Integrating routine psychological health screening and treatment during and after pregnancy can significantly reduce the risk of adverse pregnancy outcomes and improve maternal cardiovascular health, according to a new scientific statement published today in the Journal of the American Heart Association. This statement, featured in a Go Red for Women® spotlight issue, explores sex differences in cardiovascular disease and emphasizes their implications for care.
The scientific statement, titled “Optimizing Psychological Health Across the Perinatal Period: An Update on Maternal Cardiovascular Health”, underscores the critical need to support maternal cardiovascular health by incorporating comprehensive psychological health screenings during the perinatal period—defined as pregnancy through one year postpartum. Cardiovascular disease remains the leading cause of maternal death, making early intervention in maternal psychological health a key strategy for reducing risks.
Link Between Maternal Psychological and Cardiovascular Health
In the U.S., the maternal mortality rate is significantly higher than in other high-income countries, and this disparity has worsened since the onset of the COVID-19 pandemic. For instance, non-Hispanic Black birthing women are 2.6 times more likely to experience maternal mortality compared to non-Hispanic white women.
Mental health conditions like depression and anxiety during the perinatal period are leading contributors to maternal mortality and are linked to both adverse pregnancy outcomes and long-term cardiovascular issues. Psychological health, which encompasses emotional, social, and functional well-being, is influenced by factors such as living conditions, stress, and trauma. It is estimated that 52% of women of reproductive age report having a history of psychological health issues, and 40% of women from underrepresented racial and ethnic groups experience anxiety or depression during pregnancy.
Mental health conditions can contribute to unhealthy behaviors, such as poor diet, lack of physical activity, substance use, and non-adherence to medical recommendations, all of which negatively impact cardiovascular health. Additionally, maternal psychological health can also affect the neurodevelopment and well-being of the child.
The Case for Routine Psychological Screening
The statement advocates for routine screening for psychological health alongside standard cardiovascular screenings, such as for high blood pressure and Type 2 diabetes, during the perinatal period. While pregnancy is a critical time for health interventions, many healthcare professionals do not routinely screen for psychological health or understand the connection between mental and cardiovascular health.
Key risk factors for perinatal psychological health conditions include domestic violence, sleep disorders, history of mental health conditions, and socioeconomic stressors like unemployment and racism. Previous adverse pregnancy outcomes, such as miscarriage or high blood pressure during pregnancy, also increase the risk of developing anxiety or depression.
The statement recommends using screening tools, such as the Patient Health Questionnaire (PHQ-9), to assess symptoms of depression and anxiety. This tool has been effective in raising awareness of psychological health issues and reducing stigma. Healthcare professionals should conduct mental health screenings early in pregnancy and repeat them during prenatal visits to assess changes in psychological well-being.
Managing Maternal Psychological Health
The management of maternal psychological health should be culturally responsive, family-centered, and based on shared decision-making between the healthcare provider and the patient. If pharmacological treatment is necessary, it should consider the safety of medications during pregnancy and breastfeeding, as well as potential interactions with other treatments.
Non-pharmacological strategies, such as counseling, cognitive behavioral therapy, physical exercise, and stress management techniques, are also effective options. A multidisciplinary approach, with collaboration between obstetricians, psychologists, social workers, psychiatrists, and other healthcare professionals, is essential for providing comprehensive care to mothers.
Barriers and Opportunities for Improvement
Despite the potential benefits, barriers to integrating psychological health care into perinatal cardiovascular care remain. These barriers include stigma, fears about child protective services, clinician time constraints, and reimbursement issues. Furthermore, there is a lack of standardized protocols for integrating mental health screenings and interventions into routine care.
To improve outcomes and reduce health disparities, the statement suggests expanding healthcare models that incorporate psychological health screening and intervention. This includes partnering with community-based organizations and providing reimbursement for doulas, midwives, and community health workers, which may help address racial and socioeconomic health inequities.
The statement also emphasizes the need for long-term research into the impact of perinatal psychological health on maternal cardiovascular health and other chronic conditions throughout the lifespan. Future studies should include more participants from underrepresented racial and ethnic groups and explore additional psychological factors like anxiety, post-traumatic stress disorder, and childhood trauma that disproportionately affect women.
Conclusion
This scientific statement advocates for integrating routine psychological health screenings into perinatal care as a crucial step in improving maternal cardiovascular health. By identifying and addressing psychological health issues early, healthcare professionals can reduce the risk of adverse outcomes for both mothers and their children, ultimately improving long-term health outcomes.
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