The Overlooked Role of Mental Health in Pregnancy

A new scientific statement suggests that incorporating mental health screenings and support during and after pregnancy could help prevent complications and improve mothers’ long-term heart health. Published in the Journal of the American Heart Association, the statement highlights the strong link between psychological well-being and cardiovascular health during pregnancy and the first year postpartum. As heart disease is the leading cause of maternal death, experts urge healthcare providers to make mental health care a standard part of maternity care.

Dr Garima Sharma, who led the statement, explained,

"It's critical that we redefine maternal cardiovascular health to include psychological health because there is robust evidence on the association of psychological health with cardiovascular outcomes. We also recognise 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."

Mental health conditions such as depression and anxiety are among the main causes of maternal deaths in the UK and the US. They also disproportionately affect women from underrepresented racial and ethnic backgrounds. Poor mental health can contribute to behaviours that increase heart risks, such as poor diet, inactivity, and difficulty following medical advice. Additionally, a mother’s mental state can affect her child’s development. Despite this, mental health screenings are not consistently included in standard antenatal and postnatal care.

Dr Sharma emphasised the need for early and repeated screenings, stating, "Pregnancy is an important time of life from a health perspective. However, it is not known how many health care professionals understand the connection between the mind and heart and routinely screen and optimise psychological health during the perinatal period." She explained that these screenings should be carried out alongside routine checks for high blood pressure and diabetes.

Certain factors—such as domestic violence, sleep problems, lack of support, and previous pregnancy complications—can increase the risk of perinatal depression and anxiety. To address this, healthcare providers should be trained to use screening tools like the Patient Health Questionnaire (PHQ-9), which helps identify symptoms of depression and anxiety. Treatment plans should be culturally sensitive, involve shared decision-making, and consider both medication and non-medication approaches, including therapy, cognitive behavioural techniques, and stress management strategies.

However, barriers remain. Stigma, fear of child welfare involvement, provider time constraints, and a lack of insurance coverage for mental health services all make it harder to integrate psychological care into maternal health programmes. The statement calls for policy changes to make mental health support more accessible, including increased funding for doulas, midwives, and community health workers.

There is also a need for further research on the long-term effects of mental health during and after pregnancy, particularly in underrepresented communities. Dr Sharma and her team emphasise the importance of studying a wider range of psychological conditions beyond depression—such as anxiety, PTSD, and early-life trauma—which may have lasting impacts on a mother’s heart health.

In 2024, MQ Mental Health Research created an opportunity, developed and funded by Wellcome, to support researchers outside psychiatry, psychology, and neuroscience to apply bold and novel ideas and methods from their discipline to mental health science. One study looked at using artificial intelligence and mental health health apps to support mothers with perinatal depression and anxiety. Read more about this breakthrough research here.