Perinatal Care Program Research Articles

Women’s emotional roller coasters during pregnancy as a consequence of infertility: a qualitative phenomenological study

Women experiencing infertility tend to experience distinct emotions during pregnancy following infertility. Individuals in this population often struggle with psychological and social challenges during pregnancy. This qualitative phenomenological study determines how infertility experiences affect mothers’ mental well-being during pregnancy as well as their experiences and emotions after becoming pregnant. A face-to-face, in-depth interview with 15 women with infertility was conducted between November 2022 and May 2023. The study adhered to ethical guidelines, with informed written consent obtained prior to interviews and voice recordings. The COREQ checklist is applied to follow the EQUATOR guidelines for reporting research and the data were coded using MAXQDA.20 software. A thematic analysis revealed four main themes and 15 codes. Main themes included “Over Emotional Burden,” “Overprotection,” “Overthinking,” and “Social Activity Changes.” Pregnancy after infertility is a unique and emotionally charged experience for women, encompassing a spectrum of feelings that can be difficult to express. The importance of caring for these women and receiving support from their partners, families, and healthcare providers should not be overstated. Healthcare providers should be aware of these emotional challenges so they can provide better support and counselling to improve women’s overall pregnancy experience. It is believed that empathetic communication and tailored support can significantly improve the psychological well-being of this population. Psychologists, psychiatrists, and midwives should also be more attentive to mothers’ emotional challenges and integrate comprehensive emotional support and provide coping mechanisms in perinatal care programs.

Clinical Psychology and Perinatal Mental Health Programs in hospitals in the Community of Madrid: Description and recommendations of Good Practices

Specific attention to perinatal mental health is a key element in the healthcare system. In Spain and in the Community of Madrid, concern for perinatal mental health has been increasing in recent years. The objective of this work is to identify and describe the main perinatal psychological care programs and the first thousand days in the hospitals of the Madrid Health Service. Twelve Hospitals with complete or partial programs were identified. Their organizational and care characteristics are described. The ratios of perinatal clinical psychologists range from 0.04 to 0.51/10,000 deliveries and from 0.08 to 0.78/20 neonatology cribs in the region. Perinatal mental health care programs in the Madrid hospital network have been consolidated and expanded; however, there are inequities in the availability of this care. Good practice recommendations for implementing and improving these programs are provided.

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

The association between adverse childhood experiences and perinatal depression symptom trajectories

Having a history of adverse childhood experiences is associated with an increased risk for treatment-resistant depression in the general population. Whether this relationship is true in the perinatal context is unknown. This study aimed to examine the association between adverse childhood experiences and the trajectories of antenatal and postpartum depression among people enrolled in a perinatal collaborative care program for mental healthcare. This retrospective cohort study included all pregnant and postpartum people who were referred to and enrolled in a perinatal collaborative care program for mental healthcare and who delivered at a single, quaternary care institution between March 2016 and March 2021. Individuals referred to the collaborative care program were linked with a care manager and had access to evidence-based mental health treatment such as a psychiatric consult, pharmacotherapy, and psychotherapy. All individuals enrolled in the collaborative care program underwent adverse childhood experience screens at intake. A score of >3 on the validated Adverse Childhood Experiences Questionnaire was defined as a high adverse childhood experience score. Depression symptom monitoring occurred via electronic Patient Health Questionaire-9 screening every 2 to 4 weeks, and escalation of care was recommended for those without evidence of improvement. Antenatal depression trajectories were determined by comparing the earliest available prenatal Patient Health Questionaire-9 score closest to the time of referral to collaborative care with the latest Patient Health Questionaire-9 score before delivery. Postpartum trajectories were determined by comparing the earliest postpartum Patient Health Questionaire-9 score after delivery with the latest score before 12 weeks' postpartum. Depression trajectories were categorized as improved, stable, or worsened based on whether the Patient Health Questionaire-9 scores changed by at least 2 standard deviations (ie, 5 points on the Patient Health Questionaire-9 scale). Bivariable and multivariable analyses were performed. Of the 1270 people who met the inclusion criteria, 294 (23.1%) reported a high adverse childhood experience score. Those with a high adverse childhood experience score were more likely to experience a worsened antenatal depression trajectory than those with a low adverse childhood experience score (10.3% vs 4.3%; P=.008). This association persisted after adjusting for potential confounders (adjusted odds ratio, 2.39; 95% confidence interval, 1.05-5.46). There was no significant difference in the postpartum depression trajectories between those with a high and those with a low adverse childhood experience score. Having a high adverse childhood experience score is associated with a worsened antenatal depression trajectory for those enrolled in a collaborative care program. Given its high prevalence, future research should evaluate effective modalities of perinatal depression prevention and treatment specific for pregnant people with a history of adverse childhood experiences.

Association Between Antenatal Depression Symptom Trajectories and Preterm Birth.

To evaluate whether, among pregnant people referred for mental health care, improvement in antenatal depression symptoms before delivery was associated with a reduction in preterm birth. This retrospective cohort study included all pregnant people referred to a perinatal collaborative care program for mental health care who delivered between March 2016 and March 2021. Those referred to the collaborative care program had access to subspecialty mental health treatment, including psychiatric consultation, psychopharmacotherapy, and psychotherapy. Depression symptoms were monitored with the self-reported PHQ-9 (Patient Health Questionnarie-9) screens in a patient registry. Antenatal depression trajectories were determined by comparing the earliest prenatal PHQ-9 score after collaborative care referral with the score closest to delivery. Trajectories were categorized as improved, stable, or worsened according to whether PHQ-9 scores changed by at least 5 points. Bivariable analyses were performed. A propensity score was generated to control for confounders that were significantly different on bivariable analyses according to trajectories. This propensity score was then included in multivariable models. Of the 732 pregnant people included, 523 (71.4%) had mild or more severe depressive symptoms (PHQ-9 score 5 or higher) on their initial screen. Antenatal depression symptoms improved in 256 (35.0%), remained stable in 437 (59.7%), and worsened in 39 (5.3%); the corresponding incidence of preterm birth was 12.5%, 14.0%, and 30.8%, respectively ( P =.009). Compared with those with a worsened trajectory, pregnant people who had an improved antenatal depression symptom trajectory had a significantly decreased odds of preterm birth (adjusted odds ratio 0.37, 95% CI 0.15-0.89). Compared with worsened symptoms, an improved antenatal depression symptom trajectory is associated with decreased odds of preterm birth for pregnant people referred for mental health care. These data further underscore the public health importance of incorporating mental health care into routine obstetric care.

Neighborhood crime and adverse obstetrical outcomes in people enrolled in a perinatal collaborative care program

Exposure to neighborhood crime has been associated with adverse obstetrical outcomes including hypertensive disorders of pregnancy (HDP), yet the mechanism by which this occurs is not yet understood. Psychological stress is one such factor that may mediate this relationship. Our objective was to evaluate the association between neighborhood crime and obstetrical outcomes in patients enrolled in a perinatal collaborative care program with a focus on providing mental health support.

Trial of a patient-directed eHealth program to ameliorate perinatal depression: the MomMoodBooster2 practical effectiveness study

Depression is one of the most common complications of childbirth, and is experienced by approximately 17% of pregnant women and 13% of postpartum women. An estimated 85% of these women go untreated-an alarming statistic given the serious consequences for the mother, her child, other family members, and society. Professional societies (the American College of Obstetricians and Gynecologists and American Academy of Pediatrics) have recommended improvements in screening and treatment. Meta-analyses indicate that cognitive behavioral therapy eHealth interventions are efficacious for depression, generally, and for perinatal depression, specifically. Earlier controlled trials have established the effectiveness and acceptability of MomMoodBooster (including an Australian version, MumMoodBooster), an eHealth program for ameliorating postpartum depression. This study aimed to evaluate the effectiveness of a perinatal version of MomMoodBooster encompassing both prenatal and postpartum content in a healthcare delivery setting already providing universal screening and referral of at-risk patients as part of routine care. A practical effectiveness study randomly assigned 95 pregnant and 96 postpartum women screened as depressed and satisfying eligibility criteria to experimental groups: the healthcare organization's perinatal depression care program (routine-care group) and routine care+MomMoodBooster2 program (eHealth group). Eligibility criteria included: pregnant or <1 year postpartum, ≥18 years of age, no active suicidal ideation, access to broadband internet via desktop/laptop, tablet, or smartphone, and English language proficiency. Intent-to-treat analyses of group effects used fixed-effects growth models to assess 12-week posttest change in outcomes. Results showed that both groups had significantly decreased depression severity, anxiety, stress, and automatic thoughts, and increased behavioral activation and self-efficacy. Relative to the routine-care group, the eHealth group displayed significantly greater decreases in depression severity and stress. These group comparisons were not moderated by depression severity (screening or baseline), anxiety, stress, or pregnant/postpartum status. Almost all (93%; n=89) women in the eHealth group visited their program, of whom 99% visited program sessions (M sessions visited=4.3±2.0; M total session duration=73.0±70.2 minutes; 49% viewed all 6 sessions). Among confirmed eHealth program users who provided ratings, 96% (79/82) rated their program as easy to use, 83% rated it helpful, and 93% (76/82) indicated that they would recommend it. Results support the effectiveness of using MomMoodBooster2 as a treatment option for perinatal women with depression, especially when combined with universal depression screening and referral. Consequently, the eHealth program shows promise as a tool to increase the reach of treatment delivery and to potentially reduce the number of untreated perinatal women with depression.

The association between engagement in a perinatal collaborative care program and breastfeeding among people with identified mental health conditions

Untreated antenatal mental health conditions are associated with noninitiation and early discontinuation of breastfeeding. Whether interventions designed to optimize perinatal mental health can mitigate this association is unknown. This study aimed to examine whether engagement of pregnant people with mental health conditions in a perinatal mental health collaborative care program was associated with differences in breastfeeding initiation and continuation and whether any observed association was mediated by changes in depressive symptoms. This retrospective cohort study included all pregnant people who were referred antenatally by their obstetrical clinician to a perinatal collaborative care program and who delivered viable neonates between January 2017 and June 2018. Pregnant people were dichotomized by whether they engaged in collaborative care services. Breastfeeding initiation (endorsed at delivery) and continuation at the postpartum visit were compared between individuals who did and did not engage in collaborative care using bivariable and multivariable analyses. Mediation analyses were performed to determine if any observed associations were mediated by improvements or remission in depressive symptoms. During the study period, 350 eligible pregnant people were referred to the perinatal collaborative care program because of an identified mental health condition. Of these people, 264 (75.4%) engaged in collaborative care. Compared with those who did not engage in collaborative care, people who engaged in collaborative care were more likely to initiate breastfeeding (168 [95%] vs 47 [87%]; P=.046) and continue breastfeeding at the postpartum visit (92 [74%] vs 20 [53%]; P=.012). These associations persisted after controlling for potential confounders (adjusted odds ratio for initiation, 3.30; 95% confidence interval, 1.09-9.98; adjusted odds ratio for continuation, 3.08; 95% confidence interval, 1.29-7.36). Neither association was mediated by improvements or remission in depressive symptoms. Although antenatal mental health conditions are a risk factor for lack of initiation or early cessation of breastfeeding, engagement in a collaborative care program was associated with improvements in both breastfeeding initiation and continuation. This association was independent of improvement in depressive symptoms, suggesting that the benefits of perinatal collaborative care may extend beyond its psychological impact.

A qualitative examination of the implementation of a perinatal collaborative care program.

To identify implementation strategies for collaborative care (CC) that are successful in the context of perinatal care. Perinatal depression is one of the most common complications of pregnancy and is associated with adverse maternal, obstetric, and neonatal outcomes. Although treating depressive symptoms reduces risks to mom and baby, barriers to accessing psychiatric treatment remain. CC has demonstrated benefit in primary care, expanding access, yet few studies have examined the implementation of CC in perinatal care which presents unique characteristics and challenges. We conducted qualitative interviews with 20 patients and 10 stakeholders from Collaborative Care Model for Perinatal Depression Support Services (COMPASS), a perinatal collaborative care (pCC) program implemented since 2017. We analyzed interview data by employing the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to organize empirically selected implementation strategies from Expert Recommendations for Implementing Change (ERIC) to create a guide for the development of pCC programs. We identified 14 implementation strategies used in the implementation of COMPASS. Strategies were varied, cutting across ERIC domains (eg, plan, educate, finance) and across EPIS contexts (eg, inner context - characteristics of the pCC program). The majority of strategies were identified by patients and staff as facilitators of pCC implementation. In addition, findings show opportunities for improving the implementation strategies used, such as optimal dissemination of educational materials for obstetric clinicians. The implementation of COMPASS can serve as a model for the process of building a pCC program. The identified strategies can support the implementation of this evidence-based practice for addressing postpartum depression.

The association between antenatal depression symptom trajectories and preterm birth

Antenatal depression has been associated with an increased risk of preterm birth (PTB). Whether improvement of depression mitigates the risk of PTB remains uncertain. Our objective was to evaluate whether, among pregnant people referred for mental health care, improvement in antenatal depression symptoms prior to delivery was associated with a reduction in PTB. This retrospective cohort study included all pregnant people referred to a perinatal collaborative care (CC) program for mental health care and who delivered between 2016-2021. Those referred to the CC program had access to subspecialty mental health treatment, including psychiatric consultation and psychotherapy. Depression symptoms were monitored via serial PHQ-9 screens every 2-4 weeks. Antenatal depression trajectories were determined by comparing the earliest prenatal PHQ-9 score after CC referral to the latest score before delivery. Trajectories were categorized as improved, stable, or worsened based on whether the PHQ-9 scores changed by at least one standard deviation (i.e., 5 points). Bivariable analyses were performed. A propensity score was generated using confounders that were significantly different on bivariable analyses across trajectories. This propensity score was included in multivariable models to control for imbalance across the exposure. Of the 732 pregnant people included, antenatal depression symptoms improved in 256 (35.0%), remained stable in 437 (59.7%), and worsened in 39 (5.3%) (Table 1). The incidence of preterm birth was 12.5%, 14.0%, and 30.8% in those whose depression symptoms improved, remained stable, or worsened, respectively (p=0.009, Table 2). Compared to those who remained stable or worsened, those who had an improved antenatal depression symptom trajectory had a significantly decreased odds of PTB (aOR 0.60, 95% CI 0.39-0.94). For pregnant people with mental health conditions, having an improved antenatal depression symptom trajectory is associated with decreased odds of PTB. These data can be used to inform counseling regarding management of depression during pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

"Black Nurses in the Home is Working": Advocacy, Naming, and Processing Racism to Improve Black Maternal and Infant Health.

1) To explore how racism-related stress impacts Black women's health, pregnancy, and parenting. 2) To explore how a culturally-specific program affects the relationship between racism-related stress and Black women's health, pregnancy, and parenting. This qualitative study uses a Black Feminist approach to center the lived experiences and perspectives of Black women. Focus groups were conducted with clients and staff of a culturally-specific program that provides perinatal care for Black families. A thematic analysis was conducted using a Reproductive Justice framework as a guide. Participants consisted of 23 program clients and staff who all identified as Black women. Four themes emerged from the analysis: 1) The pervasive reach of structural racism, 2) Shared identities facilitate trust and healing, 3) Racism directly impacts mental health, and 4) Advocacy on macro and micro levels is a vital service. Results show the chronicity and toxicity of structural racism on Black women's physical and mental health. The presence of overt and subtle forms of racism occur in multiple systems and require interventions on macro- and micro-levels. Culturally-specific perinatal care programs that prioritize racial concordance between providers and clients/patients are well-received and effective models of care. Black perinatal care should include culturally-specific approaches, advocacy on behalf of and alongside Black people, mental health support with attention to racism-related stress, and interrogation of implicit bias. Multipronged interventions guided by Reproductive Justice principles provide a holistic framework to address interpersonal and systemic racial oppression.

Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes.

To examine the association between adverse childhood experiences and adverse pregnancy outcomes. This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses. Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06-2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38-2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99-1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05-1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth. One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.

First-time fathers' experiences during their transition to parenthood: A study of Korean fathers.

PurposeThis study was conducted to explore first-time fathers' experiences during their transition to parenthood in South Korea.MethodsData were collected from September 2019 to February 2020 through in-depth interviews that were conducted individually with 12 participants. First-time fathers with children under 2 months of age were recruited. Verbatim transcripts were analyzed using Colaizzi's phenomenological method.ResultsFour theme clusters were identified: Preparing to become a father, challenges of becoming a father, motivation to foster familial bonds, and acknowledgement of fatherhood.ConclusionThese findings suggest that Korean first-time fathers prepared to practice parenthood through prenatal education, taegyo, and feeling bonds with their new baby. They recognized their identity as fathers and experienced self-growth. These results would be beneficial for health professionals in developing perinatal care programs, and the results provide basic data for studies on fathers and families during the transition to parenthood.

Increased Depression Screening and Treatment Recommendations After Implementation of a Perinatal Collaborative Care Program.

The study evaluated whether implementation of perinatal collaborative care is associated with improvements in screening and treatment recommendations for perinatal depression by obstetric clinicians. This cohort study, conducted from January 2015 to January 2019, included all women who received prenatal care in five obstetric clinics and delivered at a single quaternary care hospital in Chicago. In January 2017, a perinatal collaborative care program (COMPASS) was implemented. Completion of depression screening and recommendations for treatment following a positive depression screen were compared before and after COMPASS implementation. Adjusted analyses included inverse probability weighting by using propensity scores to impose control over imbalance between exposure groups with respect to prespecified covariates. A total of 7,028 women were included in these analyses: 3,227 (46%) before and 3,801 (54%) after COMPASS implementation. Women who received obstetric care after implementation were significantly more likely than those who received care before implementation to receive antenatal screening for depression (81% versus 33%; adjusted odds ratio [aOR]=8.5, 95% confidence interval [CI]=7.6-9.5). After implementation, women with a positive antenatal screen for depression were more likely to receive a treatment recommendation (61% versus 44%; aOR=2.1, 95% CI=1.2-3.7). After implementation of perinatal collaborative care, combined psychotherapy and pharmacotherapy were more frequently recommended, compared with before implementation. Implementation of a perinatal collaborative care program was associated with improvements in perinatal depression screening and recommendations for treatment by obstetric clinicians.

589 Identification of bipolar disorder in the perinatal context: the role of the mood disorder questionnaire

Optimizing perinatal outcomes for women with bipolar disorder (BD) requires identification and effective treatment. However, recognition of BD during the perinatal period is challenging as the phenotypic expression most often overlaps with perinatal unipolar depression. Misdiagnosis of postpartum depressive symptoms can have detrimental consequences, yet the optimal approach to distinguish between unipolar and bipolar depression in the perinatal period is unclear. This retrospective cohort study included all women enrolled in a perinatal collaborative care program (COMPASS) between 1/2017 and 9/2020. During this time, the intended approach for all obstetric patients included universal screening for depression twice antenatally and once postpartum. Women with positive screening questionnaires for depression were referred to COMPASS for ongoing management. Once referred, women were asked to complete a series of additional screening questionnaires for other mental health conditions, including the Mood Disorder Questionnaire (MDQ) for BD. Women with any clinical concern for BD based on these evaluations or on clinical assessment by COMPASS social workers were then evaluated by a perinatal psychiatrist and a formal psychiatric diagnosis was made. We compared sociodemographic and clinical characteristics of all women who had enrolled in COMPASS with and without BD in bivariable analyses. We then evaluated test characteristics of the MDQ for identification of BD. During the study period, 1228 women were enrolled in COMPASS and 50 (4.1%) were diagnosed with BD by a psychiatrist. Compared to women without BD, women with BD were more likely to have public insurance and were less likely to be married (Table 1) with no other identified differences. The MDQ had a good discriminatory capacity for BD (AUC=0.82) with test characteristics at each score cut-off depicted in Table 2. The MDQ can be used in the setting of a positive perinatal depression screen to identify women with BD. A score of at least 8 provides reasonable discrimination with 90% of women being correctly classified.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

593 Racial and ethnic disparities in perinatal depression symptoms and symptom trajectories

Improved awareness of racial/ethnic disparities in perinatal depression is important to understand areas for improvement in care. This retrospective cohort includes individuals enrolled in a perinatal collaborative care program (COMPASS) between 2/17-12/19 who completed at least 2 Patient Health Questionnaire-9 (PHQ9) screens for perinatal depression. Perinatal collaborative care is a health services intervention designed to integrate mental health care into obstetric care. All eligible clinics can refer women to COMPASS’ mental health care, irrespective of insurance status, from initiation of prenatal care until one-year postpartum. Individuals in COMPASS receive PHQ9s every 2-4 weeks with the cadence informed by their prior scores. The proportion of individuals with a positive screen (i.e., PHQ9 > 9) across time were compared across self-identified racial/ethnic groups using generalized estimating equations with a binomial distribution and a log link assumption. A segmented multiple regression model was used to compare change in rate over time before and after delivery across racial/ethnic groups. A total of 873 individuals (26% Black, 20% Latinx, 54% White) completed 6410 PHQ9 screens. Of these 6410 screens, 1477 (23%) were positive. The trajectories of positive depressive screens diverged across races/ethnicities (Figure). Compared to White individuals who experienced a population-aggregated decrease, Latinx (p=0.066) and Black (p=0.035) individuals experienced a stable or increasing prevalence of positive depression screens postpartum. In this cohort of individuals with access to perinatal mental health care via collaborative care, White individuals demonstrated an improved trajectory of positive depression screens postpartum, whereas Black and Latinx individuals did not improve postpartum. These data suggest that relieving the financial burden to mental health care is an insufficient approach to mental health equity. Determining optimal and acceptable interventions to prevent symptom worsening and delayed symptom onset of those at increased risk are next steps.

Related Risk Factors among Women Enrolled in a Community-Based Perinatal Care Program

Background: Adverse maternal and infant health outcomes are influenced by a broad array of psychosocial determinants and behavioral risk factors. We evaluated the correlations between risk factors including mental illness and substance misuse among women from high-risk ZIP Codes in Indianapolis enrolled in a community-based perinatal care program. &#x0D; Methods: We performed a prospective cohort study of 918 women enrolled in the WeCare community perinatal care program. Data was collected during visits by community health workers (CHWs). CHWs met with the patients at home or over the phone and provided individually tailored care related to mental health, substance use, and nutrition amongst other topics. &#x0D; Results: Women with anxiety or depression were nearly twice as likely to experience complications during birth (depression: 22.4% vs. 11.5%, p = 0.022; anxiety: 21.9% vs. 11.2%, p = 0.007). Women with depression were also nearly twice as likely to report substance misuse (18.4% vs. 9.6%, p = 0.046) and women with anxiety were more than twice as likely to report substance misuse (21.9% vs. 9.0%, p = 0.0004) as well as smoking during pregnancy (21.9% vs. 9.7%, p = 0.0012). Women who reported stable or improved anxiety symptoms were less likely to report substance misuse (8.6% vs. 19.0%, p = 0.004) and women who reported stable or improved depression symptoms were less likely to report substance misuse (8.4% vs. 24.1%, p = 0.0002). There was a strong correlation between anxiety and depression. Over 70% (71.4%) of women with depression also presented with anxiety, and over 90% (92.2%) of women who reported stable or improved depression symptoms also reported stable or improved anxiety symptoms. &#x0D; Conclusions: Many of the risk factors associated with adverse maternal and infant health outcomes exist in interwoven relationships. The inclusion of CHWs into a healthcare team could assist in addressing these factors together in a holistic manner.

Meeting the Perinatal Palliative Care Needs of a Region: Development of a Novel Palliative Care Consultative Program with a Children’s Hospital Fetal Medicine Clinic

Families facing life-limiting fetal diagnosis benefit from palliative care consultation. Differing models of perinatal palliative care (PPC) programs exist in a variety of academic and community-based medical systems to provide medical, social and family-centered care during pregnancy complicated by life-limiting fetal diagnosis. We describe the development of a novel PPC consultative program within a children’s hospital multidisciplinary fetal medicine clinic. Program Goals: Through referral from obstetric specialists, we actively partner with maternal providers within our region to ensure that principles of pediatric palliative care are explored and employed for each mother-infant dyad without …

Implementation of perinatal collaborative care: a health services approach to perinatal depression care.

Our objective was to integrate lessons learned from perinatal collaborative care programs across the United States, recognizing the diversity of practice settings and patient populations, to provide guidance on successful implementation. Collaborative care is a health services delivery system that integrates behavioral health care into primary care. While efficacious, effectiveness requires rigorous attention to implementation to ensure adherence to the core evidence base. Implementation strategies are divided into three pragmatic stages: preparation, program launch, and program growth and sustainment; however, these steps are non-linear and dynamic. The discussion that follows is not meant to be prescriptive; rather, all implementation tasks should be thoughtfully tailored to the unique needs and setting of the obstetric community and patient population. In particular, we are aware that implementation on the level described here assumes commitment of both effort and money on the part of clinicians, administrators, and the health system, and that such financial resources are not always available. We conclude with synthesis of a survey of existing collaborative care programs to identify implementation practices of existing programs.

63: Is implementation of a perinatal collaborative care program associated with improvements in depression care?

63: Is implementation of a perinatal collaborative care program associated with improvements in depression care?