AHA: Optimizing psychological health during pregnancy can lower maternal CV risk
Key takeaways:
- The AHA issued a scientific statement on the screening and management of psychological health during pregnancy.
- Approximately 52% of pregnancy-age women have a history of a psychological health disorder.
The American Heart Association issued a scientific statement highlighting the significance of mental health in maternal CV health and provided considerations for pharmacological and behavioral intervention.
The document, published in the Journal of the American Heart Association, also provides an overview of the prevalence of psychological health disorders during pregnancy as well as considerations for screening.
“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,” Healio | Cardiology Today Editorial Board Member Garima Sharma, MD, FAHA, director of preventive cardiology and women’s cardiovascular health at Inova Schar Heart and Vascular in Fairfax, Virginia, and chair of the statement writing group, said in a press release. “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.”
Mental health during pregnancy and CVD risk
Sharma and colleagues estimated that approximately 52% of pregnancy-age women have a history of a psychological health disorder. In addition, 40% of people from historically underrepresented populations present with anxiety or depression during or after pregnancy.
Social determinants of health including education, health care access, income, neighborhood safety, social connectivity and discrimination, and psychosocial exposures such as adverse childhood experiences, physical abuse and trauma in adulthood contribute to psychological health and thereby CV health during pregnancy.
Citing a Swedish nationwide study published in the European Heart Journal, the authors noted a significant association between mental health during pregnancy and risk for future heart disease.
As Healio previously reported, 6.4% of women with perinatal depression developed subsequent CVD compared with 3.7% of unaffected women, translating to a 36% greater risk for CVD in women with perinatal depression (adjusted HR = 1.36; 95% CI, 1.31-1.42).
In addition, the authors reported recent research highlighting the association between history of depression and adverse pregnancy outcomes such as preeclampsia and maternal death.
Screening for perinatal mental health disorders
“During pregnancy and postpartum, identifying and intervening on modifiable risk factors that increase the risk of depression, such as social isolation, no or inadequate partner support, depression before pregnancy and poor sleep quality, may improve maternal psychological health as well as future cardiovascular health,” Sharma said in the release.
The authors wrote that screening for perinatal mental health disorders during pregnancy and postpartum may be a first step to reducing perinatal CV risk. This recommendation aligns with those from the U.S. Preventive Service Task Force for population-wide screening for depression and anxiety, and American College of Obstetricians and Gynecologists (ACOG) recommendations for screening of all pregnant people using a validated instrument to promote early diagnosis and treatment of perinatal mental health disorders.
The ACOG recommendations are published in Obstetrics & Gynecology. Please see the document for full details on ACOG’s guidelines for the screening and diagnosis of mental conditions during pregnancy and postpartum.
Managing perinatal psychological health
Sharma and colleagues recommended specific considerations of both behavioral and pharmacologic interventions for the management of perinatal mental health.
“Whatever the setting and circumstances, perinatal psychological health care should be culturally responsive, trauma-informed and family-centered,” they wrote. “It should involve shared decision-making with the pregnant person (and their significant other[s] if the patient agrees), including a full discussion of the potential risks and benefits of any treatments offered.”
The writing committee recommended the following psychotherapies intended for use in conjunction with or as an alternative to pharmaceutical use:
- structured, time-limited interpersonal psychotherapy;
- cognitive behavioral therapy to identify and modify maladaptive thinking;
- acceptance and commitment therapy, a type of cognitive behavioral therapy;
- dialectical behavioral therapy;
- trauma-focused therapy;
- stress management and mindfulness-based interventions;
- physical activity and exercise interventions;
- light therapy, nutrition-based therapy, acupuncture, massage, stress management and mindfulness-based meditation programs; and
- electroconvulsive therapy for more severe cases of postpartum depression in the right clinical settings.
For situations where pharmacologic therapies are considered, the writing group highlighted four first-line medications, all selective serotonin reuptake inhibitors: sertraline 25 mg to 200 mg, citalopram 20 mg to 40 mg, escitalopram 10 mg to 20 mg and fluoxetine 20 mg to 80 mg.
“It is unclear if antidepressants, a mainstay of treatment during pregnancy, are associated with preterm birth and possible teratogenicity,” the committee wrote. “The choice of medication should be based on whether the efficacy is known, the safety in pregnancy and during breastfeeding, and consideration of drug interaction.”
Sharma and colleagues also issued specific recommendations for second-line medications for the management of perinatal psychological health as well as recommendations for other FDA-approved medications for late pregnancy and postpartum use. Please see the document for full details.
“Although the interventions are at the individual and hospital level, the writing group recognizes the importance of community health centers and home visiting programs, community health workers and doulas as essential societal components of the care delivery,” they wrote.
References:
- ACOG committee on clinical practice guidelines–obstetrics. Obstet Gynecol. 2023;doi:10.1097/AOG.0000000000005200.
- Lu D, et al. Eur Heart J. 2024;doi:10.1093/eurheartj/ehae170.
- Screening & treating maternal psychological health key to improving cardiovascular health. https://newsroom.heart.org/news/screening-treating-maternal-psychological-health-key-to-improving-cardiovascular-health. Published Feb. 25, 2025. Accessed Feb. 25, 2025.
Collapse