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To examine the association between household food insecurity (HFI) and low subjective well-being (SWB) among pregnant and postpartum women and determine whether these potential associations differed by maternal age and pregnancy status.
Design:
We conducted a secondary analysis of nationally representative cross-sectional data from women of reproductive age (15–49 years). HFI was measured using the Food Insecurity Experience Scale and categorised as none/mild, moderate or severe. Weighted multilevel logistic regression models were used to estimate OR and 95 % CI for the association between HFI and low levels of three SWB measures: happiness, life satisfaction and optimism. Analyses were stratified by age and pregnancy status.
Setting:
Data were drawn from the 2021 Nigeria Multiple Indicator Cluster Survey, Round 6.
Participants:
The analytic sample comprised 12 587 women who were pregnant at the time of the survey or within 24 months postpartum.
Results:
HFI was significantly associated with all three measures of SWB, although the magnitude of associations varied by outcome, even after adjusting for individual-, household-and community-level characteristics. Stratified analyses revealed heterogeneity in the associations between HFI and SWB by age and pregnancy status. Overall, HFI was associated with lower levels of happiness, life satisfaction and optimism among pregnant and postpartum women in Nigeria.
Conclusions:
Our findings demonstrate a negative association between HFI and SWB among pregnant and postpartum women in Nigeria. These associations were modified by maternal age and pregnancy status, suggesting that strategies to mitigate HFI should account for subgroup differences in order to effectively improve maternal well-being.
Edited by
Liz McDonald, East London NHS Foundation Trust,Roch Cantwell, Perinatal Mental Health Service and West of Scotland Mother & Baby Unit,Ian Jones, Cardiff University
Millions of women and girls worldwide experience violence. Violence against women and girls takes many forms, including physical, emotional and sexual violence and abuse, which is associated with a range of adverse impacts on women, their families and society as a whole. Health professionals supporting women during the perinatal period should assess the risks posed by exposure to previous or current violence and how this may affect them during pregnancy. As an important risk factor in a woman’s mental health presentation, psychiatrists working with pregnant and postpartum women should consider the presence of violence in their formulation; it can increase the risk of anxiety, depression and post-traumatic stress disorder (PTSD). Domestic violence and abuse increase the risk of domestic homicide and may play a role in many perinatal suicides. Sensitive assessment and effective management of women exposed to violence can improve engagement with mental health services and response to treatment.
Edited by
Liz McDonald, East London NHS Foundation Trust,Roch Cantwell, Perinatal Mental Health Service and West of Scotland Mother & Baby Unit,Ian Jones, Cardiff University
Pregnancies among individuals with schizophrenia spectrum disorders have increased in recent years. In the perinatal period, individuals with schizophrenia spectrum disorders are faced with managing the unique effects of their symptoms on pregnancy and parenting, which fluctuate through the perinatal period with the early postpartum being a high-risk time for relapse. Their pregnancies are also associated with a range of adverse pregnancy, neonatal and long-term child outcomes, the risk for which may be related in part to modifiable factors. Prejudice, discrimination and subsequent isolation of perinatal individuals with schizophrenia spectrum disorders may limit health care and social support opportunities in this group, further exacerbating the risk for negative outcomes. These issues underscore the need for comprehensive management approaches including attention to pre-conception health, medication management during pregnancy and postpartum, and multifaceted support for the parent and family. This chapter is an overview of schizophrenia spectrum disorders in the perinatal period, including a summary of the epidemiology, clinical presentation, course, outcomes and management.
Network analysis was employed to test whether the overall pattern of depressive–anxious symptom connections remains stable or whether specific symptom-to-symptom links shift from pregnancy to postpartum.
Methods
In a perinatal sample (n = 4,461 pregnant women, n = 5,711 postpartum women), depressive and anxiety symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD-7). Phase-specific polychoric Gaussian graphical models were estimated with EBICglass. We examined strength and bridge centrality, community structure, and nodewise predictability, and compared networks using the network comparison test.
Results
Depression and anxiety formed four reproducible communities (one GAD-7 worry/arousal and three EPDS affective/anhedonic, anxious–cognitive distress, and depressed affect/sleep–suicidality modules) with identical partitions across phases. Global strength was similar, but postpartum networks showed higher edge density and more negative partial correlations, suggesting localized changes in which symptom pairs were directly linked—and how strongly—across phases. Across phases, Sadness, Crying, Uncontrollable worrying, and Trouble relaxing were most central and predictable. Worry-, arousal-, and sleep-related symptoms (e.g., hard to sleep) showed the strongest bridge centrality postpartum, and Self-harm was a prominent bridge during pregnancy; several edges shifted between phases, including stronger Enjoyment–Self-harm and weaker Hard to sleep–Self-harm postpartum.
Conclusions
Perinatal depression and anxiety organize into cohesive yet partially distinct symptom networks that remain globally stable but show localized shifts in direct symptom-to-symptom connections from pregnancy to postpartum. Central affective and arousal nodes, particularly sadness, pathological worry, and sleep disturbance, may be high-yield targets for phase-tailored screening and intervention.
Maternal–infant bonding is essential for early development and long-term well-being. In low-resource settings like Pakistan, perinatal anxiety, though prevalent, remains under-recognized and can significantly disrupt bonding. While perinatal depression has garnered greater research attention, the cultural and relational dimensions linking anxiety to bonding remain underexplored. This qualitative study examined how maternal distress, sociocultural expectations and healthcare limitations influence bonding. Eighteen pregnant and postnatal women (aged 19–45 years) with clinically significant anxiety (Generalized Anxiety Disorder 7-item scale ≥ 10) were purposively recruited from public hospitals in Rawalpindi and Islamabad. In-depth interviews were conducted in Urdu and analyzed using Braun and Clarke’s thematic analysis. Five major themes emerged: (1) emotional vulnerability during the perinatal period, (2) interpersonal and family dynamics, (3) maternal health and role strain, (4) cultural scripts and structural barriers and (5) participant-driven recommendations. Anxiety often delays emotional connection. Judgment, limited autonomy and lack of support worsened distress, while faith, rituals and relational coping offered resilience. This study provides novel qualitative evidence that perinatal anxiety and maternal–infant bonding are co-constructed within the relational and sociocultural ecologies of low- and middle-income countries like Pakistan. Findings challenge purely symptom-focused approaches, underscoring that effective intervention must address not only the emotional invisibility of mothers but also the relational pathways of distress, such as hypervigilance, exhaustion and performance anxiety, which are intensified by a lack of respect, autonomy and validation. A shift toward contextually grounded, relationship-centered care is urgently needed.
Childbirth-related post-traumatic stress disorder (CB-PTSD) is an underrecognized condition with consequences for mothers and infants. This study aimed to determine risk factors for CB-PTSD symptoms across countries within a stress–diathesis framework, focusing on antenatal, birth-related, and postpartum predictors.
Methods
The INTERSECT cross-sectional survey (April 2021–January 2024) included 11,302 women at 6–12 weeks postpartum. The study was carried out across maternity services in 31 countries. Outcomes were CB-PTSD diagnosis, symptom severity, and perceived traumatic birth, assessed with the City Birth Trauma Scale. Multiple risk factors were assessed, including preexisting vulnerability, pregnancy, birth, and infant-related factors. All models were adjusted for country-level variation as a random effect.
Results
Models explained substantial variance across all outcomes (conditional R2 = 0.53–0.58). Negative birth experience was the strongest predictor (e.g. odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.80–0.84 for diagnosis). Ongoing maternal complications predicted both CB-PTSD diagnosis and symptoms (e.g. OR = 1.61, 95% CI = 1.41–1.84), and major infant complications were associated with CB-PTSD diagnosis (OR = 1.63, 95% CI = 1.29–2.07). Reports of perceived danger to self or infant (criterion A) were linked to higher CB-PTSD symptoms and traumatic birth ratings (e.g., β =0.25, 95% CI = 0.21–0.29). Other predictors reached significance but showed small effects.
Conclusions
Findings support a stress–diathesis framework, showing that while pre-existing vulnerabilities contribute, birth-related stressors exert the strongest influence. Trauma-informed maternity care should prioritize these factors, with attention to women’s appraisals of birth.
Impaired maternal sensitivity may be a risk pathway linking maternal posttraumatic stress symptoms (PTSS) to adverse child outcomes. Respiratory sinus arrhythmia (RSA), a psychophysiological marker of emotion dysregulation, may be a key factor in how PTSS influence maternal sensitivity. Yet, these associations remain untested in early infancy. The current study tested maternal resting RSA and RSA reactivity to caregiving as moderators of the association between maternal PTSS and maternal sensitivity in trauma-exposed mothers.
Methods
Seventy-seven mother–infant dyads (maternal Mage = 30.06 years, infant Mage = 9.53 weeks) were recruited from the community and an urban public hospital setting. Mothers reported on PTSS and engaged in a caregiving task; maternal sensitivity was coded. RSA was measured at rest and in response to the task. Generalized linear models for ordinal outcomes analyses examined the moderating effect of resting RSA and RSA reactivity (decrease in RSA) on the association between PTSS and maternal sensitivity.
Results
The association between maternal PTSS and sensitivity was significantly moderated by resting RSA (B(SE) = 0.03(0.01), p = .033, and RSA reactivity, B(SE) = 0.03(0.01), p = .022.
Maternal PTSS was negatively associated with maternal sensitivity only among mothers with higher resting RSA (+1SD above mean), B(SE) = −0.05(0.02), p = .030, and with greater RSA reactivity (−1SD below mean RSA reactivity scores), B(SE) = −0.06 (0.02), p = 0.021.
Conclusions
A tendency toward autonomic overregulation and heightened physiological reactivity may serve as relevant factors influencing how PTSS leads to maladaptive parenting behavior in early postpartum.
This study included postpartum women who survived the earthquake that occurred on February 6, 2023, with epicenters in Kahramanmaraş, and assessed their experiences, psychosocial needs using a qualitative research method. The findings were organized under 5 key themes: “psychological processes experienced during and after the earthquake,” “experiences related to pregnancy and childbirth,” “biopsychosocial problems experienced after the earthquake,” “experiences related to s workers,” and “expectations and needs of earthquake-affected mothers.” Codes were established for women that were specific to their emotional responses following the earthquake: fear, sorrow, anxiety, difficulty in controlling anger, hopelessness, exhaustion, and inability to experience the mourning process; concerning their emotional reactions at the moment of the earthquake: extreme fear, helplessness, shock, and grief response; and regarding the traumatic effects of the earthquake: post-traumatic growth and post-traumatic stress disorder. During and after an earthquake, pregnant and postpartum women have biopsychosocial needs such as shelter, food, clothing, hygiene, support, and care, and these needs should be prioritized. Early psychological interventions should be provided to help women deal with the negative traumatic experiences they encounter during this process. Relevant institutions should create individual care-focused support systems and early intervention to deliver comprehensive care following earthquake.
Postnatal depression (PND) is the most prevalent mental health disorder during the postpartum period. Evidence suggests that clinical practice guidelines (CPGs) can improve the mental well-being of women affected by PND. This study aimed to identify the CPGs available globally for the management of PND and to summarize their recommendations. A comprehensive search was performed across five electronic databases (MEDLINE, PsycINFO, CINAHL, TRIP, and Epistemonikos) and four guideline-specific websites (GIN, SIGN, NICE, and WHO) to identify the English language CPGs published between 2012 and 2023. The general characteristics of the CPGs, as well as the reported pharmacological and non-pharmacological recommendations, were extracted. The AGREE-II instrument was used to assess the methodological quality. Nineteen CPGs were included in the review, with only one from a low and middle-income country (Lebanon). Cognitive-behavioral therapy (CBT) was the most frequently recommended psychological therapy. Pharmacological interventions were included by 17 CPGs, predominantly Selective Serotonin Reuptake Inhibitors (SSRIs). Only three CPGs incorporated Patient and Public Involvement and Engagement (PPIE) in the form of an advisory group. Seven CPGs matched the criteria for adequate methodological quality by achieving an overall score of ≥70%. The findings highlight limited methodological quality and underrepresentation of LMICs, which may lead to disparities in the management of PND and undermine equitable mental health care.
A systematic review and meta-analysis was undertaken to predict the effect of prepartum energy level on postpartum energy metabolism and milk production in dairy cows. In this systematic review, the criteria of PRISMA guidelines were followed: in vivo experimental evaluation of diets with different prepartum energy levels; presentation of initial, final, and/or total results; statement of treatment period including the last 21 days of the prepartum of period; and description of dry matter intake (DMI), milk production, blood parameters and feed efficiency data. A descriptive analysis was performed for better visualization of the data, and Pearson's correlation was used between the collected variables and the prepartum energy intake. The acquired data were subsequently analysed, employing a link function in a polynomial regression model. Prepartum energy intake does not influence DMI or energy balance in the postpartum phase. A higher-energy diet prepartum increased feed efficiency postpartum, accompanied by an increase in blood levels of BHB and NEFA. However, it also resulted in a decrease in milk production and blood glucose.
One in 25 patients experience PTSD following childbirth. Risk factors include unplanned cesarean delivery, operative vaginal delivery, obstetric emergencies such as cord prolapse, neonatal intensive care admission, previous trauma, and severe physical complications. Early recognition of PTSD is imperative. It can have a significant impact on the health of both the birthing parent and the infant. It is associated with difficulty in bonding with the infant, breast-feeding, or engaging in postnatal care. A multidisciplinary approach between obstetricians, psychiatrists, and other mental health providers is recommended for management. Treatment may involve eye movement desensitization and reprocessing, cognitive behavioral therapy, and pharmacotherapy. It is reasonable to perform cesarean delivery for maternal request in patients who are well informed of the risks, benefits, and alternatives.
Postpartum psychosis (PPP) is the least understood and most dangerous of the perinatal psychiatric disorders. Affecting 1–2 per 1,000 birthing persons, it is an obstetric and psychiatric emergency associated with increased risks of suicide and infanticide. Symptom onset is typically sudden, most often occurring within the first 2 weeks postpartum, and can be waxing and waning in presentation. Clinical features include delusional thoughts or bizarre beliefs, hallucinations, paranoia, rapid mood swings, irritability, hyperactivity, and decreased need for or difficulty sleeping. While the psychotic symptoms are often the most dramatic manifestation, women with PPP can also present with mood symptoms including mania and/or irritability, depression, or anxiety. This case discusses the diagnosis, initial evaluation and treatment, and long-term management of patients with postpartum psychosis.
We discuss the case of a postpartum patient that develops posterior reversible encephalopathy syndrome (PRES) as characterized by clinical and neuro-radiological findings. It is described as an acute or subacute syndrome that presents with elevated blood pressure and symptoms of headache, altered mental status, seizures, and vision changes. Diagnosis of PRES is made with neuroimaging, with magnetic resonance imaging being the preferred modality. Pathognomonic imaging includes findings of posterior encephalopathy. There is a strong correlation of PRES in patients with preeclampsia and eclampsia. The syndrome can be reversed with timely and aggressive control of symptoms and underlying causes, which in this case included blood pressure control as well as seizure prophylaxis.
The prevalence of co-morbid anxiety and depression varies greatly between research studies, making it difficult to understand and estimate the magnitude of this problem. This systematic review and meta-analysis aim to provide up-to-date information on the global prevalence of co-morbid anxiety and depression in pregnant and postpartum women and to further investigate the sources of heterogeneity. Systematic searches of eight electronic databases were conducted for original studies published from inception to December 10, 2024. We selected studies that directly reported prevalence data on co-morbid anxiety and depression during the perinatal periods. We extracted data from published study reports and calculated the pooled prevalence of symptoms of co-morbid anxiety and depression. There are 122 articles involving 560,736 women from 43 different countries included in this review. The global prevalence of co-morbid anxiety and depression during the perinatal period was about 9% (95%CI 8%–10%), with approximately 9% (95%CI 8%–11%) in pregnant women and 8% (95%CI 7%–10%) in postpartum women. Prevalence varied significantly by the assessment time points, study country, study design, and the assessment tool used for anxiety and depression, while prevalence was not dependent on publication year, country income level, and COVID-19 context. No publication bias was observed for this prevalence rate. These findings suggest that approximately 1 in 10 women experience co-morbid anxiety and depression during pregnancy and postpartum. Targeted action is needed to reduce this burden.
Mental health disorders are common in pregnancy and after childbirth with over 10% of women manifesting some form of mental illness during this time. Maternity services will encounter women with symptoms that vary in severity from mild self-limiting to potentially life-threatening. These conditions carry risks for both the woman and the fetus/newborn. Detecting women with, or at risk of, a serious mental health disorder and enabling them to access appropriate care in a timely fashion is a shared responsibility. However, given the frequency of contact they have with women through this period, maternity services have a pivotal role. From a mental health perspective, high-risk pregnancies are those primarily associated with serious mental illness (psychotic illnesses, bipolar disorder and severe depressive episodes). Healthcare professionals caring for pregnant women should have the appropriate skills to detect serious mental illness and identify women at risk and how to access specialist mental health care.
Postpartum anxiety (PPA) symptoms have harmful effects on child development and mother–infant interactions. Accordingly, in-depth knowledge of associated risk factors is crucial for prevention policies. This study aimed to estimate PPA symptom prevalence at 2 months and to identify associated risk factors in a representative sample of all women who gave birth in France in 2021, and in two subgroups: women with no postpartum depression (PPD) symptoms, and those with no history of mental health care.
Methods
Among the 12,723 women included in the representative French national perinatal survey 2021ENP, 7,133 completed the Edinburgh Postnatal Depression Scale (EPDS) self-administered questionnaire – including three anxiety-specific items (EPDS-3A) – at 2 months postpartum. We estimated the adjusted prevalence ratios (aPR) of PPA symptoms using Poisson regression models with robust variance.
Results
PPA symptom prevalence at 2 months was 27.6% (95% CI [26.5–28.8]). Associated risk factors were: age ≤ 34 years (maximum aPR = 1.38 [1.22–1.58] obtained for persons aged 25–29 years vs. 35–39 years), poorer health literacy (1.15 [1.07–1.23]), a history of medical termination of pregnancy (1.32 [1.05–1.68]), psychological (1.31 [1.17–1.47]) or psychiatric (1.42 [1.24–1.63]) care history since adolescence, nulliparity (1.23 [1.12–1.35]), no weight gain or loss (1.29 [1.03–1.61] vs. 9–15 kg gain) or gain ≥23 kg (1.20 [1.00–1.43]) during pregnancy, ≥3 pregnancy-related emergency consultations (1.16 [1.03–1.31] vs. none), poor/good support during pregnancy, (1.16 [1.00–1.34] and 1.15 [1.05–1.26], respectively, vs. very good), sadness (1.52 [1.36–1.69]), anhedonia (1.48 [1.27–1.72]), or both (1.99 [1.79–2.21]) during pregnancy, not at all/not very satisfied with pain management during childbirth (1.16 [1.01–1.32] vs. quite/very satisfied). Similar risk factors were found in the ‘no PPD symptoms’ and ‘no history of mental health care’ subgroups.
Conclusions
Estimated PPA symptom prevalence at 2 months in our study sample was 27.6%. The risk factors we identified may guide future prevention policies.
Perinatal stress and anxiety from conception to two years postpartum have important adverse outcomes for women and infants. This study examined (i) women’s perception of sources and experiences of perinatal stress and anxiety, (ii) women’s attitudes to and experiences of available supports, and (iii) women’s preferences for perinatal stress and anxiety supports in Ireland.
Methods:
An online mixed-methods cross-sectional survey was conducted with 700 women in Ireland. Participants were pregnant women (n = 214) or mothers of children ≤ 2 years old (n = 486). Participants completed closed-ended questionnaires on sociodemographic, birth and child factors, and on stress, anxiety, perceived social support, and resilience. Participants completed open-ended questions about experiences of stress and anxiety and the supports available for stress and anxiety during pregnancy and/or postpartum. Quantitative data were analysed descriptively and using correlations; qualitative data were analysed using thematic analysis.
Results:
Quantitative data indicated significant relationships between perinatal stress and/or anxiety and women’s perceived social support, resilience, having a previous mental health disorder diagnosis (both p < 0.001), and experiencing a high-risk pregnancy or pregnancy complications (p < 0.01). Themes developed in qualitative analyses included: ‘perceived responsibilities’; ‘self-care’; ‘care for maternal health and well-being’; ‘social support’; and ‘access to support and information’.
Conclusions:
Women’s stress and anxiety are impacted by multiple diverse factors related to the individual, to interpersonal relationships, to perinatal health and mental health outcomes, and to available services and supports. Development of support-based individual-level interventions and increased peer support, coupled with improvements to service provision is needed to provide better perinatal care for women in Ireland.
Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about its course and outcomes during pregnancy, labour and postpartum (the perinatal period). We searched MEDLINE, PsycInfo and Embase combining search terms for FND and the perinatal period. We extracted data on patient demographics, subtype of FND, timing of symptom onset, comorbidities, medications, type of delivery, investigations, treatment, pregnancy outcomes and FND symptoms at follow-up.
Results
We included 36 studies (34 case reports and 2 case series) describing 43 patients. Six subtypes of FND were identified: functional (dissociative) seizures, motor weakness, movement disorder, dissociative amnesia, speech disorders and visual symptoms. New onset of perinatal FND was more common in the third trimester and onwards. Some women with functional seizures were exposed to unnecessary anti-seizure prescriptions and intensive care admissions.
Clinical implications
Prospective studies are urgently needed to explore how FND interacts with women's health in the perinatal period.
Edited by
Nevena V. Radonjić, State University of New York Upstate Medical University,Thomas L. Schwartz, State University of New York Upstate Medical University,Stephen M. Stahl, University of California, San Diego
To identify the different factors associated with postpartum blues and its association with postpartum depression, from a large French cohort.
Methods
We conducted an analysis of the Interaction Gene Environment in Postpartum Depression cohort, which is a prospective, multicenter cohort including 3310 women. Their personal (according to the Diagnostic and Statistical Manual, fifth edition [DSM-5]) and family psychiatric history, stressful life events during childhood, pregnancy, and delivery were collected. Likewise, the French version of the Maternity Blues Scale questionnaire was administered at the maternity department. Finally, these women were assessed at 8 weeks and 1 year postpartum by a clinician for postpartum depression according to DSM-5 criteria.
Results
The prevalence of postpartum blues in this population was 33%, and significant factors associated with postpartum blues were found as personal (aOR = 1.2) and family psychiatric history (aOR = 1.2), childhood trauma (aOR = 1.3), obstetrical factors, or events related to the newborn, as well as an experience of stressful life events during pregnancy (aOR = 1.5). These factors had a cumulative effect, with each additional factor increasing the risk of postpartum blues by 31%. Furthermore, adjustment for sociodemographic measures and history of major depressive episode revealed a significant association between postpartum blues and postpartum depression, mainly at early onset, within 8 weeks after delivery (aOR = 2.1; 95% CI = 1.6–2.7), but also at late onset (aOR = 1.4; 95% CI = 1.1–1.9), and mainly if the postpartum blues is severe.
Conclusion
These results justify raising awareness among women with postpartum blues, including reassurance and information about postpartum depression, its symptomatology, and the need for management in case of worsening or prolongation of postpartum blues.