Psychological screenings are vital to maternal heart health, report says

Comprehensive mental health screenings should be considered an essential part of maternal cardiovascular care, a new report says.

Identifying and treating depression, anxiety and other psychological health conditions – and their risk factors – during pregnancy and up to a year afterward may improve the short- and long-term health of both mother and child, according to the American Heart Association report, which was published Tuesday as a scientific statement in the Journal of the American Heart Association.

"Pregnancy is an important time of life from a health perspective," Dr. Garima Sharma, who led the expert panel that wrote the statement, said in a news release. "However, it is not known how many health care professionals understand the connection between the mind and heart and routinely screen and optimize psychological health during the perinatal period."

Sharma, director of preventive cardiology and women's cardiovascular health at Inova Schar Heart and Vascular in Fairfax, Virginia, said it's "critical" to redefine maternal cardiovascular health to include psychological health because of ample evidence linking psychological well-being with cardiovascular outcomes.

"Screening for psychological health before, during and after pregnancy should be used alongside screening for high blood pressure, Type 2 diabetes and other modifiable risk factors for cardiovascular disease," she said.

Perinatal psychological health conditions are among the leading underlying causes of maternal deaths in the U.S. and are associated with negative pregnancy outcomes and long-term cardiovascular issues, the statement says. The perinatal period includes pregnancy through one year postpartum, or after birth.

Psychological health encompasses emotional, social and functional well-being, and it's a term often used interchangeably with mental health. Factors such as living conditions, traumatic events and daily stressors can affect it.

Mental health can influence maternal health in many ways. People with poor mental health may eat a poor diet, have irregular sleep, not get enough physical activity or use tobacco, alcohol or other harmful substances. They also may have trouble following medical advice.

Maternal psychological health can affect the child's neurodevelopment and well-being, too, the statement says.

An estimated 52% of women of reproductive age report having a history of a psychological health condition, the statement says, and 40% of those from underrepresented races and ethnicities experience anxiety or depression in the perinatal period.

The maternal mortality rate in the United States is two to three times higher than estimates from other high-income countries and has worsened since the COVID-19 pandemic, the statement says, with significant disparities among people in underrepresented races and ethnicities. The maternal mortality rate for non-Hispanic Black women is 2.6 times higher than for non-Hispanic white women.

Risk factors for psychological concerns include domestic violence, sleep disorders and personal or family history of psychological conditions. Other factors are incarceration, active-duty military service, veteran status, lack of partner support, unemployment and racism and discrimination.

Adverse outcomes in prior pregnancies, including miscarriage, ectopic pregnancy and high blood pressure during pregnancy, are also risk factors for perinatal anxiety and depression, the statement says.

Addressing modifiable factors that increase the risk of depression during pregnancy and postpartum – such as social isolation, no or inadequate partner support, depression before pregnancy and poor sleep quality – may improve maternal psychological and cardiovascular health, Sharma said.

The statement says that a prenatal mental health screening should be done as early as practical in pregnancy and be repeated at least once. During the initial obstetric visit, the authors write, it is essential to review the mother's psychological history and use of medications or other treatments to identify mental health risk factors.

Because psychological symptoms may fluctuate over time, inquiring about the mother's emotional well-being (and their partner's, if appropriate) ideally should be part of every prenatal or postpartum visit.

"We also recognize the importance of providing guidance to clinicians on how to integrate psychological health screening into the perinatal period and focus on providing a holistic approach with the mind and heart interconnection," Sharma said.

The statement encourages culturally responsive and family-centered decisions about care, including a full discussion of the potential risks and benefits of treatments. As medications carry potential side effects, the authors write that counseling, cognitive behavioral therapies, exercise, stress management strategies and other methods may be preferred.

Multidisciplinary care teams, including psychologists and other behavioral health professionals, are important to monitor and provide appropriate mental health support during pregnancy and after birth, according to the statement. It also encourages training for clinical social workers, psychiatrists, general internal medicine specialists and obstetricians.

Barriers such as stigma and fear of authorities removing a child may limit care, while health care professionals may lack time and experience and have reimbursement concerns. Solutions, the statement suggests, might be found in partnerships with community-based organizations or in expanding reimbursement for doulas, midwives and community health workers.

The authors say that increased research is needed on psychological factors besides depression. And considering the known disparities in maternal health based on race, ethnicity and social drivers of health, the authors say more people of underrepresented races and ethnicities need to be included in studies.

The National Maternal Mental Health Hotline, run by the Department of Health and Human Services' Health Resources and Services Administration, provides confidential counseling to expectant and new moms experiencing mental health challenges. The free hotline is accessible by phone or text in English and Spanish at 833-TLC-MAMA (833-852-6262).