Top Things to Know: Optimizing Psychological Health Across the Perinatal Period
- Maternal mortality in the U.S. is 2- to 3-fold higher than in other high-income countries, with worsening trends since the coronavirus pandemic, disproportionately impacting historically under-resourced communities.
- Non-Hispanic Black women experience a maternal mortality rate 2.6 times higher than White women, with over 80% of these deaths being preventable, emphasizing the critical need for equitable healthcare access.
- Adverse psychological health is the leading cause of maternal death in the U.S., accounting for 22.7% of pregnancy-related deaths, including suicide and substance use disorders, underscoring the urgency of mental health integration in obstetric care.
- An estimated 52% of pregnancy-capable individuals have a history of psychological health disorders, with 40% of those from under-resourced populations experiencing higher rates of perinatal anxiety and depression, exacerbating maternal health disparities.
- Maternal psychological health is connected to social determinants of health, where systemic factors such as racial inequities, economic instability, and inadequate healthcare access significantly influence maternal cardiovascular health and pregnancy outcomes.
- Universal screening for depression and anxiety during pregnancy and postpartum is essential, using validated tools like EPDS, PHQ-9, and GAD-7 to enable early diagnosis and targeted intervention strategies.
- Perinatal depression increases the risk of ischemic heart disease by 83% within 24 months postpartum, while anxiety, PTSD, and chronic stress contribute to hypertensive disorders, preeclampsia, and gestational diabetes, highlighting the need for comprehensive maternal care.
- Maternal psychological health directly impacts infant outcomes, with prenatal stress and depression increasing risks for preterm birth, intrauterine growth restriction, and neurodevelopmental challenges through mechanisms such as altered fetal brain development.
- Multidisciplinary care models integrating cardiologists, obstetricians, psychiatrists, and social workers are crucial in managing perinatal psychological health alongside cardiovascular risks, ensuring comprehensive, patient-centered maternal care.
- Policy reforms must prioritize expanding maternal mental health care, addressing racial disparities, improving postpartum follow-up, and embedding psychological health into cardiovascular care frameworks to reduce preventable maternal deaths and improve long-term outcomes.
Citation
Sharma G, Gaffey AE, Hameed A, Kasparian NA, Mauricio R, Breese Marsh E, Beck D, Skowronski J, Wolfe D, Levine GN; on behalf of the American Heart Association Women’s Health Science Committee of the Council on Clinical Cardiology and the Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Surgery and Anesthesia; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Optimizing psychological health across the perinatal period: an update on maternal cardiovascular health: a scientific statement from the American Heart Association. J Am Heart Assoc. Published online February 25, 2025. doi: 10.1161/JAHA.125.041369