Comprehensive mental health care should be an “essential” part of maternal cardiovascular care, according to a new report from the American Heart Association (AHA).
Mental health conditions are among leading causes of maternal mortality in the United States and are linked to negative pregnancy outcomes and long-term cardiovascular issues, explained AHA.
To reframe maternal cardiovascular health to include psychological health, AHA created the report which includes evidence of the impact mental health has on cardiovascular outcomes; the social and environmental factors involved; and guidance around integrating mental health into maternal cardiovascular care—especially throughout the perinatal period, which includes pregnancy and up to one year postpartum.
“It’s critical that we redefine maternal cardiovascular health to include psychological health because there is robust evidence on the association of psychological health with cardiovascular outcomes,” said writing group Chair Garima Sharma, M.D., FAHA, director of preventive cardiology and women’s cardiovascular health at Inova Schar Heart and Vascular in Fairfax, Virginia, in a statement. “We also recognize the importance of providing guidance to clinicians on how to integrate psychological health screening into the perinatal period and focus on providing a holistic approach with the mind and heart interconnection.”
AHA underscored the following connections between mental health and maternal heart health:
- An estimated 52 percent of women of reproductive age report having a history of a mental health condition.
- Forty percent of women form underrepresented races and ethnicities experience anxiety or depression in the perinatal period.
- Individuals with suboptimal mental health may engage in negative health behaviors, such as poor diet; irregular sleep; decreased physical activity; tobacco, alcohol, or substance use; or difficulty adhering to medical recommendations, all of which negatively affect cardiovascular health.
- Maternal mental health can also affect the child’s neurodevelopment and well-being.
AHA urged for regular mental health screening throughout the perinatal period to identify risk factors, such as domestic violence, sleep disorders, personal or family history of mental health conditions, incarceration, active-duty military service, veteran status, lack of partner support, unemployment, racism and discrimination, and adverse outcomes in previous pregnancies.
The report authors also emphasized the need to address longstanding barriers to perinatal mental health concerns at all levels—an individual level, across the health system, in communities, and government and policy levels, ranging from stigma, fears of Child Protective Services removing the child, clinician time constraints, clinician inexperience, workforce issues, and reimbursement related concerns.
“Pregnancy is an important time of life from a health perspective. However, it is not known how many health care professionals understand the connection between the mind and heart and routinely screen and optimize psychological health during the perinatal period,” added Sharma in the statement. “Screening for psychological health before, during and after pregnancy should be used alongside screening for high blood pressure, Type 2 diabetes and other modifiable risk factors for cardiovascular disease.”