Effects of Two Group Prenatal Care Interventions on Mental Health: An RCT.

INTRODUCTION: Perinatal depression and anxiety cost the U.S. health system $102 million annually and result in adverse health outcomes. Research supports that cognitive behavioral therapy improves these conditions, but barriers to obtaining cognitive behavioral therapy have prevented its success in pregnant individuals. In this study, the impact of a cognitive behavioral therapy-based intervention on anxiety, depression, stress, healthy lifestyle beliefs, and behaviors in pregnant people was examined. STUDY DESIGN: This study used a 2-arm RCT design, embedded in group prenatal care, with one arm receiving a cognitive behavioral therapy-based Creating Opportunities for Personal Empowerment program and the other receiving health promotion content. SETTING/PARTICIPANTS: Black and Hispanic participants (n=299) receiving prenatal care from 2018 to 2022 in New York and Ohio who screened high on 1 of 3 mental health measures were eligible to participate. INTERVENTION: Participants were randomized into the manualized Creating Opportunities for Personal Empowerment cognitive behavioral therapy-based program, with cognitive behavioral skill-building activities delivered by advanced practice nurses in the obstetrical setting. MAIN OUTCOME MEASURES: Outcomes included anxiety, depression, and stress symptoms using valid and reliable tools (Generalized Anxiety Disorder scale, Edinburgh Postnatal Depression Scale, and Perceived Stress Scale). The Healthy Lifestyle Beliefs and Behaviors Scales examined beliefs about maintaining a healthy lifestyle and reported healthy behaviors. RESULTS: There were no statistically significant differences between groups in anxiety, depression, stress, healthy beliefs, and behaviors. There were significant improvements in all measures over time. There were statistically significant decreases in anxiety, depression, and stress from baseline to intervention end, whereas healthy beliefs and behaviors significantly increased. CONCLUSIONS: Both cognitive behavioral therapy and health promotion content embedded in group prenatal care with advanced practice nurse delivery improved mental health and healthy lifestyle beliefs and behaviors at a time when perinatal mood generally worsens. TRIAL REGISTRATION: This study is registered with clinicaltrials.gov NCT03416010.

Depression, anxiety, and stress in pregnant Black people: A case for screening and evidence-based intervention.

BACKGROUND: Guidelines call for pregnant people to be screened for depression and anxiety. Screening may be particularly important for pregnant Black individuals who are reported to be more likely than non-Hispanic White pregnant people to experience prenatal stress, anxiety, and depressive symptoms. The purpose of this study was to determine if depression, anxiety, and stress co-occur in pregnant Black people and to identify which demographic factors are related to these mental health concerns. METHODS: A subset analysis of an ongoing randomized controlled trial examined the risk of coexisting mental health conditions in pregnant Black people who screened eligible to participate (that is, they had high levels of depression, anxiety, and/or stress) in two urban clinics using a descriptive correlational design. RESULTS: Of the 452 pregnant Black people who were screened for eligibility, 194 (42.9%) had elevated scores on depression, anxiety, and/or stress measures and were enrolled in the larger study. The average scores of the 194 enrolled participants were anxiety, mean (M) = 9.16 (standard deviation [SD] = 4.30); depression, M = 12.80 (SD = 4.27); and stress, M = 21.79 (SD = 4.76). More than one-third (n = 70, 36.1%) experienced two symptoms and 64 (33.0%) reported all three symptoms. CONCLUSION: Pregnant Black individuals experience high levels of comorbid mental health distress including depression, anxiety, and stress. The findings indicate that treatment for mental health concerns needs to be broad-based and effective for all three conditions. Prenatal interventions should aim to address mental health distress through screening and treatment of depression, anxiety, and stress, especially for pregnant Black individuals. This study furthers understanding of the prevalence of prenatal mental health conditions in pregnant Black people.

Randomized controlled trial of the COPE-P intervention to improve mental health, healthy lifestyle behaviors, birth and post-natal outcomes of minority pregnant women: Study protocol with implications.

BACKGROUND: Emotionally distressed pregnant minority women experience multiple adverse outcomes, including pre-eclampsia, preterm birth, operative deliveries and low birth weight. Although the United States Preventive Services Task Force recommends screening in pregnant women, many practices do not screen because efficacious interventions and systems are not in place to treat them. AIM: Purpose of this randomized controlled trial (RCT) is to test a group delivered manualized cognitive-behavioral skills building intervention entitled COPE-P versus an attention control program on the mental health, birth and postpartum outcomes of minority pregnant women experiencing depressive, anxiety and stress symptoms. METHODS: Design is a longitudinal randomized block RCT with repeated measures (beginning with screening prior to 18 weeks, group prenatal care in both groups from 16 + 1 to 31 + 1 weeks and ending at 6 months postpartum) at two study sites (New York city and Columbus, Ohio). Race/ethnicity is being blocked to ensure equal numbers of Hispanic and Black women. 384 women are being recruited from antenatal clinics if they are: between 18 and 40 years; in an uncomplicated singleton pregnancy <18 weeks; and self-identify as Black or Hispanic. Valid and reliable measures are being used to assess healthy lifestyle behaviors and mental health outcomes immediately following the interventions, six - eight weeks postpartum and at the children's six-month well baby visit. Birth and delivery outcomes also are being assessed. CONCLUSION: If found to be efficacious, the COPE-P intervention could be a key solution to managing those with emotional distress and improving their outcomes.

Perinatal Anxiety and Depression in Minority Women.

Depression and anxiety are common during pregnancy and are experienced at higher rates among women who are racial and ethnic minorities. Because depression and anxiety influence maternal and infant outcomes, intervening to improve perinatal mental health should be a priority for all healthcare providers. However, in the United States, a number of barriers including lack of mental health providers, lack of perinatal behavioral health systems, and stigma, limit access to care. Universal screening has been recommended and here we examine how universal screening can help nurses improve the mental health of childbearing women. Interventions that are currently in use to improve perinatal anxiety and depression are reviewed and include: psychopharmacology, cognitive behavioral therapy, interpersonal psychotherapy, and mindfulness. Recommendations for future research and healthcare system changes are made.

Patient portal readiness among postpartum patients in a safety net setting.

BACKGROUND: Maternity patients interact with the healthcare system over an approximately ten-month interval, requiring multiple visits, acquiring pregnancy-specific education, and sharing health information among providers. Many features of a web-based patient portal could help pregnant women manage their interactions with the healthcare system; however, it is unclear whether pregnant women in safety-net settings have the resources, skills or interest required for portal adoption. OBJECTIVES: In this study of postpartum patients in a safety net hospital, we aimed to: (1) determine if patients have the technical resources and skills to access a portal, (2) gain insight into their interest in health information, and (3) identify the perceived utility of portal features and potential barriers to adoption. METHODS: We developed a structured questionnaire to collect demographics from postpartum patients and measure use of technology and the internet, self-reported literacy, interest in health information, awareness of portal functions, and perceived barriers to use. The questionnaire was administered in person to women in an inpatient setting. RESULTS: Of the 100 participants surveyed, 95% reported routine internet use and 56% used it to search for health information. Most participants had never heard of a patient portal, yet 92% believed that the portal functions were important. The two most appealing functions were to check results and manage appointments. CONCLUSIONS: Most participants in this study have the required resources such as a device and familiarity with the internet to access a patient portal including an interest in interacting with a healthcare institution via electronic means. Pregnancy is a critical episode of care where active engagement with the healthcare system can influence outcomes. Healthcare systems and portal developers should consider ways to tailor a portal to address the specific health needs of a maternity population including those in a safety net setting.

Improving Prenatal Care for Minority Women.

Since the inception of prenatal care in the early 1900s, the focus of care has been on risk reduction rather than on health promotion. Prenatal care began as individualized care, but more recently group prenatal care has been shown to be very successful in improving birth outcomes. For all women, an emphasis on improving health behaviors is important at this critical time while women are engaging regularly with the healthcare system. An emphasis on mental health promotion may decrease some of the disparities in birth outcomes that are well documented between minority and majority women, as minority women are known to experience increased levels of stress, anxiety, and depression. Providing support for pregnant women and incorporating knowledge and skills through prenatal care may promote both physical and mental health in minority women.

CRH as a Predictor of Preterm Birth in Minority Women.

OBJECTIVE: To determine the predictive capability of corticotropin-releasing hormone (CRH) as a biomarker of preterm birth (PTB) in minority women. STUDY DESIGN: Venous blood samples were obtained at 22-24 weeks' gestation in a prospective, descriptive study of 707 minority women experiencing low-risk pregnancies. CRH was analyzed using a radioimmunoassay and methanol extraction protocol. RESULT: CRH predicted PTB in both African American and Hispanic women. The odds ratio was 1.8 times greater for having a PTB if the CRH level was >24 pg/ml. The median CRH for African American women having a PTB was 46.6 pg/ml and for Hispanic women was 35.03 pg/ml. Using a receiver-operating characteristic curve, the threshold for CRH among the African American women was 30.6 pg/ml and among the Hispanic women was 27.4 pg/ml. CONCLUSION: CRH may be an important biomarker for predicting PTB in minority women, especially when combined with other predictors.

Measuring coping in pregnant minority women.

Coping strategies may help explain why some minority women experience more stress and poorer birth outcomes, so a psychometrically sound instrument to assess coping is needed. We examined the psychometric properties, readability, and correlates of coping in pregnant Black (n = 186) and Hispanic (n = 220) women using the Brief COPE. Exploratory and confirmatory factor analysis tested psychometric properties. The Flesch-Kincaid Reading Level test assessed readability. Linear regression models tested correlates of coping. Findings suggested two factors for the questionnaire: active and disengaged coping, as well as adequate reliability, validity, and readability level. For disengaged coping, Cronbach's α was .78 (English) and .70 (Spanish), and for active coping .86 (English) and .92 (Spanish). A two group confirmatory factor analysis revealed both minority groups had equivalent factor loadings. The reading level was at the sixth grade. Age, education, and gravidity were all found to be significant correlates with active coping.

Secondhand smoke exposure among nonsmoking pregnant women in New York City.

INTRODUCTION: Although secondhand smoke (SHS) exposure during pregnancy has detrimental effects on fetal health, little is known about levels of SHS in nonsmoking pregnant women. We examined disparities in SHS exposure among nonsmoking, ethnic minority pregnant women in New York City. METHODS: We used self-reported smoking and serum cotinine collected from 244 pregnant women from the Bronx who self-identified as African American, Caribbean American, or Black Hispanic to examine smoking prevalence (>3 ng/ml) and, in an adjusted logistic regression model, risk factors for SHS (≥ 0.05 ng/ml and ≤ 3 ng/ml). RESULTS: Although only 4.1% of women self-reported they were smokers, 10.7% had serum cotinine levels indicating they were smokers. Among the 218 nonsmokers, 46.8% had serum cotinine levels indicating SHS exposure. Women at highest risk included those with less than a high school degree (66.7%) and those who were U.S.-born Black Hispanic (63.2%) or African American (63.0%). Women with more than 12 years of education were less likely to have detectable SHS exposure than women with fewer than 12 years (adjusted odds ratio 0.39, 95% CI = 0.17, 0.91). Compared with African American U.S.-born women, those who were African American foreign-born or Caribbean American and either U.S.-born or foreign-born were less likely to have detectable SHS exposure (all p ≤ .05). CONCLUSIONS: Nearly half of nonsmoking pregnant women in New York City had elevated cotinine levels despite living in a city with comprehensive tobacco control policies. Health professionals need to assess sources of SHS exposure during pregnancy and promote smoke-free environments to improve maternal and fetal health.