Promoting Mental Health During Pregnancy and Postpartum To Support Heart Health

The perinatal period, which spans from pregnancy through 12 months postpartum, is often a time of joy and excitement for expecting parents. It can also be a time of major life changes, like the transition to parenthood, new financial burdens, or changes in a relationship, which can cause stress or anxiety.

“Most women are focused on having a safe delivery and a healthy baby and aren’t thinking about their long-term cardiovascular risk,” says Allison Gaffey, PhD, assistant professor of medicine (cardiovascular medicine). “However, we know that mental health is profoundly connected to heart health. We can and should do more to help expecting and new mothers care for their mental health and prevent long-term heart issues.”

Gaffey, a clinical health psychologist, recently co-authored a new scientific statement from the American Heart Association, “Optimizing Psychological Health Across the Perinatal Period: An Update on Maternal Cardiovascular Health.” The statement offers new guidance on integrating psychological health into cardio-obstetric care to help arm clinicians with tools they can use to better screen and treat patients.

We recently spoke with Gaffey about the perinatal period, the link between mental health and heart health, and the importance of education and screening.

We know that the perinatal period is stressful for parents, especially the one who experiences pregnancy. While some level of stress is normal, and our bodies can usually adapt, prolonged or chronic stress can become overwhelming, especially for those who lack sufficient social support or access to resources.

During periods of chronic stress, the body’s systems can become dysregulated. The immune system may become overactive, and we may see disruptions in the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis, along with elevated stress hormone levels.

This kind of imbalance across multiple systems can predispose us to major cardiovascular events, like a heart attack. It can also predispose us to a faster progression to cardiovascular disease, often beginning with high blood pressure and inflammation.

People can only receive the care they need when they feel safe and supported enough to speak openly about their mental health symptoms. Current recommendations say that health care providers should regularly screen patients in the perinatal period for mental health or psychological health symptoms.

One of the most common methods to screen patients is with the four-item Patient Health Questionnaire, which includes two questions focused on depression and two focused on anxiety. Some health care offices also offer longer questionnaires focused on depression or anxiety.

If a patient is diagnosed with a mental health condition, there are many different evidence-based treatment options available. We frequently use cognitive behavioral therapies and stress management, mindfulness, or biofeedback to treat patients. Some patients also benefit from prescription medications, many of which are safe during pregnancy.

While society has become more accepting of mental health conditions, there is still a long way to go to improve our dialogue and foster open, honest conversations around mental health.

Stigma remains one of the biggest barriers to screening and treatment. People may also fear that being diagnosed with a mental health condition could lead to judgment, unwanted involvement from authorities, or challenges to raising their children in the way they choose.

Yale has a maternal wellness program that provides screening and therapy to people both during pregnancy and up to one year postpartum, which aligns well with the recommendations in the new AHA statement. Unfortunately, not all health care systems have adopted recommended standardized screening due to their own barriers and constraints.

I’m hopeful that with continued research, education, and efforts like the AHA statement, we can continue to improve mental and cardiovascular care for people in the perinatal period.

Cardiovascular Medicine, one of 10 sections in the Yale Department of Internal Medicine, is dedicated to improving cardiovascular health by advancing groundbreaking research, training the next generation of experts in cardiology, and delivering world-class patient care to people with a range of cardiovascular issues. To learn more, visit Cardiovascular Medicine.