A comprehensive scientific statement published in the Journal of the American Heart Association underscores the critical need for routine psychological health screening and treatment during pregnancy and postpartum periods to reduce adverse cardiovascular outcomes. The statement reveals that psychological health conditions such as depression and anxiety are among the leading causes of maternal mortality in the United States, with cardiovascular issues remaining the primary cause of maternal death. Maternal mortality rates in the United States are two to three times higher than in other high-income countries, and non-Hispanic Black birthing women experience mortality rates 2.6 times higher than non-Hispanic white women.
The research emphasizes that psychological health encompasses emotional, social, and functional well-being, and suboptimal mental health can lead to negative health behaviors such as poor diet, irregular sleep, low physical activity, and difficulty adhering to medical recommendations, all of which can significantly impact cardiovascular health. An estimated 52% of women of reproductive age report a history of psychological health conditions, with 40% of women from underrepresented races and ethnicities experiencing anxiety or depression during the perinatal period.
Experts recommend implementing universal screening tools like the Patient Health Questionnaire (PHQ-9) to identify and address psychological health challenges. Initial mental health screening should occur as early as possible in pregnancy and be repeated regularly, with healthcare professionals trained to use these tools effectively. The statement advocates for a multidisciplinary approach, involving psychologists, clinical social workers, psychiatrists, and obstetricians working collaboratively to provide comprehensive, culturally responsive care.
Non-pharmacological strategies such as counseling, cognitive behavioral therapies, exercise, and stress management are also highlighted as potential interventions. Barriers to integrating perinatal psychological health care include stigma, clinician time constraints, and workforce issues. The research calls for developing healthcare delivery models that incentivize evidence-based, accessible care and reduce racial and socioeconomic health inequities. Future research needs include long-term studies on perinatal psychological health, with a particular focus on including more participants from underrepresented races and ethnicities to better understand the complex interactions between psychological health and cardiovascular outcomes.
