Mental Health Problems In Pregnancy Research Articles

Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales

ObjectivesBetween 1997 and 2021, the number of children looked after (CLA) in Wales, UK, increased steadily, with stark inequalities. We aimed to assess how deprivation and maternal and child perinatal characteristics influence the risk of becoming CLA in Wales. Study designWe constructed a prospective longitudinal cohort of children born in Wales between April 2006 and March 2021 (n = 395,610) using linked administrative records. MethodsSurvival models examined the risk of CLA from birth by small-area deprivation and maternal and child perinatal characteristics. Population attributable fractions quantify the potential impact of action on modifiable risk factors. ResultsChildren from the most deprived fifth of the population were 3.4 times more likely to enter care than those in the least deprived (demographic adjusted hazard ratios [aHRs] 3.40, 95% confidence interval [CI] 3.08, 3.74). Maternal mental health problems in pregnancy (fully aHR, 2.03, 95% CI 1.88, 2.19) and behavioural factors, such as smoking (aHR 2.46, 95% CI 2.34–2.60), alcohol problems (aHR 2.35, 95% CI 1.70–3.23) and substance use in pregnancy (aHR 5.72, 95% CI 5.03–6.51), as well as child congenital anomalies (aHR 1.46, 95% CI 1.16–1.84), low birth weight (aHR 1.28, 95% CI 1.17, 1.39) and preterm birth (aHR 1.16, 95% CI 1.06, 1.26), were associated with higher risk of CLA status. The risk of CLA in the population may be reduced by 35% (95% CI 0.33, 0.38) if children in the two most deprived fifths of the population experienced the conditions of those in the least deprived. ConclusionsDeprivation and perinatal maternal health are important modifiable risk factors for children becoming CLA. Our analysis provides insight into the mechanisms of intergenerational transfer of disadvantage in a vulnerable section of the child population and identifies targets for public health action.

Risks and benefits of pre-delivery taper in pregnant women taking antidepressants.

Serotonin reuptake inhibitors are commonly used for treatment of mental health problems in pregnancy but may cause neonatal adaptation syndrome. It is unknown whether reduction or discontinuation of medication prior to delivery may mitigate this effect. We present a case series of 38 women who either tapered their medication prior to delivery or maintained or increased their dose. Greater reductions in maternal antidepressant dose just prior to delivery were associated with fewer admissions to the neonatal intensive care unit (NICU) for infants. There was a slightly greater increase in depressive symptoms across delivery for women who tapered, which was not statistically significant. NICU admissions may be less frequent among neonates whose mothers tapered their medication prior to delivery. Large prospective randomized trials are needed to further study this practice.

Public Health Series 4. Awareness to Action: Perinatal Mental Health

Up to 20% of women and birthing people experience perinatal mental health (PNMH) problems,1 a broad spectrum that encompasses symptoms from low mood to psychosis or suicidal urges and ideation. The impact of poor PNMH can be tragic; suicide is the leading direct cause of maternal mortality in the year after birth.2 Mental health problems in pregnancy and the postpartum period can have far-reaching consequences for women, birthing people, and families. Postnatal depression can negatively affect a woman’s ongoing quality of life, mental wellbeing, relationships with family and bonding with her infant.3

Investigating the Potential Determining Factors Contributing to Mental Health Problems in Pregnancy During the COVID-19 Pandemic: A Systematic Review

Objectives: The present study aimed to investigate the potential determining factors responsible for the mental health problems during the COVID-19 pandemic. Methods: The databases including PubMed/MEDLINE, Web of Science, and Cochrane Library were searched for the required articles in February, 2021. The quality of the studies was determined based on the STROBE checklist. Results: A total of 31 articles were included in this systematic review. Stopped in-person prenatal care and using the phone for prenatal care were significantly associated with greater changes of anxiety during COVID-19. Parity, gestational age, and pregnancy complication were found to be statistically and significantly associated with anxiety. Social and family supports were specifically associated with reduced anxiety. Women with low body mass index (BMI) were detected to be more prone to developing depression and anxiety. While obesity had protective effects on depression, stress and anxiety, lower sleep quality, lower household income, lower physical health, and less physical activity were found associated with higher anxiety levels. Other significant factors related to mental health included employment status, employment status, marriage status, household size, educational level, ethnicity, knowledge score, marital life satisfaction, and fear of the COVID-19 infection. Conclusions: Clinical, economic, and socio-demographic physical health were associated with mental health problem during COVID-19. Therefore, it was recommended that the potential determining factors should be further explored and identified in order to help protect people against mental health problems.

The Time is Now: An Overview on Perinatal Psychiatry

Perinatal mental health (PMH) has been a growing field of practice for psychiatry in the last decades. It focuses on mental health during pregnancy, childbirth and the postpartum period including the distinctive presentations of mental illness and well‐being challenges associated with parenting experiences. Mental health problems in pregnancy and the postnatal period can have significant differences and challenges to its approach compared to other periods of life. Working in PMH requires specific and updated know­ ‐ledge regarding carers’ experiences and manifestations of mental illness in this particular life stage and psychotropic management during pregnancy and breastfeeding, as well as regarding the mother/parent and baby relationship and bond, and the baby’s safeguarding along several developmental issues. For all this, PMH specialist services and multidisciplinary teams with specific training have been developing to cater to this need in several countries around the world. To provide a broadened overlook on the matter, some key aspects of PMH will be discussed below in this perspective.

Thoughts of self-harm in early and late pregnancy in urban South Africa: Investigating prevalence, predictors and screening options.

Thoughts of self-harm (TSH) are an important marker of mental health risk, and risk for attempted and completed suicide. While there is increasing attention being paid to mental health problems in pregnancy in South Africa (SA), TSH have received less attention despite some cross-sectional studies suggesting that prevalence may be high (12 - 39%). There is a dearth of longitudinal research to inform prevention and treatment. To examine the rates of TSH across pregnancy in a longitudinal SA cohort and to investigate factors associated with the onset and persistence of TSH, as well as the relationship between TSH, depression and/or anxiety. Women were enrolled in a prospective pregnancy cohort (S1000) in Soweto, SA between 2014 and 2016, and assessed using validated screening measures (Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Index short form) in early and later pregnancy. Data were available for 649 women. TSH were determined using EPDS item 10. Logistic regression and bifactor models were used to determine factors associated with TSH across pregnancy. Of the 649 women, 18% reported TSH at some stage during their pregnancy. Prevalence of TSH was slightly higher in early pregnancy (12.5%) than later in pregnancy (11.6%). TSH were associated with a history of mental illness (adjusted odds ratio (aOR) 4.17; 95% confidence interval (CI) 1.3 - 13.7; p=0.020), concurrent depression (aOR 4.8; 95%CI 2.7 - 8.6; p<0.001); marital stress (aOR 1.74; 95% CI 1.0 - 3.0; p=0.040); and practical support (aOR 0.43; 95% CI 0.2 - 1.0; p=0.040) using a multivariate logistic regression. Bifactor analysis examining depression and anxiety scales showed that TSH contributed the highest variance to a shared depression and anxiety factor in early pregnancy. Logistic regressions showed that early depression was a strong predictor of later reports of TSH. The present study shows that the risk of TSH during pregnancy is relatively common, and starts early during pregnancy. Screening approaches could be simplified to encourage healthcare practitioners working in busy and over-burdened public healthcare settings to engage in identifying at-risk women. Efforts in improving early identification of mental health risk in pregnancy should be matched with strengthening of current treatment and referral options. Since practical support and a good marital relationship reduce the risk of TSH, these may be important avenues of focus for designing interventions.

Coping strategies mediate the associations between COVID-19 experiences and mental health outcomes in pregnancy.

The COVID-19 pandemic has resulted in elevated mental health problems for pregnant women. Effective coping strategies likely reduce the impact of COVID-19 on mental health. This study aimed to (1) understand how COVID-19 stressors are related to different coping strategies and (2) identify whether coping strategies act as mechanisms accounting for the associations between COVID-19 stressful experiences and mental health problems in pregnancy. Participants were 304 pregnant women from Ontario, Canada. Depression, anxiety, insomnia, and perceived stress were assessed using validated measures. COVID-related stressors (i.e., financial difficulties, social isolation), subjective negative impact of COVID-19, and coping strategies used in response to COVID-19 were assessed by questionnaires. Results indicated that the subjective negative impact of COVID-19 was associated with more dysfunctional coping and less emotion-focused coping, whereas specific COVID-19 stressors, namely financial difficulties and social isolation, were associated with more dysfunctional coping and problem-focused coping. Dysfunctional coping was linked to elevated mental health problems and emotion-focused coping was linked to less mental health problems. Dysfunctional coping and emotion-focused coping partially mediated the effects of specific COVID-19 stressors on mental health outcomes. Findings indicate that coping is one pathway through which the COVID-19 pandemic impacts mental health in pregnancy. Supports and interventions for pregnant women during the pandemic should focus on bolstering coping skills, in order to minimize the mental health consequences of COVID-19.

Awareness Mental Health During Pregnancy in Practice Midwife of Bogor, Jawa Barat

Mental health problems in pregnancy still lack the attention of midwives, which is identified in the lowmental health checks of pregnant women during ante natal care. A subsequent research was conducted byIdaiani in Jakarta and Bogor regions 2018 regarding the incidence of Perinatal Depression that reached18.6% in Bogor region.This research was a qualitative research and was conducted January 2019 in Independent Midwifery Practicein Bogor. The subjects of this research were The interview was conducted with 15 informants, they wereone person from the ministry of health, coordinating midwives, chairmen of Indonesian midwives’ branchassociations in Bogor with total of 5 midwives who provided services in independent midwifery practiceand as a key is 3 woman pregnant and three families of pregnant women, data were analyzed by usingtriangulation analysis.Based on result of the research, The Construction Model Mental Health on Mothers during pregnancy inIndependent Midwifery Practice is very important and needs attention. Pregnancy is still considered asa physical change that needs to be intervened because it is easier to be handled and detected. Maternalexamination during pregnancy is carried out by Midwives in the implementation of mental health checksduring pregnancy for pregnant women and this role has not been carried out optimally.This research suggests conducting socialization with midwives as well as across related sectors to getpolitical support in carrying out activities in health facilities and independent practice midwives.

Cardiovascular changes and mental health problems in pregnancy

Cardiovascular changes and mental health problems in pregnancy

The association between symptoms of depression during pregnancy and low birth weight: a prospective study

BackgroundMost studies have showed that maternal depression is associated with pregnancy complications. However, there were limited evidences in Chinese population. We examined the associations of antenatal depression symptoms with pregnancy outcomes, especially for low birth weight.MethodsA total of 1377 singleton pregnant women were recruited from Nanshan Maternity & Child Healthcare Hospital of Shenzhen in this prospective cohort study. Depression symptoms were assessed by the Edinburgh postnatal depression scale (EPDS) questionnaire in the second trimester of gestation; cut-points for the indication of antenatal depression were ≧12 scores in this study. Socio-demographic data, life-style and pregnancy outcomes were collected through Shenzhen Maternity & Child Healthcare database. The risks of adverse outcomes in pregnant women with antenatal depression were determined by multivariate logistic regression and represented as odds ratio(OR) and 95% confidence interval (CI).ResultsOf the 1377 subjects, the prevalence of antenatal depression was 19.1%. The EPDS scores were 13.8 ± 2.0 and 6.5 ± 2.9 (P < 0.001) in subjects with and without antenatal depression, respectively. After adjustment for maternal age, education, parity, pre-pregnancy body mass index (BMI), residential area, fetal gender, an EPDS score ≥ 12 (versus. < 12) was associated with an increased risk for low birth weight (odds ratio: 2.05, 95% CI: 1.12–4.64), but not for preterm birth, large for gestational age, small for gestational age or macrosomia.ConclusionPregnant women presenting antenatal depressive symptoms are at elevated risk of low birth weight. Mental health problems of pregnancy should be addressed for the prevention of low birth weight.

Adverse life experiences and common mental health problems in pregnancy: a causal pathway analysis.

Risk factors for antenatal common mental problems include a history of depression, lack of social support and a history of both childhood and adulthood sexual and physical abuse. However, it is less clear whether pregnancy is a time of particular susceptibility to mental disorders due to prior childhood experiences. The aim of the paper was to investigate the potential pathways to antenatal mental health problems. A total of 521 women attending prenatal care attended a clinical interview and answered psychological questionnaires. Univariate analysis, sequential binary logistic regression and structural equation modelling (SEM) were used to analyse the relationships between variables. Having experienced parental maladjustment, maltreatment and serious physical illness in childhood and domestic violence, financial difficulties and serious spousal substance abuse in adulthood significantly predicted antenatal common mental health symptoms. SEM showed that history of depression and adverse experiences in adulthood had mediating effects on the relationship between adverse childhood events and symptoms of antenatal common mental disorders. Adverse childhood experiences are distal risk factors for antenatal common mental health problems, being significant indicators of history of depression and adverse experiences in adulthood. We therefore conclude that pregnancy is not a time of particular susceptibility to common mental health problems as a result of childhood abuse, but rather, these childhood experiences have increased the risk of adulthood trauma and prior mental disorders. Women at risk for antenatal common mental disorders include those with a history of depression, domestic violence, financial difficulties, spousal substance abuse and lack of social support.

Care and self-reported outcomes of care experienced by women with mental health problems in pregnancy: Findings from a national survey

Backgroundmental health problems in pregnancy and the postnatal period are relatively common and, in pregnancy, are associated with an increase in adverse outcome. It is recommended that all women are asked about their emotional and mental health and offered treatment if appropriate. Objectivesto describe the care received by women self-identifying with mental health problems in pregnancy, and to describe the effects of support, advice and treatment on outcomes in the postnatal period. Designthis study used cross-sectional survey data collected in 2014 which described women's experience of maternity care. SettingEngland Participantsa random sample of women who had a live birth in January 2014. Measurementsthe questionnaire asked about sociodemographic characteristics, whether women were asked about emotional and mental health in pregnancy, support and treatment offered, about postnatal wellbeing, and questions relating to attachment to their baby. Descriptive statistics and logistic regression were used to examine the associations between mental health and outcomes taking account of sociodemographic characteristics. Findingsthe survey response rate was 47%. Women with antenatal mental health problems were significantly more worried at the prospect of labour and birth, had lower satisfaction with the experience of birth, worse postnatal mental health, and indications of poorer attachment to their baby. They received substantially more care than other women but they did not always view this positively. Support, advice and treatment for mental health problems had mixed effects. Conclusionsthis study describes the significant additional care provided to women self-identifying with mental health problems in pregnancy, the mixed effects of support, advice and treatment, and the poor perception of staff interaction among women with mental health problems. Implications for practicehealth care professionals may need additional training to effectively support women with mental health problems during the perinatal period.

Who is actually asked about their mental health in pregnancy and the postnatal period? Findings from a national survey.

BackgroundPregnancy and the postnatal period is a period of potential vulnerability for women and families. It is UK policy that all women are asked about their mental health and wellbeing early in pregnancy and following the birth to help detect potential problems and prevent serious adverse outcome. However, identification of mental health problems in pregnancy may be less than 50 %.The aim of the study was to find out which women are asked about their mood and mental health during pregnancy and postnatally, and about offer and uptake of treatment.MethodsSecondary analysis of a national maternity survey carried out in 2014 which asked about sociodemographic factors, care in pregnancy, childbirth, and the postnatal period with specific questions on emotional and mental health.ResultsThe usable response rate to the survey was 47 % (4571 women). Most women recalled being asked about their mental health in pregnancy (82 %) and in the postnatal period (90 %). However, antenatally, Asian and older women were less likely to be asked and to be offered treatment. In the postnatal period, differences were more marked. Non-white women, those living in more deprived areas, and those who had received less education were less likely to be asked about their mental health, to be offered treatment, and to receive support. Women with a trusting relationship with their midwife were more likely to be asked about their mental health.ConclusionThe inequities described in this study suggest that the inverse care law is operating in relation to this aspect of maternity care. Those women most likely to be in need of support and treatment are least likely to be offered it and may be at risk of serious adverse outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1029-9) contains supplementary material, which is available to authorized users.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

A review of research and nursing management of mental health problems in pregnancy and motherhood

A review of research and nursing management of mental health problems in pregnancy and motherhood

Prenatal and Postnatal Maternal Mental Health and School-Age Child Development: A Systematic Review

One in six children entering school experiences developmental delay. Maternal mental health represents one of the earliest, modifiable influences in a child's life. The objective of the review was to evaluate the association between maternal mental health and school-age child development, and we hypothesized there would be a negative association. Five databases were searched (Embase, CINAHL, Eric, PsycInfo, Medline). Key journals and reference lists were hand-searched. Two reviewers assessed studies based on inclusion criteria: (1) the exposure was any form of maternal mental health occurring during pregnancy or postpartum periods; (2) the outcome was child development (>48months to 8years); (3) the study recruited participants from developed countries; and (4) publication was in English between January, 1990 and December, 2012. Disagreements were resolved by consensus. Study quality was assessed by two reviewers using the Scottish Intercollegiate Guideline Network and disagreements were resolved by consensus. Data extraction was conducted by one reviewer using standardized forms. Maternal mental health problems in pregnancy and/or the postpartum period increased the likelihood that school-age children experienced suboptimal global, behavioral, cognitive, and socio-emotional development. The findings highlight the need for maternal mental health assessment during the prenatal, postnatal, and early childhood periods.

Maternity and mental health services working collaboratively for women

Through the collaboration and partnership working of key professionals within maternity services, Child and Adolescent Mental Health Services (CAMHS), health visiting, GP services and Oxford Primary Care Trust (PCT), an innovative new service has been established which addresses the needs of women with mild to moderate mental health problems in pregnancy and the perinatal period—the Infant Parent Perinatal Service (IPPS). The partnership model of working has created firm pathways across service providers and has resulted in a forum for ongoing opportunity and creativity which continues to seek and develop new ways of improving mental health care for vulnerable women in pregnancy and the perinatal period. It is now well recognized that not only the physical but also the mental and emotional health of a woman while pregnant and in her infant’s early years will have a lifelong effect ( Department of Health, 2011 : 10). The IPPS project has been recognized nationally, receiving second place in the 2009 British Journal of Midwifery awards for ‘team of the year’ and a highly commended second place in the Royal College of Midwives 2010 awards for excellence in partnership working.

Antepartum and postpartum exposure to maternal depression: different effects on different adolescent outcomes

Postpartum depression (PPD) is considered a major public health problem that conveys risk to mothers and offspring. Yet PPD typically occurs in the context of a lifelong episodic illness, and its putative effects might derive from the child's exposure to other episodes, in pregnancy or later childhood. The aim of the study is to test two hypotheses: (1) that the effects of PPD on adolescent outcomes are partly explained by antepartum depression (APD) and (2) that the effects of APD and PPD are both explained by later exposure to the mother's depression. A random sample of 178 antenatal patients was drawn from two general medical practices in South London; 171 gave birth to live infants, and 150 (88%) were assessed at 3 months post partum, with 121 of their offspring (81%) assessed for emotional disorders (ED), disruptive behaviour disorders (DBD) and IQ, at 11 and 16 years of age. When APD and subsequent episodes of depression were taken into account, PPD had a significant effect on adolescent IQ, especially for boys, but did not predict psychopathology. ED and DBD in adolescence were predicted by the extent of exposure to maternal depression after 3 months post partum; a significant effect of APD on ED in girls was accounted for by later exposure to the mother's illness. Mothers' symptoms of anxiety, smoking and alcohol use in pregnancy did not predict adolescent outcomes, once maternal depression was taken into account. Some effects attributed to mothers' mental health problems in pregnancy or post partum may be mediated by cumulative exposure to maternal illness, probably reflecting genetic influence and gene-environment correlation. However, PPD has a direct effect on cognition. Clinicians should endeavour to identify women with depression in pregnancy (31% of this sample) and help them to manage their lifelong illness.