Research-Based Articles

Summary: Pilot study focused on feasibility; missing quantified outcome change for depressive symptoms in the abstract.

Abstract: Introduction: Perinatal depression occurs in 12% to 18% of childbearing women. Telehealth is a promising platform for delivering perinatal mental health care, particularly during a pandemic when in-person services have been significantly curtailed. However, there is little research to document the feasibility of telehealth to address perinatal depression. This pilot study evaluated the feasibility and preliminary results of an 8-week facilitated group videoconference intervention.

Methods: The study enrolled pregnant and postpartum women into an 8-week group mindfulness-based cognitive behavioral intervention, delivered via videoconference platform. Women receiving care at outpatient clinics who either screened positive for perinatal depression symptoms or had risk factors predictive of perinatal depression were invited to participate. Women attended weekly one-hour group sessions using their own electronic device and completed the Edinburgh Postnatal Depression Scale (EPDS) at several time points. Session attendance and survey completion rates were evaluated.

Results: A total of 47 women enrolled (8 postpartum; 39 prenatal) into groups of 4 to 6. Twenty-four (51.1%) women were currently experiencing mild to moderate perinatal depression symptoms (EPDS score of 10-20), whereas 23 (48.9%) women had EPDS scores less than 10 but were at high risk for developing perinatal depression due to health history and significant life events. Seventy percent of women attended at least 5 of the 8 sessions. Trajectories of EPDS measures were promising (ie, downward among those with current perinatal depression symptoms and stable among those at high risk for developing perinatal depression).

Discussion: These observational results are promising, suggesting further study of effectiveness for women with symptoms of perinatal depression, as well as for women at high risk for developing perinatal depression. Randomized trials could evaluate the effectiveness of the intervention, compared with standard of care approaches. Telehealth interventions can be tailored to meet the needs of different communities, and increase access to care, regardless of where women live or inability to receive in-person services.

Keywords: Perinatal depression; telehealth; group intervention; pilot study

Topic(s):

• Behavioral/mental health services and substance use
• Infrastructure development, financing, and expansion of services

Intervention Type: Counseling

Summary: Abstract unavailable.

Abstract: Introduction: Pregnant patients with prior traumatic experiences and their providers face challenges during prenatal care, peripartum, and postpartum. To date, no structured simulations have been published focused on improving care for patients in subsequent pregnancies.

Methods: This multidisciplinary simulation included trainees and providers. Standardized patients were used. The patient was multiparous with a remote history of substance use and was initiating prenatal care late due to concerns related to the prior traumatic experience of losing custody of a newborn after a Department of Children and Family Services report had been opened in a prior pregnancy. Simulation participants completed the prenatal intake and counseling regarding this prior experience. Debriefing sessions reviewed critical actions, including collecting a history, empathizing with the patient, praising efforts to maintain pregnancy health, discussing available resources, constructing a plan for care, and utilizing motivational interviewing techniques. The simulation and debriefing sessions were allotted 30 minutes total. Pre- and postsimulation surveys evaluated for increased comfort and knowledge in caring for patients with prior traumatic experiences.

Results: Simulation participants included obstetrics and gynecology students and residents, nurses, advanced practice providers, generalist attendings, and maternal fetal medicine fellows and attendings. Sixty participants completed the presimulation survey. Twenty-seven (45%) completed the postsimulation survey. Responses were paired for analysis. Scores on knowledge assessments improved postsimulation (p = .001). Responses suggested increased comfort in discussing prior traumatic experiences (p = .13).

Discussion: This simulation led to improved background knowledge and comfort regarding providing trauma-informed care during pregnancies impacted by a prior traumatic event.

Keywords: Trauma-informed care, pregnancy, simulation, multidisciplinary

Topic(s):

• Workforce training and development
• Dyadic, culturally congruent, family-centered care

Intervention Type: Education and Promotion

Summary: Phase I pilot study assessing usability and acceptability, reporting high scores but lacking clinical outcome quantification.

Abstract: Background: Perinatal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) require targeted interventions to address gaps in maternal education and support. Maternal involvement in non-pharmacological NAS care is essential for improving neonatal outcomes, yet many mothers lack accessible resources to manage NAS symptoms and to navigate social and healthcare challenges. Mobile health applications offer a promising solution, but few cater specifically to the needs of perinatal women with OUD. Objective: We assessed the usability, acceptability, and feasibility of a new mobile educational tool for pregnant women with OUD, focusing on the perinatal period and NAS care. Results: Six perinatal women with OUD (n = 1 pregnant, n = 5 postpartum; mean age 31) found the tool highly acceptable (modified CSQ-8 mean = 28.8 out of 32) and usable (modified SUS mean = 45.0 out of 50). Most were likely to use the tool during pregnancy and postpartum, citing improved preparedness for advocating for themselves, managing NAS, and navigating CPS. Feedback suggested expanding content on infant withdrawal medications. Conclusions: This mobile tool shows promise in empowering perinatal women with OUD. Further research is needed to evaluate its impact on clinical and neonatal outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

Topic(s):

• Resources for consumers/new mothers
• Behavioral/mental health services and substance use

Intervention Type: Education and Promotion

Summary: Descriptive article on tool creation and qualitative initial impressions.

Abstract: Background and Purpose: Studies have shown that postpartum weight retention is a key contributor to obesity among women. Studies have also shown that resources dedicated to postpartum weight loss are scarce. Weight tracking has been found to help with weight management during pregnancy. However, a postpartum weight-loss tracker (PPWLT) was yet to exist. This article describes the creation and initial impressions of a PPWLT that were collected via focus groups (FG) discussions with WIC participants. Methods: Two FG discussions (English and Spanish) were conducted at a WIC clinic in Southern California. All discussions were audio-recorded for transcription. Transcripts were analyzed using the scissor -and-sort technique. The sample consisted of ten Latina women, with a mean age of 28.7 ± 5.06 years and a mean current Body Mass Index (BMI) of 32.8 ± 7.8. Results: Participants in both FGs expressed a strong interest in the PPWLT and reported a willingness to use the tracker if provided by WIC. The Spanish-speaking group had several specific suggestions to make the instructions easier to understand. Conclusion: We believe that this new innovative tool has the potential to impact a mother's well-being and give her an opportunity to optimize her health before a subsequent pregnancy.

Keywords: Postnatal Period ; Weight Loss ; Wearable Sensors Utilization ; Consumer Attitudes ; Socioeconomic Factors ; Women's Health ; Human ; Focus Groups ; California ; Audiorecording ; Female ; Young Adult ; Adult ; Body Mass Index ; Motivation ; Goal-Setting ; Mobile Applications ; Adult: 19-44 years ; Female

Topic(s):

• Resources for consumers/new mothers
• Nonclinical postpartum care

Intervention Type: Education and Promotion Social Marketing

Summary: Educational innovation describing the implementation and evaluation of a clinical experience for students (measured student preparation/satisfaction).

Abstract: This educational innovation describes the implementation and evaluation of a telehealth maternal-newborn home visit clinical experience for nurse practitioner students at an urban, private research university in the Midwest. The visits were conducted using the Family Connects evidence-based universal support program for families with newborns to evaluate each family's unique risks and to align their needs with available community resources. Students were prepared for the clinical experience through advanced practice didactic modules and simulation and then participated in the visits over a 2-week period. After the clinical opportunity, both students and community health nurse collaborators completed a survey about their experiences. The students reported feeling prepared to participate in the visits, that they were able to meet clinical objectives using telehealth, and learned about the community resources available for families with newborns. The nurses reported feeling prepared to collaborate with nurse practitioner students and that they benefitted from having a student participate in the visits. The experience prepared the students to meet the needs of a diverse patient population during the early postpartum/newborn period by providing newborn care advice, addressing access to health, assessing social determinants of health, and considering community resource referrals to reduce disparities and improve health equity. This article describes how a telehealth clinical experience addresses the American Association of Colleges of Nursing Essentials for advanced-level nursing students and provides recommendations for incorporating and evaluating telehealth clinical experiences in pediatric advanced practice education.

Keywords: telehealth, maternal-newborn, health equity, home visit, nurse practitioner; professional education

Topic(s):

• Workforce training and development
• Infrastructure development, financing, and expansion of services

Intervention Type: Education and Promotion Referral and Follow-Up

Summary: Abstract unavailable.

Abstract: A flipped classroom module using telemedicine effectively taught postpartum depression concepts to trainees.

Keywords: Flipped classroom, postpartum depression, telemedicine, education

Topic(s):

• Workforce training and development
• Behavioral/mental health services and substance use

Intervention Type: Education and Promotion Screening

Summary: Feasibility and acceptability study reporting on attendance rates and qualitative satisfaction, without providing quantifiable clinical outcome changes.

Abstract: This study examined the feasibility and accessibility of brief perinatal mindfulness-based interventions (1 prenatal, 2 postnatal) aimed at supporting the wellbeing of women and their infants living in the context of low income. First time expectant mothers (n = 202) were recruited through clinics and community-based organizations. We examined the feasibility of recruitment, research assessments and intervention implementation, and the acceptability of the intervention programs. Feasibility was assessed by recruitment and attendance numbers, and participant self-report on barriers and facilitators to participation. Intervention acceptability was assessed by class evaluation questions and qualitative interview. The study showed mixed feasibility with successful recruitment and retention in the study, attributable to incentives and strong community relationships which lead to high levels of completion of research assessments. However, there were low levels of group intervention attendance in the postpartum groups due to significant barriers to in-person program attendance. In qualitative interviews, participants indicated having an online or combined online and in-person option would address attendance challenges. Program evaluation and participant interview data show high levels of program acceptability, with over 95% reporting satisfaction with skills and information taught. The high level of class satisfaction across all three intervention programs, along with responses in the qualitative interviews suggests that a mindfulness approach is accepted and valued by this population. Intervention groups were valued by participants, pointing to the need for future iterations of such interventions to explore the use of online and combined online and in-person formats to assess their success in addressing attendance barriers. Highlights: Perinatal mindfulness interventions were accepted and valued by a diverse sample of mothers with low income. Expectant and new first-time mothers valued the connections and support of other new mothers in the intervention group setting. Significant barriers to attendance for low-income mothers in the perinatal period undermine the feasibility of in-person interventions. Adapting the perinatal interventions to an online or combination online and in-person program was desired by participants and may address attendance barriers.

Keywords: Mindfulness ; Postnatal Period ; Prenatal Care ; Patient Attitudes ; Expectant Mothers Psychosocial Factors ; Income ; Socioeconomic Factors ; Program Evaluation ; Psychosocial Intervention ; Adaptation, Psychological ; Pilot Studies ; Qualitative Studies ; Interviews ; Human ; Male ; Female ; Adolescence ; Young Adult ; Adult ; Middle Age ; Aged ; Funding Source ; Psychological Well-Being ; Maternal-Child Health ; Data Analysis Software ; Adolescent: 13-18 years ; Adult: 19-44 years ; Middle Aged: 45-64 years ; Aged: 65+ years ; Male ; Female

Topic(s):

• Behavioral/mental health services and substance use
• Health equity and access to care

Intervention Type: Counseling

Summary: Secondary analysis objective; missing quantified outcome change in the abstract.

Abstract: Objective: Remote self-measured blood pressure (SMBP) programs improve racial health equity among postpartum people with hypertensive disorders of pregnancy (HDP) who receive recommended blood pressure ascertainment after hospital discharge.1-3 However, as prior studies have been conducted within racially diverse but ethnically homogeneous populations,1-3 the effect of SMBP programs on ethnicity-based inequities is less understood.4 We examined whether SMBP rates differed among Hispanic versus non-Hispanic participants in remote SMBP programs.

Study design: This is a planned secondary analysis of a RCT conducted among postpartum patients with HDP who were enrolled into our remote SMBP program, in which they obtain SMBP and then manually enter the SMBP value into a patient portal for individual provider response. In the parent trial, consenting patients were randomized to continued manual blood pressure entry of SMBP or use of a Bluetooth-enabled blood pressure cuff synched to a smartphone application utilizing artificial intelligence to respond to each obtained blood pressure or symptom for six weeks and to flag abnormalities for providers. Both SMBP programs were available in Spanish and English. For this study, women who self-reported their ethnicity were stratified into two ethnic groups - Hispanic and non-Hispanic - regardless of randomization group. Those who did not self-report ethnicity but completed all study procedures in Spanish were also categorized as Hispanic. Outcomes were the same in the parent study and this secondary analysis. The primary outcome was ≥1 SMBP assessment within 10 days postpartum. Secondary outcomes included number of blood pressure assessments and healthcare utilization outcomes (remote antihypertensive medication initiation or dose-increase and presentation to the Emergency Department or readmission for hypertension within 30 days of discharge). Participants rated their experience with SMBP via a scale from 0 (worst possible) to 10 (best possible) and the Decision Regret Scale, which assessed their regret in SMBP program participation (0=no regret; 100=high regret)).5 Outcomes were compared between groups. Risk differences (RD) were calculated for categorical and regression coefficients for continuous outcomes. The parent RCT was IRB-approved and published on clinicaltrials.gov (NCT05595629) before enrollment.

Results: Among 119 women in the parent study, 83 (70%) self-reported ethnicity and the proportion of Hispanic people was similar in both treatment groups. This study compared 23 Hispanic (19% monolingual in Spanish) to 62 non-Hispanic women. Rates of SMBP assessment within 10 days postpartum was similar (Hispanic 64% vs non-Hispanic 79%; RD -0.1 (95% Confidence Interval (CI) -0.4, 0.1). There were no differences in mean number of remote SMBP assessments or rates of remote antihypertensive medication initiation or dose titration. The rates of hypertension-related presentations to the Emergency Department or hospital readmission were also similar between groups. Lastly, regardless of ethnicity, participants had low scores on the Decision Regret Scale and rated their experience with their remote SMBP program highly favorably. (See Table 1.) Conclusion: Hispanic and non-Hispanic postpartum patients with HDP had similar outcomes and favorable patient perceptions. The small sample size in this study may have produced inadequate power to detect a difference between study groups, thereby leading to Type II error. Thus, more research on Hispanic participants in remote SMBP programs is needed. However, the effect of remote SMBP programs on perinatal equity may not be limited to race-based disparities.

Keywords: Postpartum blood pressure; remote monitoring; Hispanic ethnicity; engagement

Topic(s):

• Infrastructure development, financing, and expansion of services
• Health equity and access to care

Intervention Type: Screening Direct Care

Summary: Pilot trial conclusion suggests effectiveness but does not provide quantified efficacy data in the abstract.

Abstract: Introduction: Perinatal depression is a leading cause of preventable US maternal morbidity and mortality. Although Mindfulness-Based Cognitive Therapy for Perinatal Depression (MBCT-PD) is highly effective, it faces significant scalability challenges. Center M, a brief, group-based, mindfulness-based cognitive behavioral therapy (CBT) intervention, is an adaptation of MBCT-PD designed to overcome these challenges. The purpose of this pilot study was to evaluate Center M's preliminary acceptability, feasibility, mechanisms of action, and efficacy.

Methods: In this mixed-methods pilot study, data were collected from 99 pregnant people at 3 time points: preintervention, postintervention, and 6-weeks postpartum (Clinical Trials no. NCT06525922). Participants engaged in 4 one-hour, weekly group telehealth Center M sessions facilitated by social workers. Participants strengthened mindfulness CBT skills using home practice materials between group sessions. Data included self-report measures evaluating depressive symptoms, mindfulness skills, and emotion regulation. Satisfaction was assessed via focus groups or surveys.

Results: Depressive symptoms significantly decreased preintervention to postintervention (Patient Health Questionnaire-8 score: preintervention mean [SD] 5.02 [3.52], postintervention mean [SD] 4.23 [2.84]; P = .03), and mindfulness capacity significantly increased preintervention to 6 weeks postpartum (Five Facets of Mindfulness Questionnaire score: preintervention mean [SD] 125.56 [18.68], 6 weeks postpartum mean [SD] 130.10 [17.15]; P = .004). Linear regression analyses indicate that higher mindfulness at 6 weeks postpartum significantly predicted fewer depression symptoms at 6 weeks postpartum (β, -0.07; 95% CI, -0.123 to -0.021, R2 = 0.22; P = .006). Reduction in the use of maladaptive emotion regulation was significantly associated with decreased depressive symptoms at 6 weeks postpartum (β, 0.21; 95% CI, 0.048 to 0.376, R2 = .21; P = .012). Qualitative themes indicated high Center M acceptability and appeal.

Discussion: Our findings support the feasibility, acceptability, and appeal of Center M. Results suggest Center M may be effective in reducing depression and enhancing mindfulness skills. Future research must confirm these initial findings to more widely address Center M implementation capacity and sustainability.

Keywords: Mental health, prenatal care, prevention, integration, pilot trial

Topic(s):

• Promising models of care and best practices
• Behavioral/mental health services and substance use

Intervention Type: Counseling Education and Promotion

Summary: Descriptive paper on telepsychiatry consultations.

Abstract: Background: Limited access to mental health resources has challenged clinicians in delivering early behavioral health interventions to perinatal populations. We describe telepsychiatry consultations to a rural hospital's labor and delivery unit.

Objective: To demonstrate how consultation-liaison services during peripartum hospitalization could meet this need.

Methods: One-year data from electronic medical records of women who were at risk of postpartum syndromes and offered a telepsychiatry consult was extracted and reviewed.

Results: A total of 85 consults were conducted via telepsychiatry primarily for depression, anxiety, and medication management. Bedside psychotherapeutic interventions and education were provided to 63 patients, medications were initiated for 32 patients, and outpatient referrals were made for 47 patients.

Conclusions: Our results indicate that consultation-liaison telehealth can successfully engage at-risk mothers in psychiatric treatment. Given accelerated telemedicine efforts due to the COVID-19 pandemic, improving access to telepsychiatry for rural, peripartum populations is an important area of development.

Keywords: Telepsychiatry, obstetric, consultation-liaison, labor and delivery

Topic(s):

• Infrastructure development, financing, and expansion of services
• Behavioral/mental health services and substance use

Intervention Type: Consultation Counseling

Summary: Methodology paper describing the adaptation and formative development of a digital technology framework (Digilego).

Abstract: Digital health technologies offer unique opportunities to improve health outcomes for mental health conditions such as peripartum depression (PPD), a disorder that affects approximately 10-15% of women in the U.S. every year. In this paper, we present the adaption of a digital technology development framework, Digilego, in the context of PPD. Methods include mapping of the Behavior Intervention Technology (BIT) model and the Patient Engagement Framework (PEF) to translate patient needs captured through focus groups. This informs formative development and implementation of digital health features for optimal patient engagement in PPD screening and management. Results show an array ofPPD-specific Digilego blocks ("My Diary", "Mom Talk", "My Care", "Library", "How am I doing today?"). Initial evaluation results from comparative market analysis indicate that our proposed platform offers advantageous technology aspects. Limitations and future work in areas of interdisciplinary care coordination and patient engagement optimization are discussed.

Keywords: Peripartum depression; digital health; patient-facing tool

Topic(s):

• Resources for consumers/new mothers
• Behavioral/mental health services and substance use

Intervention Type: Screening Education and Promotion

Summary: Proof-of-concept study evaluating the feasibility, acceptability, and validity of an app-based screening tool.

Abstract: Background: Depression during the postnatal year is prevalent in mothers (17%) and fathers (9%), and suicide is the leading cause of maternal death in this period. Lifelong costs and consequences of untreated postnatal depression (PND) are high due to impacts on infants as well as parents. We aimed to improve access to PND treatment using digital screening. We developed a smartphone app (ClinTouch DAWN-P) that allows parents to monitor their mood daily with the Edinburgh Postnatal Depression Scale (EPDS), uploading responses in real-time to a secure server. We evaluated the app's feasibility, acceptability, validity and safety in a proof-of-concept study.

Methods: Pregnant women (≥ 36 weeks gestation) and partners were recruited from antenatal services and invited to complete daily EPDS assessments via the ClinTouch DAWN-P app until 6 weeks postpartum. Participants completed standard paper-based EPDS at two time points for validity comparisons. We examined app acceptability and usability at 6 weeks postpartum with qualitative interviews, examined using framework analysis, and the abridged Mobile App Rating Scale (convergent mixed methods design).

Results: Most (96%) eligible pregnant women approached were keen to try the app. Participating mothers (n = 15) and partners/fathers (n = 8) found the app easy to use, and 91% continued to use it for the full study period. Overall, 67% of daily app-based assessments were completed, with a history of depression predicting lower app usage. Participants suggested modifications to the app and its deployment to improve usability (e.g., extending the response window and including feedback and parenting advice). The validity of app-based responses was confirmed by high agreement with standard EPDS. App-based and paper-based ratings showed perfect agreement in identifying cases of likely PND. There were no serious adverse events relating to app use.

Conclusions: Digital PND screening appears feasible, acceptable, valid and safe. It also benefits from being remotely delivered: we enrolled all participants remotely during the first COVID-19 lockdown. Use of digital screening could address known shortcomings of conventional health visitor-delivered screening such as limited staff time, parental unwillingness to disclose difficulties to a professional, lack of partner/father screening, and language barriers.

Trial registration: The study was prospectively registered (Clinicaltrials.gov: NCT04279093 ).

Keywords: Digital mental health; Framework analysis; Maternal mental health; Mixed methods; Postnatal depression; Screening; Smartphone; mHealth.

Keywords: Digital screening, Postnatal depression, Mixed methods, Proof-of-concept study

Topic(s):

• Universal screening tools and billing codes
• Resources for consumers/new mothers

Intervention Type: Screening

Summary: Validation study for a new 3-item screening instrument.

Abstract: A number of countries now recommend population-wide depression screening for perinatal women, using validated tools. A stepped-approach to screening – involving universal screening with a brief measure, followed by targeted screening using a longer measure for those women identified as at greater risk – is used in some settings. This brief report describes the test performance characteristics of a 3-item mood screening instrument, developed for use within a digital parenting program. Participants (n = 404) in this cross-sectional study were mothers of children aged up to 3 years. The majority (65.5 %) were first-time mothers, and their mean age was 32.8 years. Data were collected using an online survey. The test performance of the brief 3-item mood screening instrument (possible score range = 0–300) was examined using Receiver Operating Characteristic (ROC) analysis, with a score of 13 or more on the Edinburgh Postnatal Depression Scale (EPDS) used as the reference standard. The mood screening instrument demonstrated excellent range when compared to the reference standard. Optimal balance between sensitivity (0.77) and specificity (0.78), was achieved at a cut-point of 160 or less. Analysis was limited by using only the EPDS as the reference standard. This preliminary data supports the use of this 3-item mood screening instrument to screen for postnatal depression symptoms and may be integrated into a mobile Health or online tool. Future research should examine the test performance of the 3-item mood screening instrument against a diagnostic tool.

Keywords: Health Screening ; Mothers Psychosocial Factors ; Depression ; Instrument Validation ; Psychometrics ; Human ; Female ; Pregnancy ; Adult ; Validation Studies ; Cross Sectional Studies ; Questionnaires ; Emotions ; Internet ; Edinburgh Postnatal Depression Scale ; Psychological Tests ; Sensitivity and Specificity ; Depression, Postpartum Symptoms ; Telemedicine ; Parenting ; Maternal Health Services ; Perinatal Care ; Descriptive Statistics ; Comparative Studies ; ROC Curve ; Adult: 19-44 years ; Female

Topic(s):

• Universal screening tools and billing codes
• Behavioral/mental health services and substance use

Intervention Type: Screening

Summary: Validation study assessing the validity and reliability of the CORE-10 screening measure.

Abstract: Women experience diverse symptoms of mental ill-health in pregnancy, yet measures usually only assess depression or anxiety. Measures may, therefore, miss out on identifying women experiencing distress. We aimed to examine the validity and reliability of the CORE-10: a short measure with broad coverage of symptoms of distress and associated functioning, in pregnant women. 366 women 26–38 weeks pregnant completed online measures of distress (CORE-10), depression (Whooley questions), anxiety (Generalised Anxiety Disorder-2), and a single item measuring worry about psychological health. We examined convergent and factorial validity and concordance rates of the measures. Levels of distress were high, with anxiety the most reported symptom. The CORE-10 showed good convergent validity. A two-factor structure representing 'symptoms' and 'ways of coping' best fit this sample. Internal reliability of the symptoms' factor was good. The self-selected online sample may not be representative of pregnant women in the third trimester and a diagnostic interview was not used. Based on this validation study, the CORE-10 potentially offers an assessment of a broad range of symptoms of postnatal distress within the confines of a measure brief enough to be usable in clinical settings. Further validation is needed.

Keywords: Psychological Distress Evaluation ; Scales Evaluation ; Reliability and Validity ; Instrument Validation ; Pregnancy ; Female ; Human ; Factor Analysis ; Signs and Symptoms ; Validation Studies ; Psychometrics ; Scales ; Questionnaires ; Convenience Sample ; Descriptive Statistics ; Data Analysis Software ; Young Adult ; Adult ; Adult: 19-44 years ; Female

Topic(s):

• Data collection, measurement, analysis
• Behavioral/mental health services and substance use

Intervention Type: Screening Epidemiology and Surveillance

Summary: Feasibility/acceptability study; adhesion was lower than expected, lacking a quantified clinical efficacy outcome.

Abstract: To explore the feasibility, acceptability, and potential benefits associated with a mind–body intervention and varied delivery styles among women during the postpartum period. Mixed-methods feasibility study. Fraser Valley, British Columbia, Canada. Forty-three women (93% White), with an average age of 32.1 (SD = 2.9) years, who had given birth within the last 6 months. Participants were randomized to three physical activity groups. Validated questionnaires were administered before and after the 12-week intervention. Attendance and feasibility metrics and qualitative semistructured interviews were conducted to assess the intervention. The intervention and trial were partially feasible, and retention to the intervention was high; however, adherence as assessed by attendance was lower than expected. There was high acceptability among those in the group-based, in-person intervention. There was moderate acceptability among those in the individual, home-based asynchronous program. Findings highlight the necessity of better understanding what is desired by this population or simply providing more options to participants so that we can tailor physical activity to their needs and provide the necessary support. [Display omitted] Acceptability differs among women regarding physical activity program delivery methods in the postpartum period, suggesting that mode of delivery needs to be flexible and tailored to individual needs.

Keywords: Mind Body Techniques In Pregnancy ; Delivery, Obstetric Methods ; Postnatal Period ; Expectant Mothers ; Women's Health ; Movement ; Human ; Female ; Adult ; Canada ; Descriptive Statistics ; Pilot Studies ; Qualitative Studies ; Semi-Structured Interview ; Physical Activity ; Questionnaires ; Pregnancy ; Individualized Medicine ; Adult: 19-44 years ; Female

Topic(s):

• Nonclinical postpartum care
• Promising models of care and best practices

Intervention Type: Direct Care

Summary: Feasibility study protocol providing preliminary effectiveness indications, but lacking final quantified outcome results in the abstract.

Abstract: Background: Up to 50% of women in areas of high socio-economic deprivation are at risk of developing depressive symptoms in pregnancy. Feeling well supported, can facilitate good mental health perinatally. A brief, innovative intervention to facilitate access to support and resources was developed and tested. This included one antenatal and one postnatal session, each with three evidence-based components: i) support from a non-professional peer to enable a woman to identify her needs; ii) information about local community services and signposting; and iii) development of a personalised If-Then plan to access that support. The aims were to evaluate the intervention and research methods for feasibility and acceptability for perinatal women, maternity care providers and peers, and provide preliminary effectiveness indications.

Methods: Pregnant women living in an area of high deprivation were recruited from community-based antenatal clinics and randomised to intervention or control condition (a booklet about local resources). Outcome measures included women's use of community services by 34 + weeks gestation and 6 months postnatally; mental health and wellbeing measures, and plan implementation. Interviews and focus groups were conducted with women participants, providers, and peers. Data were analysed using framework analysis. Recruitment and retention of peers and participants, intervention fidelity, and acceptability of outcome measures were recorded.

Results: Peer facilitators could be recruited, trained, retained and provide the intervention with fidelity. One hundred twenty six women were recruited and randomised, 85% lived in the 1% most deprived UK areas. Recruitment constituted 39% of those eligible, improving to 54% after midwifery liaison. Sixty five percent were retained at 6 months postnatally. Women welcomed the intervention, and found it helpful to plan access to community services. Providers strongly supported the intervention philosophy and integrated this easily into services. The study was not powered to detect significant group differences but there were positive trends in community service use, particularly postnatally. No differences were evident in mental health and wellbeing.

Conclusions: This intervention was well received and easily integrated into existing services. Women living in highly deprived areas could be recruited, randomised and retained. Measures were acceptable. Peer facilitators were successfully trained and retained. Full effectiveness studies are warranted.

Keywords: Perinatal support; feasibility study; intervention; maternal health; resource access

Topic(s):

• Community outreach and engagement
• Behavioral/mental health services and substance use

Intervention Type: Outreach Counseling

Summary: RCT protocol/objective; missing quantified outcome change in the abstract.

Abstract: Background: For non-treatment-seeking women who use substances during pregnancy, immediately postpartum may be an optimum time for intervention. Our study tested a novel, brief, hospital-initiated, adaptive motivational interviewing plus acceptance and commitment therapy (MIACT) intervention to facilitate treatment initiation and reproductive planning postpartum among mothers who used substances during pregnancy.

Methods: Mothers (N = 64) with an infant admitted to a neonatal intensive care unit were enrolled if they or their infant tested positive for an illicit substance at delivery or had a documented positive drug screen during pregnancy. A parallel group, randomized controlled design assigned participants to MIACT or conventional care (CC), with assessments at week 2 and 4 during treatment and follow-up at 2 and 6 months post treatment. Bayesian generalized linear modeling was used to evaluate outcomes as a function of treatment.

Results: Results indicated that during treatment the MIACT group demonstrated an 84% probability of benefit relative to CC with regard to initiating treatment (RR=1.5), however the effect was not seen at follow-up. MIACT was also associated with an increased probability of attending a postpartum obstetrics visit (RR=1.4), and receiving contraception during treatment and at both follow-ups, with posterior probabilities of 96% or higher and relative risks ranging from 1.5 to 5.1 at varying timepoints. Substance use rates for the MIACT versus CC were higher at follow-up.

Conclusions: Brief, hospital-initiated interventions can assist postpartum mothers who use substances to enter treatment and obtain contraception in order to reduce future substance-exposed pregnancies.

Keywords: Acceptance and Commitment Therapy; Addiction; Contraception; Maternal substance use; Motivational Interviewing; SBIRT; Treatment; drug abuse; perinatal; postpartum.

Keywords: Substance use, Postpartum, Reproductive care, Substance-exposed pregnancies, Randomized controlled trial

Topic(s):

• Behavioral/mental health services and substance use
• Promising models of care and best practices

Intervention Type: Counseling Consultation

Summary: Abstract unavailable.

Abstract: The study aim was to implement and evaluate the feasibility of a culturally informed ("BeFAB") app for African American/Black women to address postpartum weight. Women (n = 136; mean age = 27.8 ± 5.4; mean BMI = 32.5 ± 4.3) were recruited from postpartum units, and randomly assigned to receive BeFAB (n = 65) or usual care (n = 71) for 12 weeks. App content included didactic lessons delivered via a virtual coach, app-based messages, goal setting and tracking, and edutainment videos. Feasibility outcomes included recruitment, retention and engagement, and self-reported acceptability. Behavioral (i.e., diet, physical activity), psychosocial (i.e., stress, coping, support, self-efficacy) and weight outcomes were also examined. Recruitment goals were met, but attrition was high, with 56% retention at 12 weeks. Approximately half of participants accessed the app and set a goal ≥one time, but <10% reported achieving a nutrition or activity goal. Among study completers, ≥60% found the app content at least somewhat helpful. Within-group changes for BeFAB among completers were found for increased moderate-to-vigorous physical activity and decreased fruit/vegetable intake and weight. Findings indicate initial feasibility of recruiting postpartum women to participate in a digital healthy body weight program but limited use, reflecting low acceptability and challenges in engagement and retention. Future research is needed on strategies to engage and retain participants in postpartum interventions.

Keywords: digital intervention; postpartum; weight management; African American women; feasibility

Topic(s):

• Nonclinical postpartum care
• Resources for consumers/new mothers

Intervention Type: Education and Promotion Consultation

Summary: Case study describing the development of an implementation guide for screening programs.

Abstract: Background: Pregnancy is a time of increased risk for developing or re-experiencing mental illness. Perinatal mental health screening for all women is recommended in many national guidelines, but a number of systems-level and individual barriers often hinder policy implementation. These barriers result in missed opportunities for detection and early intervention and are likely to be experienced disproportionately by women from culturally and linguistically diverse backgrounds, including women of refugee backgrounds. The objectives of this study were to develop a theory-informed, evidence-based guide for introducing and integrating perinatal mental health screening across health settings and to synthesize the learnings from an implementation initiative and multisectoral partnership between the Centre of Perinatal Excellence (COPE), and a university-based research centre. COPE is a nongovernmental organization (NGO) commissioned to update the Australian perinatal mental health guidelines, train health professionals and implement digital screening. Methods: In this case study, barriers to implementation were prospectively identified and strategies to overcome them were developed. A pilot perinatal screening programme for depression and anxiety with a strong health equity focus was implemented and evaluated at a large public maternity service delivering care to a culturally diverse population of women in metropolitan Melbourne, Australia, including women of refugee background. Strategies that were identified preimplementation and postevaluation were mapped to theoretical frameworks. An implementation guide was developed to support future policy, planning and decision-making by healthcare organizations. Results: Using a behavioural change framework (Capability, Opportunity, Motivation-Behaviour Model), the key barriers, processes and outcomes are described for a real-world example designed to maximize accessibility, feasibility and acceptability. A Programme Logic Model was developed to demonstrate the relationships of the inputs, which included stakeholder consultation, resource development and a digital screening platform, with the outcomes of the programme. A seven-stage implementation guide is presented for use in a range of healthcare settings. Conclusions: These findings describe an equity-informed, evidence-based approach that can be used by healthcare organizations to address common systems and individual-level barriers to implement perinatal depression and anxiety screening guidelines. Patient or Public Contribution: These results present strategies that were informed by prior research involving patients and staff from a large public antenatal clinic in Melbourne, Australia. This involved interviews with health professionals from the clinic such as midwives, obstetricians, perinatal mental health and refugee health experts and interpreters. Interviews were also conducted with women of refugee background who were attending the clinic for antenatal care. A steering committee was formed to facilitate the implementation of the perinatal mental health screening programme comprising staff from key hospital departments, GP liaison, refugee health and well-being, the NGO COPE and academic experts in psychology, midwifery, obstetrics and public health. This committee met fortnightly for 2 years to devise strategies to address the barriers, implement and evaluate the programme. A community advisory group was also formed that involved women from eight different countries, some of refugee background, who had recently given birth at the health service. This committee met bimonthly and was instrumental in planning the implementation and evaluation such as recruitment strategies, resources and facilitating an understanding of the cultural complexity of the women participating in the study. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

Topic(s):

• Universal screening tools and billing codes
• Health equity and access to care

Intervention Type: Screening Direct Care

Summary: Study protocol for a future pilot RCT.

Abstract: Background: Postpartum depression remains a significant concern, posing substantial challenges to maternal well-being, infant health, and the mother-infant bond, particularly in the face of barriers to traditional support and interventions. Previous studies have shown that mobile health (mHealth) interventions offer an accessible means to facilitate early detection and management of mental health issues while at the same time promoting preventive care.

Objective: This study aims to evaluate the effectiveness of the Leveraging on Virtual Engagement for Maternal Understanding & Mood-enhancement (LoVE4MUM) mobile app, which was developed based on the principles of cognitive behavioral therapy and psychoeducation and serves as an intervention to prevent postpartum depression.

Methods: This single-blinded, pilot randomized controlled trial includes 64 mothers recruited from the postnatal ward and randomized using a 1:1 ratio to receive either postpartum care (treatment as usual) or postpartum care (treatment as usual) plus the self-guided LoVE4MUM mobile app. The primary outcome is the effectiveness of the mobile app at improving postpartum depression. Secondary outcomes are changes in the mental health literacy score and negative automatic thoughts, which are collected using a self-reported questionnaire.

Results: Patient recruitment began on September 1, 2024. As of January 1, 2025, recruitment was successfully completed, with a total of 72 participants enrolled: 36 in the intervention group and 36 in the control group . The final results are anticipated to be available by March 2025, and publication is expected by the end of 2025.

Conclusions: By examining the LoVE4MUM app alongside standard postpartum care, this pilot randomized controlled trial seeks to offer preliminary evidence on the potential of mHealth tools to improve maternal mental health as well as to reduce postpartum depression symptoms. The findings are expected to contribute to the future development of effective, accessible, and scalable interventions for mothers.

Keywords: Postpartum depression, mobile app, prevention, protocol, RCT

Topic(s):

• Behavioral/mental health services and substance use
• Resources for consumers/new mothers

Intervention Type: Counseling Advocacy

Summary: Pilot feasibility study analyzing trajectories and associations between biomarkers (metabolites) and psychiatric history (observational/associational data).

Abstract: Depression and anxiety during pregnancy and postpartum are common, but affected women differ in timing, trajectories, and extent of symptoms. The objective of this pilot, feasibility study is to analyze trajectories of serotonin and tryptophan-related metabolites, bile acid metabolites, and microbial composition, in relation to psychiatric history and current symptoms across the perinatal period. Serum and fecal samples were collected from 30 women at three times points in the perinatal period and assayed with LC-MS/MS and 16S sequencing respectively. We defined mean trajectories for each metabolite, clustered individuals by metabolite trajectories, tested associations between metabolites, and examined metabolite levels in relation to microbial composition. Findings of note include: (1) changes in kynurenine and the ratio of kynurenic acid to kynurenine from second trimester to third trimester were strongly associated with baseline primary and secondary bile acids. (2) Secondary bile acid UDCA and its conjugated forms were associated with lower bacterial diversity and levels of Lachnospiraceae, a taxa known to produce Short Chain Fatty Acids. (3) History of anxiety was associated with UDCA levels, but history of major depression was not associated with any of the bile acids. (4) There was a trend towards lower dietary fiber for those with history of anxiety or depression. Overall, our results reveal substantial temporal variation in tryptophan-related metabolites and in bile acid metabolites over the perinatal period, with marked inter-individual variability. Trajectories of TRP -related metabolites, primary and secondary bile acids, and the absence or presence of microbes that produce Short Chain Fatty Acids (SCFAs) considered in concert have the potential to differentiate individuals based on perinatal adaptations that may impact mental and overall health.

Keywords: Perinatal period, mental health, tryptophan, bile acids, microbiome

Topic(s):

• Data collection, measurement, analysis
• Behavioral/mental health services and substance use

Intervention Type: Epidemiology and Surveillance Screening

Summary: Study protocol for a future pilot RCT.

Abstract: Background: Midwifery continuity of care is the only health system intervention shown to reduce preterm birth (PTB) and improve perinatal survival, but no trial evidence exists for women with identified risk factors for PTB. We aimed to assess feasibility, fidelity, and clinical outcomes of a model of midwifery continuity of care linked with a specialist obstetric clinic for women considered at increased risk for PTB.

Methods and findings: We conducted a hybrid implementation-effectiveness, randomised, controlled, unblinded, parallel-group pilot trial at an inner-city maternity service in London (UK), in which pregnant women identified at increased risk of PTB were randomly assigned (1:1) to either midwifery continuity of antenatal, intrapartum, and postnatal care (Pilot study Of midwifery Practice in Preterm birth Including women's Experiences [POPPIE] group) or standard care group (maternity care by different midwives working in designated clinical areas). Pregnant women attending for antenatal care at less than 24 weeks' gestation were eligible if they fulfilled one or more of the following criteria: previous cervical surgery, cerclage, premature rupture of membranes, PTB, or late miscarriage; previous short cervix or short cervix this pregnancy; or uterine abnormality and/or current smoker of tobacco. Feasibility outcomes included eligibility, recruitment and attrition rates, and fidelity of the model. The primary outcome was a composite of appropriate and timely interventions for the prevention and/or management of preterm labour and birth. We analysed by intention to treat. Between 9 May 2017 and 30 September 2018, 334 women were recruited; 169 women were allocated to the POPPIE group and 165 to the standard group. Mean maternal age was 31 years; 32% of the women were from Black, Asian, and ethnic minority groups; 70% were in employment; and 46% had a university degree. Nearly 70% of women lived in areas of social deprivation. More than a quarter of women had at least one pre-existing medical condition and multiple risk factors for PTB. More than 75% of antenatal and postnatal visits were provided by a named/partner midwife, and a midwife from the POPPIE team was present at 80% of births. The incidence of the primary composite outcome showed no statistically significant difference between groups (POPPIE group 83.3% versus standard group 84.7%; risk ratio 0.98 [95% confidence interval (CI) 0.90 to 1.08]; p = 0.742). Infants in the POPPIE group were significantly more likely to have skin-to-skin contact after birth, to have it for a longer time, and to breastfeed immediately after birth and at hospital discharge. There were no differences in other secondary outcomes. The number of serious adverse events was similar in both groups and unrelated to the intervention (POPPIE group 6 versus standard group 5). Limitations of this study included the limited power and the nonmasking of group allocation; however, study assignment was masked to the statistician and researchers who analysed the data.

Conclusions: In this study, we found that it is feasible to set up and achieve fidelity of a model of midwifery continuity of care linked with specialist obstetric care for women at increased risk of PTB in an inner-city maternity service in London (UK), but there is no impact on most outcomes for this population group. Larger appropriately powered trials are needed, including in other settings, to evaluate the impact of relational continuity and hypothesised mechanisms of effect based on increased trust and engagement, improved care coordination, and earlier referral on disadvantaged communities, including women with complex social factors and social vulnerability.

Trial registration: We prospectively registered the pilot trial on the UK Clinical Research Network Portfolio Database (ID number: 31951, 24 April 2017). We registered the trial on the International Standard Randomised Controlled Trial Number (ISRCTN) (Number: 37733900, 21 August 2017) and before trial recruitment was completed (30 September 2018) when informed that prospective registration for a pilot trial was also required in a primary clinical trial registry recognised by WHO and the International Committee of Medical Journal Editors (ICMJE). The protocol as registered and published has remained unchanged, and the analysis conforms to the original plan.

Keywords: Midwifery continuity; preterm birth; maternity care; pilot trial; implementation

Topic(s):

• Promising models of care and best practices
• Quality, performance, and outcome indicators

Intervention Type: Case Management

Summary: Mixed method study focused on patient preference and acceptability of a video consultation (VC) model.

Abstract: Background: Telehealth, including video consultation (VC), has become prevalent during the COVID-19 pandemic. However, the experience and concern of women using VC for postpartum care has yet to be adequately studied but is crucial for their adoption. The study aimed to assess the experience and attitude of postpartum mothers (PPM) towards using VC as a novel model of care delivery and the factors that could potentially affect their adoption.

Method: Data were gathered from PPM participating in VC using Zoom platform for postpartum care using mixed method. In-depth interviews (IDI) of twenty-five PPM were audio-recorded, transcribed verbatim and audited for accuracy. Thematic analysis was conducted to identify themes relating to perceived threat, usefulness, ease of use, and attitudes toward using VC in postpartum care. The themes are reported based on the "Health Information Technology Acceptance Model" framework. Preliminary quantitative data on the acceptability of VC were collected using structured surveys.

Results: PPMs valued convenience, accessibility, and personalised care VC offered to address their immediate postpartum concerns. They perceived VC as suitable for seeking medical opinions, improving confidence in parent crafting, and providing better care access. They recognised the lack of physical examination as a major limitation in VC and proposed a hybrid postpartum care model, combining VC and in-person consultation to cater to individual needs and preferences. PPMs alluded to trust in the care providers, flexibility in VC appointment timings and enhanced interface of remote platforms as enablers for VC adoption. Preliminary quantitative data shows that PPMs found VC saved time (100%), energy (98%), and money (90%) and was appropriate (94%), easy to use (96%), acceptable (96%) for postpartum care.

Conclusion: PPMs favoured combining VC and in-person consultation to mitigate their concerns and personalise their care needs.

Keywords: postpartum care; hybrid model; mixed methods; maternal preferences; virtual care

Topic(s):

• Infrastructure development, financing, and expansion of services
• Promising models of care and best practices

Intervention Type: Consultation Counseling

Summary: Pilot study reporting uptake, engagement, and mean depression scores of app users, without measuring clinical outcome change resulting from the app's use.

Abstract: Women may experience new-onset or worsening depressive disorders during pregnancy and the postpartum. If untreated, there may be detrimental consequences to the health and wellbeing of the woman and to her baby. There is a need for improved tools and approaches that can be easily and broadly implemented to effectively detect depression during the perinatal period. Early identification of depression during pregnancy is an important first step towards connecting women to treatment and preventing continued depression into the postpartum or beyond. This report provides preliminary findings from a pilot study of a digital screening app for perinatal depression expiring potential for app reach, engagement, and user demographics and mental health symptoms. With mainly passive recruitment efforts, we collected cross-sectional mental health data on over 700 women during the perinatal period, including women across over 30 countries. We report on mean depression scores among women during pregnancy and the postpartum as well as on constructs that are commonly comorbid with depression, including anxiety, sleep dysregulation, and perceived stress. Over half of the women during pregnancy and over 70% of women in the postpartum had a depression score indicative of clinical depression. Future research directions for this work and potential for public health impact are discussed, including longitudinal data collection and analyses of symptomology over time and embedding evidence-based digital therapeutics into the app as a means to increase access to mental health services.

Keywords: Perinatal depression, Screening, Smartphone technology, MGH Perinatal Depression Scale, Uptake, Engagement

Topic(s):

• Universal screening tools and billing codes
• Resources for consumers/new mothers

Intervention Type: Counseling Screening

Summary: Pilot RCT focused on documenting feasibility metrics (connect rate, attend rate) and qualitative experience.

Abstract: Background: Psychological distress in the early postpartum period can have long-lasting deleterious effects on a mother's well-being and negatively affect her infant's development. Intervention approaches based in contemplative practices such as mindfulness and loving-kindness and compassion are intended to alleviate distress and cultivate well-being and can be delivered effectively as digital mental health interventions (DMHIs). Objective: To understand the feasibility of engaging perinatal women in digital interventions, this study aimed to document participants' experiences in the Mums Minds Matter (MMM) study, a pilot randomized controlled trial comparing mindfulness, loving-kindness and compassion, and progressive muscle relaxation training delivered in a digital format and undertaken during pregnancy. To assess the different stages of engagement during and after the intervention, we adapted the connect, attend, participate, enact (CAPE) framework that is based on the idea that individuals go through different stages of engagement before they are able to enact change. Methods: The MMM study was nested within a longitudinal birth cohort, The ORIGINS Project. We aimed to recruit 25 participants per randomization arm. Data were collected sequentially during the intervention through regular web-based surveys over 8 weeks, with opportunities to provide regular feedback. In the postintervention phase, qualitative data were collected through purposive sampling. Results: Of 310 eligible women, 84 (27.1% [connect rate]) enrolled to participate in MMM. Of the remaining 226 women who did not proceed to randomization, 223 (98.7%) failed to complete the baseline surveys and timed out of eligibility (after 30 weeks' gestation), and 3 (1.3%) displayed high psychological distress scores. Across all program groups, 17 (20% [attend rate]) of the 84 participants actively opted out, although more may have disengaged from the intervention but did not withdraw. The main reasons for withdrawal were busy life and other priorities. In this study, we assessed active engagement and ongoing skills use (participate and enact) through postintervention interviews. We undertook 15 participant interviews, conducted 1 month to 3 months after the intervention. Our results provide insights into participant barriers and enablers as well as app changes, such as the ability to choose topics, daily reminders, case studies, and diversity in sounds. Implementing a DMHI that is brief, includes frequent prompts or nudges, and is easily accessible is a key strategy to target perinatal women. Conclusions: Our research will enable future app designs that are sufficiently nuanced to maximize the uptake, engagement, and application of mental health skills and contemplative practices in the perinatal period. Providing convenient access to engaging and effective prevention programs is critical and should be part of prenatal self-care. Our research underscores the appeal and feasibility of digital intervention approaches based in contemplative practices for perinatal women. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Topic(s):

• Behavioral/mental health services and substance use
• Resources for consumers/new mothers

Intervention Type: Counseling Education and Promotion

Summary: Observational feasibility study quantifying prevalence of depressive symptomatology and associations with risk factors (e.g., not exclusively breastfeeding OR 1.76).

Abstract: Objective: To assess the feasibility of the family paediatrician's (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being.

Design, setting and participants: Data for this observational prospective study were collected within the NASCITA (NAscere e creSCere in ITAlia) cohort. During the first visit, paediatricians collected sociodemographic data regarding the parents and information about their health status, the pregnancy and the delivery. Whooley questions were administered during the first and second visits (scheduled 60-90 days after childbirth). Moreover, on the third visit (5-7 months after childbirth) the FP was asked to answer 'yes' or 'no' to a question on the parental postpartum depression, based on his knowledge and on the acquired information.

Results: In 2203 couples who completed the assessment, 529 mothers (19.9%), 141 fathers (6.3%) and 110 (5%) couples reported any depressive symptomatology. Of these, 141 mothers (5.3% of the total sample) and 18 fathers (0.8% of the total sample) were classified as 'likely depressed'. An association was found between maternal postnatal depressive symptoms and having a diagnosed psychiatric disorder during pregnancy (OR 9.49, 95% CI: 3.20 to 28.17), not exclusively breastfeeding at hospital discharge (OR 1.76, 95% CI: 1.19 to 2.61) and the presence of child sleeping disorders at 3 (OR 2.46, 95% CI: 1.41 to 4.28) and 6 months (OR 2.18, 95% CI: 1.37 to 3.47). Another significant predictor of postpartum depression was being primiparous (OR 1.99, 95% CI: 1.31 to 3.02). Concerning the fathers, a significant association was reported only between likely depressed fathers and child sleeping disorders at 3 months (OR 7.64, 95% CI: 2.92 to 19.97). Moreover, having a likely depressed partner was strongly associated with depressive symptoms in fathers (OR 85.53, 95% CI 26.83 to 272.69).

Conclusions: The findings of this study support the feasibility of an active screening programme for parental postnatal depression during well-child visits as an integral part of postpartum care.

Trial registration number: NCT03894566; Pre-results.

Keywords: Depression & mood disorders; MENTAL HEALTH; PERINATOLOGY.

Keywords: Postpartum depression screening, Mothers, Fathers, Well-child visits, Feasibility study, NASCITA cohort

Topic(s):

• Universal screening tools and billing codes
• Dyadic, culturally congruent, family-centered care

Intervention Type: Screening Consultation

Summary: Study protocol for a future feasibility cluster RCT.

Abstract: Background: Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies.

Objective: The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable.

Design: The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up.

Setting: The trial took place in Birmingham, UK.

Participants: Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed.

Interventions: The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet.

Main outcome measures: The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme).

Results: The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight.

Limitations: Fewer participants were recruited than planned.

Conclusions: Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention.

Keywords: Weight management, postnatal, nurse-supported, feasibility, cluster RCT

Topic(s):

• Nonclinical postpartum care
• Promising models of care and best practices

Intervention Type: Education and Promotion Direct Care

Summary: Study protocol outlining the plan for a multicentric prospective study to assess the prevalence of psychiatric disorders.

Abstract: Introduction: During the perinatal period, women have an increased risk for psychiatric disorders, which are highly prevalent in this context. In addition, there are significant delays in diagnosing these conditions, worsening their prognosis and increasing their societal burden. Studies describing psychiatric disorders in the perinatal period often focus on specific disorders; only postpartum depression and, to a lesser extent, anxiety disorders are studied. There are also very few evaluations conducted by clinicians based on a semistructured interview, relying on the diagnostic criteria of international nosography.

Methods and analysis: This multicentric prospective study will recruit 140 adult pregnant women based on randomly selected second trimester (T2) ultrasound consultations. The primary outcome is the prevalence of any psychiatric disorder assessed with a standardised psychiatric assessment, the Mini-International Neuropsychiatric Interview (M.I.N.I.). Within 10 days after the T2 ultrasound appointment, we will conduct the M.I.N.I., collect demographic data, evaluate suicidal behaviour with the Columbia-Suicide Severity Rating Scale, describe negative life events from the past year using the Paykel questionnaire and evaluation of social deprivation (Evaluation of the Deprivation and Inequalities of Health in Healthcare Centres score). Participants will also complete self-administered psychiatric questionnaires that screen for specific pathologies. We will build a biological sample collection. At two months post partum, we will repeat the questionnaires, adding an assessment of mother-child bonding. Patients can choose between in-person or telemedicine visits on both occasions.

Ethics and dissemination: All participants will be required to provide written informed consent. The study has received ethical approval from the French National Committee ('Comité de Protection des Personnes Ouest VI') (approval number: 23.03919.000236). Results will be disseminated through peer-reviewed journal publications and at scientific conferences and meetings.

Keywords: Psychiatric disorders, pregnancy, prevalence, protocol, feasibility

Topic(s):

• Behavioral/mental health services and substance use
• Universal screening tools and billing codes

Intervention Type: Screening Screening

Summary: Study protocol outlining the plan for a pilot RCT; no results provided.

Abstract: Background: Black women are significantly more likely to experience severe maternal morbidity and are 3 times as likely to die from pregnancy-related causes compared to White women. Using a strengths-based wellness approach within an integrated supportive care program provided by a community doula could offer pragmatic solutions for Black maternal disparities. The Protective Assets Reinforced with Integrated Care and Technology (PARITY) program consists of a wellness technology platform, including informational links to wellness content and reinforcing motivational SMS text messages, as well as community-based doula support delivered both in person and through the technology platform to improve Black maternal wellness.

Objective: This pilot randomized controlled trial (RCT) and mixed methods evaluation aims to (1) determine the feasibility and acceptability of the PARITY intervention; (2) investigate the preliminary efficacy of the PARITY intervention on clinical outcomes (maternal blood pressure, gestational weight gain, and cesarean birth); and (3) investigate changes to wellness behavioral outcomes (nutrition, physical activity, sleep, and health care adherence) and empowered strengths (self-efficacy, social support, motivation, resilience, problem-solving, and self-regulation) in the intervention group compared to a control group.

Methods: A 2-arm RCT and mixed methods evaluation will be conducted. Overall, 60 Black pregnant individuals will be randomized in a ratio of 1:1 to either the intervention or informational control group. Participants in the intervention group will receive access to the technology platform over a 12-week period that ends before birth. Intervention participants will be assigned a doula interventionist, who will meet with them 4 times during the intervention. All participants (intervention and control) will receive a referral for a birth doula at no cost, printed materials about having a healthy pregnancy, and community resources. Feasibility and acceptability will be assessed at the end of the program. Measures will be obtained at baseline (20-28 weeks), the 36th week of pregnancy, birth, and 6-12 weeks post partum. Summary statistics and distribution plots will be used to describe measured variables at each time point. A generalized linear mixed model with a shared random component will be used to analyze the effects of PARITY on clinical, wellness behavioral, and empowered strength outcomes, including baseline nutrition, physical activity, and sleep measures as covariates. For significant effects, post hoc contrasts will be adjusted using the Holm method to maintain comparison-wise error at or <.05. Missing data will be addressed using a pattern-mixture model.

Results: The National Institute of Nursing Research funded this pilot RCT. Recruitment, enrollment, and data collection are ongoing, and the estimated study completion date is October 2024.

Conclusions: The expected results of this study will provide the feasibility and preliminary efficacy of the PARITY intervention, to be used in a larger trial with a 12-month PARITY program intervention.

Keywords: Integrated care; technology; maternal health; randomized controlled trial; protocol

Topic(s):

• Promising models of care and best practices [628, : The LEAP cluster randomized controlled trial
• Nonclinical postpartum care

Intervention Type: Case Management Screening

Summary: Feasibility study focused on construction, acceptability, and feasibility of a counseling intervention, without providing quantifiable clinical outcome changes in the abstract.

Abstract: Background: Complications during pregnancy and birth are known risk factors for negative birth experience. Women value the opportunity to review their birth experiences, but limited knowledge exists about appropriate interventions and the feasibility of providing this care for women following high-risk pregnancies.

Objective: To describe the construction and evaluate the feasibility and acceptability of a postpartum midwifery counselling intervention for women following high-risk pregnancies.

Design: A mixed-method study.

Setting: A high-risk antenatal outpatient clinic at Landspítali University Hospital in Reykjavík, Iceland.

Sample, recruitment and data collection: Thirty women who experienced high-risk pregnancies were invited to write about and review their birth experience with a known midwife 4-6 weeks postpartum. Eight midwives working in a high-risk antenatal clinic provided the intervention after a special training. Data including birth outcomes, birth experience and experience of the intervention were collected by questionnaires from women at two time points before and after the counselling intervention. Midwives providing the intervention completed diaries and participated in focus group interview to explore their experiences of the process.

Data analysis: Descriptive and content analysis.

Findings: Women and midwives perceived the intervention positively and feasible in this context. Midwives evaluated the pre-training program as helpful. Most women would like to review their birth experience with a midwife they know, 4-6 weeks postpartum. Almost half of the women wrote about their birth experiences.

Key conclusions: The findings indicate that women experiencing high-risk pregnancies might benefit from a follow up by a midwife they know. Women and midwives perceived the counselling intervention as an acceptable and feasible option in maternity care. The training program sufficiently prepared the midwives to provide the counselling intervention.

Keywords: Birth experience, high-risk pregnancy, feasibility, review, psychological outcome

Topic(s):

• Dyadic, culturally congruent, family-centered care
• Chronic health conditions/mortality and morbidity drivers

Intervention Type: Counseling Direct Care

Summary: Quality improvement project describing education and toolkit development, lacking specific quantifiable pre/post screening data.

Abstract: Background: Postpartum anxiety is a mental health problem that has largely been ignored by maternity care providers despite an estimated incidence as high as 28.9%. Though postpartum anxiety may or may not be accompanied by depression, and while screening for postpartum depression has become more common place, postpartum anxiety is often not assessed or addressed.

Purpose: The purpose of this pilot quality improvement project was to implement a screening, treatment and referral program for postpartum anxiety in the birth centre environment.

Procedures: Midwives from 10 geographically diverse birth centres, and all members of the American Association of Birth Centres, were recruited to participate in the project. An online video was developed which detailed postpartum anxiety, screening through use of the anxiety subscale of the Edinburgh Postnatal Depression Scale and a toolkit for treatment and/or referral for screen positive patients. Participants entered patient scores into the Perinatal Data Registry of the American Association of Birth Centres. Individual interviews of midwives were conducted following the 10-week pilot period.

Main findings: There were a total of 387 participants across 9 participating sites. Among all screened participants with follow-up data, (n = 382), 9.69% (n = 37) were lost to follow-up. Among all participants screened with the Edinburgh Postpartum Depression Scale -3A and Edinburgh Postpartum Depression Scale (n = 318), 12.58% (n = 40) had a positive Edinburgh Postpartum Depression Scale -3A score of greater than six. Of all screened participants with an Edinburgh Postpartum Depression Scale score, 15 (6.98%) had a Edinburgh Postpartum Depression Scale score of less than 12 and an Edinburgh Postpartum Depression Scale -3A score greater than six, and would have not received follow up care if only screened for postpartum depression. Midwife participants expressed heightened awareness of the need to screen and felt screening was easy to integrate into clinical practice.

Conclusions: The Edinburgh Postpartum Depression Scale -3A is a valid, easy-to-use tool which should be considered for use in clinical practice. Modification of the electronic health record can serve as an important impetus triggering screening and treatment. It is important that clinicians are educated on the prevalence of postpartum anxiety, its risk factors, symptoms and implications.

Keywords: Postpartum anxiety; Postpartum depression; Postpartum mental health; Postpartum mood disorders; Postpartum period; Postpartum screening.

Keywords: Postpartum anxiety, Screening, Quality improvement, Women's health

Topic(s):

• Universal screening tools and billing codes
• Behavioral/mental health services and substance use

Intervention Type: Screening Consultation

Summary: Abstract unavailable.

Abstract: Background: No evidence was identified in relation to the downward titration/cessation of intravenous oxytocin post spontaneous vaginal birth, in the absence of postpartum haemorrhage (PPH); suggesting clinicians' management is based on personal preference in the absence of evidence.

Aim: To determine the proportion of induced women with a spontaneous vaginal birth and PPH, when intravenous oxytocin was utilised intrapartum and ceased 15, 30 or 60minutes post birth.

Methods: This three armed pilot randomised controlled trial, was undertaken on the Birth Suite of an Australian tertiary obstetric hospital. Incidence of PPH was assessed using univariable and adjusted logistic regression, which compared the effect of titrating intravenous oxytocin post birth on the likelihood of PPH, relative to the 15minute titration group.

Findings: Postpartum haemorrhage occurred in 26% (30 of 115), 20% (23 of 116), and 22% (30 of 134) of women randomised to a 15, 30 and 60minute titration time post birth, with no statistically significant differences between groups.

Conclusion: There was no difference in the incidence of PPH between the three groups. Therefore, we question the benefit of delaying cessation of intravenous oxytocin for 60minutes post birth. Further investigation in this cohort is recommended, to compare the incidence of PPH when intravenous oxytocin is ceased either immediately, or 30minutes post birth. This research is warranted, as an evidence-based framework is lacking, to guide midwives globally in relation to their management of intravenous oxytocin post an induced spontaneous vaginal birth, in the absence of PPH.

Keywords: Oxytocin, induction, blood loss, postpartum hemorrhage, regimes

Topic(s):

• Chronic health conditions/mortality and morbidity drivers
• Data collection, measurement, analysis

Intervention Type: Direct Care Consultation

Summary: Study describing co-development and feasibility testing; abstract lacks quantified pre/post outcome data.

Abstract: Introduction: Sepsis is one of the most common causes of mortality in postnatal women globally and many other women who develop sepsis are left with severe morbidity. Women's knowledge of postnatal sepsis and how it can be prevented by simple changes to behaviour is lacking.

Methods: This paper describes the co-development and feasibility testing of a digital animation intervention called DAISI (digital animation in service improvement). This DAISI is designed to enhance postnatal women's awareness of sepsis and how to reduce their risk of developing the condition. We co-designed the digital animation over a six-month period underpinned by theory, best evidence and key stakeholders, translated it into Urdu then assessed its use, firstly in a focus group with women from different Black, Asian and Minority Ethnic (BAME) groups and secondly with 15 clinical midwives and 15 women (including BAME women). Following exposure to the intervention, midwives completed a questionnaire developed from the COM-B behaviour change model and women participated in individual and focus group interviews using similar questions.

Results: The animation was considered acceptable, culturally sensitive and simple to implement and follow.

Discussion: DAISI appears to be an innovative solution for use in maternity care to address difficulties with the postnatal hospital discharge process. We could find no evidence of digital animation being used in this context and recommend a study to test it in practice prior to adopting its use more widely. If effective, the DAISI principle could be used in other maternity contexts and other areas of the NHS to communicate health promotion information.

Keywords: Maternal sepsis; digital intervention; animation; postnatal period; feasibility study

Topic(s):

• Resources for consumers/new mothers
• Chronic health conditions/mortality and morbidity drivers

Intervention Type: Collaboration Education and Promotion

Summary: Case report (N=1) focused on evaluating the effect and applicability of a theoretical model.

Abstract: Objective: The purpose of this case report was to evaluate the effect of telehealth and postpartum care provided to a mother with maternal depression according to Watson's Theory of Human Caring during the pandemic on the improvement in the mother's emotional state and to evaluate the applicability of the model. Methods: Edinburgh Postnatal Depression Scale was administered to eight women who responded to the announcement made on social media, and verbal and written permission was obtained from the mother with the highest scale score. A total of six video calls were made with the mother via WhatsApp, twice a week in the first week after postnatal discharge and once a week in the next 4 weeks, in accordance with the form drawn up according to Watson's Theory of Human Caring. Results: In this study, it was observed that home-based telehealth and postpartum care provided using Watson's Theory of Human Caring, which includes a holistic approach, was very useful, and the care provided according to the model provided a positive improvement in the emotional state of the mother with depression. Conclusions: It was concluded that telehealth and postpartum care is useful in home-based care in extraordinary situations/quarantine conditions such as pandemic; care can also be provided in the form of telehealth service according to Watson's Theory of Human Caring to mothers with depression; and care provides positive improvement in the emotional state of mothers.

Keywords: Telehealth; postpartum care; Watson's Theory; emotional state; pandemic

Topic(s):

• Behavioral/mental health services and substance use
• Promising models of care and best practices

Intervention Type: Counseling Direct Care

Summary: Observational cohort study assessing the prevalence of synechiae and evaluating the association between synechiae and management techniques (e.g., manual uterine examination OR 5.00).

Abstract: Study objective: To prospectively assess the prevalence of intrauterine synechia following medically treated postpartum hemorrhage (PPH) and to evaluate the association between synechiae formation and PPH management techniques.

Design: A prospective observational cohort study.

Setting: Angers University Hospital.

Participants: A total of 83 women presenting with medically treated PPH from January to December 2021 were included in the study.

Intervention: Diagnostic hysteroscopy was performed twelve weeks postpartum to assess for the presence of uterine synechiae. Detailed data on PPH management techniques were collected for analysis.

Measurements and main results: The majority of participants were primiparous and had undergone vaginal delivery. Only 7% required intrauterine balloon tamponade (IUBT), and 4% underwent uterine artery embolization. Uterine synechiae were identified in 20 women during diagnostic hysteroscopy, yielding a prevalence of 24% at 12 weeks postpartum; all classified as type I according to the ESGE classification system. IUBT was used in 15% of women with synechiae compared to 5% in the nonsynechiae group, although this difference was not statistically significant (OR 3.52, 95% CI 0.65-19.10, p = .123). Multivariate analysis identified second manual uterine examination (OR 5.00, 95% CI 1.50-16.66, p = .009) and bimanual uterine massage (OR 3.50, 95% CI 1.12-10.09, p = .020) as independent risk factors for synechiae formation.

Conclusion: This is the first study to evaluate the risk of intrauterine synechiae following medically treated PPH. Mild uterine synechiae were observed in one in four women in the cohort. The need for a second manual uterine examination and bimanual uterine massage were significantly associated with the development of synechiae. Further research is warranted to explore the long-term clinical consequences, including fertility outcomes, and to determine the potential role of diagnostic hysteroscopy in postpartum follow-up after PPH.

Summation: The study prospectively investigates the prevalence of uterine synechiae following nonsurgical postpartum hemorrhage, revealing a 24% occurrence, with second manual uterine examination and bimanual massage identified as independent risk factors.

Keywords: Uterine synechiae, postpartum hemorrhage, prevalence, pilot study

Topic(s):

• Chronic health conditions/mortality and morbidity drivers
• Data collection, measurement, analysis

Intervention Type: Epidemiology and Surveillance Consultation

Summary: Prospective cross-sectional study assessing feasibility and acceptability of monitoring and comparing physiological parameters (observational/feasibility).

Abstract: Introduction: Maternal blood pressure (BP) is a critical cardiovascular marker with profound implications for maternal and fetal well-being, particularly in the detection of hypertensive disorders during pregnancy. Although conventional clinic-based BP (CBP) measurements have traditionvally been used, monitoring 24-hour ambulatory BP (ABP) has emerged as a more reliable method for assessing BP levels and diagnosing conditions such as gestational hypertension and preeclampsia/eclampsia. This study aimed to assess the feasibility and acceptability of 24-hour ABP monitoring in pregnant women and report on various ABP parameters, including ambulatory blood pressure variability (ABPV). Method: A prospective cross-sectional study design was employed, involving 55 multipara pregnant women with and without prior adverse pregnancy outcomes (APOs). The participants underwent baseline assessments, including anthropometrics, resting CBP measurements, and the placement of ABP and actigraphy devices. Following a 24-hour period with these devices, participants shared their experiences to gauge device acceptability. Pregnancy outcomes were collected postpartum. Results: Twenty-four-hour ABP monitoring before 20 weeks of gestation is feasible for women with and without prior APOs. Although some inconvenience was noted, the majority of participants wore the ABP monitoring device for the entire 24-hour period. Pregnant women who later experienced APOs exhibited higher 24-hour ABP and ABPV values in the early stages of pregnancy. Conclusion: The study highlights the potential benefits of 24-hour ABP monitoring as a valuable tool in prenatal care, emphasizing the need for further research in this area.

Keywords: Blood Pressure Monitoring, Ambulatory ; Expectant Mothers Psychosocial Factors ; Patient Attitudes Evaluation ; Pregnancy Outcomes Adverse Effects ; Human ; Pilot Studies ; Cross Sectional Studies ; Prospective Studies ; Multiparas ; Pregnancy ; Female ; Anthropometry ; Life Experiences ; Prenatal Care ; Adult ; Adult: 19-44 years ; Female

Topic(s):

• Data collection, measurement, analysis
• Chronic health conditions/mortality and morbidity drivers

Intervention Type: Screening Epidemiology and Surveillance