The relationship between diagnosed antenatal depression and anxiety and adverse birth outcomes between 2009 and 2020

Trends in demographics and needs for nurse-family partnership clients enrolled between 1997 and 2022

BACKGROUND

Demographics and needs of nulliparous, Medicaid-eligible pregnant individuals, the target profile for Nurse-Family Partnership (NFP), have shifted over recent decades as teen pregnancy rates have dropped and Medicaid eligibility has expanded.

OBJECTIVE

We examined trends in the proportion of NFP clients with demographic characteristics and needs impacting client and child outcomes.

PARTICIPANTS AND SETTING

Participants were nulliparous, pregnant individuals (N = 349,935; 33 % Hispanic, 30 % non-Hispanic Black, 30 % non-Hispanic White) enrolled between 1997 and 2022 in NFP, a national public health intervention aimed at improving client and child outcomes through in-home nurse visitation.

METHODS

Generalized linear models and time-varying models examined change over time.

RESULTS

Later enrollment year predicted enrollment of: more racially/ethnically diverse clients with older age (β = 0.24 ± 0.002, P < .0001) more educated clients (college degree vs. high school diploma/GED OR 1.195, 95 % CI 1.194-1.195), more married/cohabiting clients (OR 1.131, 95 % CI 1.129-1.132), clients with higher mastery scores (β = 0.007 ± 0.0001, P < .0001), and increased client needs (pre-pregnancy mental/physical health diagnoses, substance use/addiction, IPV exposure, and homelessness; ORs 1.082 to 1.300, all P < .0001). The average summed needs of clients increased from 1.17 in 1997 to 1.36 in 2022. Non-Hispanic White clients had greater summed needs compared to Hispanic and non-Hispanic Black clients, driven by higher rates of health diagnoses and substance use.

CONCLUSION

The demographics and needs of NFP clients have shifted over time. Compared to the original trials and earlier program replication, recent clients are older and more educated but have greater needs in a variety of domains increasing risk of poor client and child outcomes.

Racial Categorization in Women's Mental Health Research Fails to Meet the Needs of Multiracial, Biracial, and Mixed-Race Women in the United States

The author challenges women's mental health researchers to critically examine the categories of race available for research participants, surveillance data, and medical records.

Disparities in Utilization and Delivery Outcomes for Women with Perinatal Mood and Anxiety Disorders

Perinatal mood and anxiety disorders (PMAD), which include depression and/or anxiety in the year before and/or after delivery, are common complications of pregnancy, affecting up to one in four perinatal individuals, with costs of over $15 billion per year in the US. In this paper, we provide an overview of the disparities in utilization and delivery outcomes for individuals with perinatal mood and anxiety disorders in the US. In addition, we discuss the current US screening and treatment guidelines as well as the high societal costs of illness of PMAD for both perinatal individuals and children. Finally, we outline opportunities for quality improvement of PMAD care in the US, including leveraging increased engagement with healthcare system during prenatal care, working toward a more cohesive national strategy to address PMAD, leaning into evidence-based policymaking through collaboration with a panel of experts, and generating state-level profiles focused on PMAD.

Perinatal Mental Health: The Need For Broader Understanding And Policies That Meet The Challenges

Perinatal mental health is gaining recognition as a key antecedent of adverse maternal and child outcomes as the United States experiences a maternal mortality and morbidity crisis. Recent policy efforts have attempted to mitigate adverse outcomes through legislation such as the Taskforce Recommending Improvements for Unaddressed Mental Perinatal and Postpartum Health (TRIUMPH) for New Moms Act of 2021 and postpartum coverage through Medicaid expansion. Even with progress, perinatal mental health policy continues to grapple with a basic truth: The United States lacks an overarching health care system capable of meeting the mental health care needs of perinatal people and their families.  Moreover, the burden of undiagnosed and untreated perinatal mental health challenges remains greatest among racially minoritized populations, such as Black, Asian, and multiracial people. A broader understanding of perinatal mental health is needed, grounded in the tenets of reproductive justice. From this perspective, we articulate specific policies to meet perinatal mental health challenges and promote thriving for birthing people and their families.