medical education. Operant conditioning was the only treatment component which appeared to positively impact maternal substance use outcomes; no other treatment components were associated with outcomes of interest. This review provides preliminary evidence highlighting the benefits of substance use treatments for mothers of young children on substance use and mental health outcomes. Future randomized controlled trials with harmonized outcome measures and qualitative data that identifies treatment needs of mothers with lived experience are crucial to evaluate maternal substance use treatments and improve treatment development.

The relationship between perceived social support, self-esteem, and postpartum depression among Saudi women: A correlational cross-sectional study

Background: Postpartum depression is a significant mental health concern affecting many women globally, with potential adverse effects on both maternal and infant well-being. Social support and self-esteem are crucial factors influencing postpartum depression, yet their relationships in the context of Saudi Arabia remain underexplored. Objective: This study aimed to examine the relationships between social support, self-esteem, and postpartum depression among women who have recently given birth in Saudi Arabia. Methods: A cross-sectional design was used, with convenience sampling targeting women who gave birth within the past six months. Data were collected between January and February 2023 via an online self-administered questionnaire, which included sociodemographic information and three standardized scales: The Multidimensional Scale of Perceived Social Support (MSPSS), The Rosenberg Self-Esteem Scale (RSS), and The Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics and Pearson correlation coefficients were conducted using IBM SPSS Statistics version 26. Results: The mean score for postpartum depression was 14.81, with a standard deviation of 6.30, indicating a moderate level of depression symptoms. Significant negative correlations were found between social support and postpartum depression (r = -0.54, p = 0.001) and between self-esteem and postpartum depression (r = -0.63, p = 0.001). A positive correlation was observed between social support and self-esteem (r = 0.53, p = 0.001), highlighting the protective roles of these factors. Conclusion: The study emphasizes the importance of improving social support and self-esteem to reduce postpartum depression risk among new mothers. Midwives and healthcare providers should focus on creating supportive environments and strategies that foster both social support and self-esteem. Such approaches will not only improve maternal mental health outcomes but also contribute to a more sustainable and holistic healthcare system by addressing the root factors influencing postpartum well-being.

The Link between Racial, Ethnic, and Socioeconomic Disparities, Maternal Mental Health, and Birth Outcomes

This study sought to understand the link between maternal mental health and birth outcomes, exacerbated by ethnic and socioeconomic disparities among women in the U.S. It was hypothesized that minorities experienced adverse birth outcomes, specifically preterm birth and low birth weight, due to a higher risk for mental health disorders. The study used a data set consisting of 38 participants, two of whom had twins, who utilized a pregnancy and postpartum assessment application called vidaRPM, to produce 41 sets of data. Data from this application were collected and examined for potential relationships between mood alerts (moments of concern for a participant’s mental health) and preterm birth, low birth weight, and high blood pressure. The results did not indicate any significant relationships between mood alerts and any of the physical health indicators analyzed in this project, suggesting that there are more aspects to consider than just ethnicity when conducting a study of this magnitude.

Exploring racial inequalities in maternal mental health outcomes

Abstract Perinatal mental illness affects around 1 in 5 birthing people globally and is associated with adverse outcomes for those affected and their families. Such adverse outcomes are not inevitable and there is now good evidence for a range of both preventive and treatment interventions. There are well-documented inequalities in mental health outcomes across a range of social determinants, including race; such inequalities are also apparent during the perinatal period. There are also racial disparities in mental health care delivery during the perinatal period. Racial inequalities in perinatal mental health are now being recognized as key policy priorities in both the United States and the United Kingdom. This presentation will present routinely collected epidemiological data, investigating the drivers of these racial inequalities in access to perinatal mental health services and associated maternal and child outcomes. It also will present qualitative approaches to exploring current initiatives to reduce inequalities. Findings have the potential to inform the development of culturally sensitive interventions to promote equity in this area for underserved populations in the U.K., U.S., and elsewhere.

Examining the Link Between Delivery Method, Sleep Quality, and Postpartum Depression: Insights from a Prospective Study

This study investigates the prevalence of postpartum depression (PPD) among 200 women who delivered at Government Women’s Hospital, Dharashiv, from October 2023 to March 2024. The findings reveal a half-year prevalence of PPD at 13% for vaginal deliveries and 26% for cesarean deliveries, resulting in a pooled prevalence of 22% in India. This figure is notably higher than the 12.9% reported in high-income countries and aligns with the 19.2% prevalence found in low- and middle-income nations. The study highlights the challenges faced by mothers in accessing adequate postpartum care, especially given the short hospital stays and low rates of follow-up visits, which contribute to undetected mental health issues. Urban mothers exhibited higher rates of PPD, potentially due to factors such as overcrowding and increased stress. The mean age of affected mothers was 28.05 years, with no significant associations found between PPD and socio-demographic variables like family type or maternal education. Notably, a prior history of depression was linked to higher prevalence rates. These findings underscore the urgent need for enhanced screening and intervention strategies for PPD in India, particularly for vulnerable populations, to improve maternal mental health outcomes and overall family well-being.

A Scoping Review of Multimodal, Dyadic Early Relational Health Interventions in NICUs in the United States.

Early relational health (ERH) interventions can buffer toxic stress and improve the developmental trajectories of neonatal intensive care unit (NICU) infants. The purpose was to examine the current state of the science related to multimodal, dyadic ERH interventions implemented in the NICU setting in the United States and identify gaps in the current literature. PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo were searched in November 2022 and November 2023 for original studies and conference proceedings from 1970 to present in the English language. Gray literature searches were performed in February 2023 and December 2023. English language, original research, with a focus on multimodal, dyadic ERH interventions that took place primarily in a NICU in the United States were included. Outcome measures could be related to implementation, relational health, or physical and/or mental health outcomes of parent and/or infant. Eighteen of 2021 reviewed articles met the inclusion criteria. Data were extracted for author, year, intervention, purpose, methods, sample, paternal inclusion, dyadic components, non-dyadic components, and major outcomes/results and distilled for study characteristics, multimodal, dyadic intervention characteristics, and outcome measures. Several multimodal dyadic interventions exist to aid ERH in the NICU, providing evidence of improved outcomes for infants and families. More research is required using higher sample sizes and replication studies. ERH interventions show promise in improving neurodevelopmental, behavioral, and maternal mental health outcomes and should be considered for implementation into NICU services.

Exploring the intersection of polygenic risk scores and prenatal alcohol exposure: Unraveling the mental health equation.

Prenatal alcohol exposure poses significant risks to offspring mental health. However, the interplay between genetic predispositions to mental health disorders and prenatal alcohol exposure remains incompletely understood, limiting our ability to develop effective interventions for these conditions. Data from the Adolescent Brain and Cognitive Development (ABCD) Study were analyzed to explore associations between polygenic risk scores (PRS) for mental disorders and maternal alcohol consumption during pregnancy. Logistic regression and structural equation modeling were utilized to assess these relationships. Maternal alcohol consumption after pregnancy awareness was significantly associated with an increased genetic risk for specific mental health disorders, particularly bipolar disorder in offspring. The relationship between maternal alcohol consumption and mental health outcomes was influenced by polygenic risk scores, with both externalizing and internalizing problems being affected. Our findings highlight the specific interaction between increased genetic risk for bipolar disorder and prenatal alcohol exposure in shaping offspring mental health outcomes. The significant associations we observed underscore the importance of considering both polygenic risk scores and prenatal alcohol exposure when assessing mental health risks in children. These insights emphasize the need for targeted interventions that address both genetic predispositions and environmental exposures to better understand and mitigate the impact on offspring mental health.

A systematic review of postpartum psychosis resulting in infanticide: missed opportunities in screening, diagnosis, and treatment.

Impacting 1 in 1000 women, untreated postpartum psychosis is associated with a 4% infanticide rate. This systematic review aims to identify factors that are associated with infanticide resulting from psychosis in the puerperal period and pinpoint areas of missed opportunity for intervention. A systematic literature review was conducted in accordance with PRISMA guidelines to identify and synthesize cases of maternal infanticide among perinatal females with evidence of postpartum psychosis. Four independent reviewers screened 231 articles identified in searches of three databases (PsycInfo, PubMed, and Web of Science) for studies conducted from 2013 to 2023. Twelve studies were included in the final review. Findings indicate that those experiencing puerperal psychosis have increased incidence of infanticide suggesting missed opportunities for intervention and treatment. Common factors in mothers who committed infanticide as a result of delusions and/or hallucinations associated with PMADs were identified, including lack of standardized screening tools, preference for traditional and/or cultural healing practices, and access to care. The current body of evidence supports developing and evaluating clinical interventions aimed at improving maternal mental health outcomes and infant outcomes in perinatal women experiencing puerperal psychosis.

Relationship Between Postpartum Care Practices and Mental Health Outcomes: Understanding the Impact on Maternal Well-Being

Introduction: Postpartum depression (PPD) is a major mental health condition affecting mothers during the first year postpartum, often beginning within the initial six weeks. The purpose of the study was to assess the relationship between postpartum care practices and their effects on maternal mental health outcomes. Aim of the study: The aim of the study was to evaluate the relationship between postpartum care practices and their effects on maternal mental health outcomes. Methods: This prospective observational study included 130 postpartum women aged 18-45, recruited from the outpatient and inpatient departments of BSMMU and Dhaka Medical College, Dhaka, from July 2020 to June 2021. Women were eligible if they were within six months postpartum and provided informed consent. Data were collected through face-to-face interviews using structured questionnaires, including the EPDS and GAD-7 scales. Analysis was performed using SPSS software version 22.0. Result: The majority of patients, 83 (63.85%), are in the ≥30 age group, have completed primary school, 92 (70.77%), and are Muslim, 104 (80.00%). For pre-pregnancy BMI, 58 (44.62%) of patients had a normal BMI. Parental support was available to 111 (85.38%) of patients. Regarding mental health outcomes, 74 (56.92%) of patients scored within the normal range on the Edinburgh Postnatal Depression Scale (EPDS). Conclusion: The study concludes that comprehensive postpartum support systems are crucial for reducing maternal depression and anxiety, highlighting the need for targeted interventions and systematic screening in postpartum care to improve mental health outcomes.

Maternal heart rate variability at 3-months postpartum is associated with maternal mental health and infant neurophysiology

Previous research has demonstrated a critical link between maternal mental health and infant development. However, there is limited understanding of the role of autonomic regulation in postpartum maternal mental health and infant outcomes. In the current study, we tested 76 mother-infant dyads from diverse socioeconomic backgrounds when infants were 3-months of age. We recorded simultaneous ECG from dyads while baseline EEG was collected from the infant; ECG heart rate variability (HRV) and EEG theta-beta ratio and alpha asymmetry were calculated. Dyadic physiological synchrony was also analyzed to better understand the role of autonomic co-regulation. Results demonstrated that lower maternal HRV was associated with higher self-reported maternal depression and anxiety. Additionally, mothers with lower HRV had infants with lower HRV. Maternal HRV was also associated with higher infant theta-beta ratios, but not alpha asymmetry. Exploratory analyses suggested that for mother-infant dyads with greater physiological synchrony, higher maternal HRV predicted increased infant theta-beta ratio via infant HRV. These findings support a model in which maternal mental health may influence infant neurophysiology via alterations in autonomic stress regulation and dyadic physiological co-regulation.

Maternal Fiber Intake and Perinatal Depression and Anxiety.

(1) Background: Dietary fiber can significantly alter gut microbiota composition. The role of the gut microbiome in the Gut-Brain Axis and modulation of neuropsychiatric disease is increasingly recognized. The role of antenatal diet, particularly fiber intake, in mitigating maternal mental health disorders remains unexplored. The objective of this review is to investigate the association between maternal fiber intake and perinatal depression and anxiety (PDA). (2) Methods: A literature review of PubMed and Google Scholar was conducted using appropriate keyword/MeSH terms for pregnancy, diet, fiber, and mental health. Observational and clinical trials published between 2015 and 2021 were included and data pertaining to dietary patterns (DP), food intake, mental health, and demographic data were extracted. The top three fiber-containing food groups (FG) per study were identified using a sum rank scoring system of fiber per 100 g and fiber per serving size. The consumption of these top three fiber FGs was then ranked for each dietary pattern/group. Mental health outcomes for each study were simplified into three categories of improved, no change, and worsened. The relationship between top three fiber FGs consumed within each DP and mental health outcomes was analyzed using Spearman's correlation. (3) Results: Thirteen of fifty-two studies met the inclusion criteria. Ten (76.9%) studies assessed DPs (seven examined depression only, two examined depression and anxiety, and one examined anxiety only). Seven (53.9%) studies reported at least one significant positive relationship between mental health outcomes and DPs while three reported at least one negative outcome. Three (23.1%) studies compared intake of different food groups between depressed and non-depressed groups. In studies of DPs, the average consumption ranking of the top three fiber FGs bore a significant inverse association with mental health outcomes [r = -0.419 (95%CI: -0.672--0.078)] p = 0.015. In studies comparing the intake of different FGs between depressed and non-depressed groups, the consumption of top-ranking fiber foods was higher in the non-depressed groups, but significantly higher in four of the ten high fiber FGs. (4) Conclusions: This study reframes findings from previously published studies of maternal diet and mental health outcomes to focus on fiber intake specifically, using a fiber ranking system. A significant correlation between lower intake of fiber and poorer mental health outcomes warrants further investigation in future studies.

Interventions for intimate partner violence during the perinatal period: A scoping review: A systematic review.

Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes. This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes. We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed. Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included. We used standard methodological procedures expected by The Campbell Collaboration. In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes. The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.

Disparities in spatiotemporal clustering of maternal mental health conditions before and during the COVID-19 pandemic

Mounting evidence indicates the worsening of maternal mental health conditions during the COVID-19 pandemic. Mental health conditions are the leading cause of preventable death during the perinatal and postpartum periods. Our study sought to detect space-time patterns in the distribution of maternal mental health conditions in pregnant women before (2016–2019) and during (2020–2021) the COVID-19 pandemic in North Carolina, USA. Using the space-time Poisson model in SaTScan, we performed univariate and multivariate cluster analysis of emergency department (ED) visits for perinatal mood and anxiety disorders (PMAD), severe mental illness (SMI), maternal mental disorders of pregnancy (MDP), suicidal thoughts, and suicide attempts during the pre-pandemic and pandemic periods. Clusters were adjusted for age, race, and insurance type. Significant multivariate and univariate PMAD, SMI, and MDP clustering persisted across both periods in North Carolina, while univariate clustering for both suicide outcomes decreased during the pandemic. Local relative risk (RR) for all conditions increased drastically in select locations. The number of zip code tabulation areas (ZCTAs) included in clusters decreased, while the proportion of urban locations included in clusters increased for non-suicide outcomes. Average yearly case counts for all maternal mental health outcomes increased during the pandemic. Results provide contextual and spatial information concerning at-risk maternal populations with a high burden of perinatal mental health disorders before and during the pandemic and emphasize the necessity of urgent and targeted expansion of mental health resources in select communities.

Pregnancy and birth complications and long-term maternal mental health outcomes: A systematic review and meta-analysis.

Few studies have examined the associations between pregnancy and birth complications and long-term (>12 months) maternal mental health outcomes. To review the published literature on pregnancy and birth complications and long-term maternal mental health outcomes. Systematic search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), PsycInfo®, PubMed® and Web of Science from inception until August 2022. Three reviewers independently reviewed titles, abstracts and full texts. Two reviewers independently extracted data and appraised study quality. Random-effects meta-analyses were used to calculate pooled estimates. The Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines were followed. The protocol was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022359017). Of the 16 310 articles identified, 33 studies were included (3 973 631 participants). Termination of pregnancy was associated with depression (pooled adjusted odds ratio, aOR 1.49, 95% CI 1.20-1.83) and anxiety disorder (pooled aOR 1.43, 95% CI 1.20-1.71). Miscarriage was associated with depression (pooled aOR 1.97, 95% CI 1.38-2.82) and anxiety disorder (pooled aOR 1.24, 95% CI 1.11-1.39). Sensitivity analyses excluding early pregnancy loss and termination reported similar results. Preterm birth was associated with depression (pooled aOR 1.37, 95% CI 1.32-1.42), anxiety disorder (pooled aOR 0.97, 95% CI 0.41-2.27) and post-traumatic stress disorder (PTSD) (pooled aOR 1.75, 95% CI 0.52-5.89). Caesarean section was not significantly associated with PTSD (pooled aOR 2.51, 95% CI 0.75-8.37). There were few studies on other mental disorders and therefore it was not possible to perform meta-analyses. Exposure to complications during pregnancy and birth increases the odds of long-term depression, anxiety disorder and PTSD.

A critical need for the concept of matrescence in perinatal psychiatry.

The concept of matrescence, akin to adolescence but for mothers, has gained increasing attention in perinatal psychiatry, marking a paradigm shift towards understanding the holistic development of mothers. Matrescence encompasses the myriad psychological, social, cultural, and existential changes which occur as women transition into motherhood. Despite advances in maternal mental health, a bias towards pathologizing maternal experiences persists in research and practice. This commentary advocates for the integration of matrescence into perinatal psychiatry, drawing from the work of Dana Raphael and contemporary scholarship. Matrescence offers a strengths-based framework that acknowledges both the challenges and opportunities of motherhood, emphasizing the normative aspects of a mother's self-development. By adopting matrescence terminology and nosology, clinicians and researchers can enhance traditional psychiatric classifications. Additionally, matrescence underscores the importance of considering ecological systems and historical factors in maternal well-being, highlighting the need for comprehensive and compassionate healthcare services. Embracing matrescence as a fundamental concept in perinatal psychiatry holds promise for improving maternal mental health outcomes and promoting the flourishing of mothers worldwide.

Differing Within-Household Food Security Statuses Are Associated with Varied Maternal Mental Health Outcomes.

Household food insecurity is not necessarily equally experienced by all household members, with mothers often changing their intake first when food resources are limited. The purpose of this study was to understand the association between maternal mental health and intrahousehold differences in food security statuses. A cross-sectional survey was administered to Virginia mothers with low income (August-October 2021), assessing validated measures of food security, mental and physical health and related factors. Participants (n = 570) were grouped according to the food security status of adults and children within the household. Linear regression was used to assess the outcomes of interest by group and controlled for key demographic variables. Mothers in households with any food insecurity reported worse overall mental health and used 3-4 more food coping strategies than households experiencing food security (p < 0.05). Only mothers in households where adults experienced food insecurity reported significantly greater anxiety and depressive symptoms (61.5 and 58.1, respectively) compared to households experiencing food security (55.7 and 52.4, p < 0.001). While any experience of household food insecurity is associated with worse maternal mental health, there were differences by the within-household food security status. Future research should explore screening measures that capture specific household members' food security to connect households with available resources.

Potentially modifiable risk and protective factors affecting mental and emotional wellness in pregnancy.

Impaired mental and emotional wellness often co-occurs with prenatal substance use, and both affect infant socio-emotional, cognitive, language, motor, and adaptive behavioral outcomes. Guided by the modified biopsychosocial framework, this study examined the role of common substance exposures during pregnancy (i.e., alcohol and cannabis), socio-cultural factors (social support during pregnancy, adverse childhood experiences), and reproductive health factors on maternal mental health (MMH). Data were obtained from a prospective cohort study-Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH-2), and included 202 pregnant persons. Alcohol and cannabis exposures were assessed through repeated prospective interviews and a comprehensive battery of drug and ethanol biomarkers. MMH outcomes were evaluated during the third trimester through the Perceived Stress Scale, Edinburgh Depression Scale, Generalized Anxiety Disorders-7, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders. Univariate and multivariable linear regression models evaluated significant predictors of MMH. Results of multivariable analysis indicate that both maternal adverse childhood experiences and alcohol exposure, even at low-to-moderate levels, during pregnancy were associated with poorer scores for most MMH measures, while higher level of social support and Spanish as the primary language at home (as a proxy of enculturation) had protective effects (all p's < 0.05). These findings highlight the importance of assessing substance use, including periconceptional alcohol exposure, and mental health in pregnant persons as closely related risk factors which cannot be addressed in isolation. Our findings also emphasize a strong protective effect of socio-cultural factors on maternal mental and emotional wellbeing-a strong precursor to maternal-infant bonding and infant neurodevelopment.

Pregnancy Outcomes of Women With Hypertensive Disease in Lagos State, Nigeria

This study investigates the differences in pregnancy outcomes among women with hypertensive disease in pregnancy, with and without mental health disorders, in Lagos State, Nigeria. Utilizing a longitudinal research design, data was collected from pregnant women in their 20-24 weeks of gestation through delivery and postpartum. The sample size of 300 was determined using the Cochran formula, with participants selected from six maternal and child health centers across three senatorial districts. A validated questionnaire comprising fifteen questions assessed pregnancy outcomes, and statistical analyses included descriptive and inferential statistics. Results revealed no significant associations between mental health status and gestational age, mode of delivery, duration of labor, or delivery period. Apgar scores at 1 and 5 minutes also showed no significant association with mental health status. However, a notable association was found between mental health status and birth weight, indicating a higher prevalence of low-birth-weight infants among women with mental health disorders. Other factors, including estimated blood loss, postpartum packed cell volume, blood transfusion, duration of hospital admission, and NICU admission, showed no significant associations with mental health status. In conclusion, birth weight is significantly associated with the mental status of pregnant women with hypertensive disease, while other factors appear to have negligible impact. Recommendations include routine mental health assessments, early detection, and intervention for better maternal mental health outcomes. Midwives are advised to implement early monitoring of fetal growth, emphasizing closer prenatal care and nutritional counseling to reduce the risk of mental health disorders in pregnant women.

Role of a multidisciplinary approach in maternal health and mental health outcomes

A multidisciplinary approach to maternal health signifies the integration of diverse healthcare professionals working collaboratively to address the complex needs of expectant and postpartum women. This approach acknowledges the intricate interplay between physical health and mental well-being during pregnancy, childbirth, and the postpartum period. In this framework, a team comprising obstetricians, midwives, psychologists, psychiatrists, nurses, social workers, and other specialists works together to provide holistic care. This teamwork ensures a comprehensive assessment of the physical and psychological aspects of maternal health. For instance, obstetricians focus on the physical health of the mother and baby, while mental health professionals assess and manage conditions, such as perinatal depression, anxiety, or postpartum mood disorders. Lactation consultants and nutritionists are also able to identify mental health concerns based on the time and anatomy of their consultations. The multidisciplinary team approach discussed will suggest the employment of early screening tools to detect mental health concerns by obstetricians and midwives, allowing for timely interventions and personalized care plans. This approach not only addresses immediate mental health issues but also prevent long-term complications that might affect both the mother and child. Furthermore, this collaborative model promotes education and support for mothers and their families. It empowers women with information about mental health during pregnancy and postpartum, equipping them to recognize symptoms and seek assistance when needed. In addition, it provides social and emotional support, reducing the stigma often associated with maternal mental health challenges. By engaging the expertise of various professionals, the multidisciplinary approach enhances the quality of care, leading to improved maternal mental health outcomes. It contributes to healthier pregnancies, reduces the risk of postpartum mental health issues, and fosters an environment where mothers receive comprehensive support, positively influencing the well-being of both the mother and child eventually.

Frequency of Prenatal Care Visits: A Core Outcome Set for Prenatal Care Schedules.

Objective: The aim of this study is to develop a core outcome set for the frequency and modality of prenatal care visits. Material and Methods: A consensus development study was conducted in the United States with participants, including 31 health care professionals, 12 public policy members or public health payers, and 18 public members, representing 24 states. A modified Delphi method and modified nominal group technique were utilized. Results: Twenty-one potential core outcomes were developed by combining the outcomes reported in three systematic reviews that evaluated the frequency of prenatal care visits or modality of prenatal visit type (e.g., in person, telemedicine, or hybrids of both). Eighteen consensus outcomes were identified from the Delphi process, following which 10 maternal and 4 neonatal outcomes were agreed at the consensus development meeting. Maternal core outcomes include maternal quality of life; maternal mental health outcomes; the experience of maternity care; lost time; attendance of recommended visits; unplanned care utilization; completion of the American College of Obstetricians and Gynecologists-recommended services; diagnosis of obstetric complications-proportion and timing; disparities in care outcomes; and severe maternal morbidity or mortality. Neonatal core outcomes include gestational age at birth, birth weight, stillbirth or perinatal death, and neonatal intensive care unit admissions. Conclusions: The core outcome set for the frequency and modality of prenatal visits should be utilized in forthcoming randomized controlled trials and systematic reviews. Such application will warrant that in future research, consistent reporting will enrich care and improve outcomes. Clinical Trial Registration number: 2021.