The importance of incorporating comprehensive mental health screenings into maternal cardiovascular care is being emphasized in a new report, highlighting their critical role. Addressing depression, anxiety, and other mental health conditions during pregnancy and the subsequent year could significantly enhance both the immediate and long-term well-being of mothers and their children. This report, issued by the American Heart Association, was detailed in a scientific statement published recently in the Journal of the American Heart Association.
Dr. Garima Sharma, who spearheaded the expert panel responsible for the statement, highlighted the vital nature of pregnancy from a health standpoint. Despite this, there remains uncertainty about whether healthcare professionals adequately recognize the significant link between mental well-being and heart health, routinely screening and optimizing psychological health during the perinatal period. Dr. Sharma, serving as the director of preventive cardiology and women’s cardiovascular health at Inova Schar Heart and Vascular, stressed the necessity of redefining maternal cardiovascular health to incorporate psychological well-being, given the substantial evidence of its impact on cardiovascular outcomes.
Screening for mental health issues should accompany traditional checks for high blood pressure, Type 2 diabetes, and other cardiovascular risk factors during and after pregnancy, Sharma advocated. Psychological conditions are prominent determinants of maternal mortality in the U.S., closely tied to adverse pregnancy outcomes and long-term cardiovascular challenges. The perinatal period, spanning pregnancy to a year post-birth, sees these mental health conditions impact emotional, social, and functional aspects of well-being, often affected by living conditions, trauma, and everyday stressors.
Mental health plays a considerable role in the broader scope of maternal health, potentially affecting diet, sleep, physical activity, and susceptibility to tobacco and alcohol use. These factors can further complicate adherence to medical advice. Additionally, a mother’s mental health influences her child’s neurodevelopment and overall health. Notably, over half of women of reproductive age report experiencing psychological health issues, with significant disparities among women from underrepresented racial and ethnic groups.
The maternal mortality rate in the United States is markedly higher than in other developed nations, with the rate worsening amidst the COVID-19 pandemic. Non-Hispanic Black women, in particular, face a mortality rate 2.6 times that of their non-Hispanic white counterparts. Psychological risk factors encompass domestic violence, sleep disorders, incarceration, military service, unemployment, and racism. Similarly, negative outcomes from previous pregnancies can elevate the risk for perinatal mental health issues.
Tackling modifiable risks for depression during pregnancy and postpartum, including social isolation and insufficient partner support, could foster improved maternal mental and cardiovascular health outcomes. The report advocates for initial prenatal mental health screening and continued assessment throughout pregnancy. It also emphasizes reviewing a mother’s mental health history, medication use, and symptom fluctuations to inform care strategies.
In terms of intervention, the report promotes culturally aware and family-oriented care, weighing the risks and benefits of treatment options. Given the potential side effects of medication, alternative strategies, such as counseling, cognitive behavior therapy, and stress management, are preferred. Multidisciplinary care teams, including psychologists and other health professionals, are essential for delivering necessary mental health support to pregnant and postpartum women.
The report recognizes the barriers to accessing care, such as stigma and fear of child removal, and suggests partnerships with community organizations and expanded support for community health workers to bridge these gaps. Furthermore, it calls for more diverse research into psychological health in maternal care, particularly involving underrepresented groups to address health disparities.
The National Maternal Mental Health Hotline offers confidential, multilingual support to mothers facing mental health challenges. With its free services, accessible by phone or text, it underscores the importance of comprehensive care for maternal mental well-being.
