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Background Previous research suggests that mothers whose infants are admitted to neonatal units (NNU) experience higher rates of mental health problems compared to the general perinatal population. This study examined the prevalence and factors associated with postnatal depression, anxiety, post-traumatic stress (PTS), and comorbidity of these mental health problems for mothers of infants admitted to NNU, six months after childbirth. Methods This was a secondary analysis of two cross-sectional, population-based National Maternity Surveys in England in 2018 and 2020. Postnatal depression, anxiety, and PTS were assessed using standardised measures. Associations between sociodemographic, pregnancy- and birth-related factors and postnatal depression, anxiety, PTS, and comorbidity of these mental health problems were explored using modified Poisson regression and multinomial logistic regression. Results Eight thousand five hundred thirty-nine women were included in the analysis, of whom 935 were mothers of infants admitted to NNU. Prevalence of postnatal mental health problems among mothers of infants admitted to NNU was 23.7% (95%CI: 20.6–27.2) for depression, 16.0% (95%CI: 13.4–19.0) for anxiety, 14.6% (95%CI: 12.2–17.5) for PTS, 8.2% (95%CI: 6.5–10.3) for two comorbid mental health problems, and 7.5% (95%CI: 5.7–10.0) for three comorbid mental health problems six months after giving birth. These rates were consistently higher compared to mothers whose infants were not admitted to NNU (19.3% (95%CI: 18.3–20.4) for depression, 14.0% (95%CI: 13.1–15.0) for anxiety, 10.3% (95%CI: 9.5–11.1) for PTS, 8.5% (95%CI: 7.8–9.3) for two comorbid mental health problems, and 4.2% (95%CI: 3.6–4.8) for three comorbid mental health problems six months after giving birth. Among mothers of infants admitted to NNU (N = 935), the strongest risk factors for mental health problems were having a long-term mental health problem and antenatal anxiety, while social support and satisfaction with birth were protective. Conclusions Prevalence of postnatal mental health problems was higher in mothers of infants admitted to NNU, compared to mothers of infants not admitted to NNU six months after giving birth. Experiencing previous mental health problems increased the risk of postnatal depression, anxiety, and PTS whereas social support and satisfaction with birth were protective. The findings highlight the importance of routine and repeated mental health assessments and ongoing support for mothers of infants admitted to NNU.

Background: Mental illness affects 1 in 5 women in pregnancy and after birth with a cost to society of £8.1 billion for every annual cohort of births. Anxiety is one of the most common mental illnesses, affecting around 15% of women, and is associated with increased risk of adverse outcomes for women and their children. Despite this, there is no validated method of screening or assessing anxiety to identify women who need treatment. To be useful, any assessment tool for antenatal anxiety must meet a number of criteria. It must be: (1) acceptable to women; (2) effective at identifying women who require treatment; (3) acceptable and feasible to use in different context of the NHS and other services across the UK; (4) acceptable and easy to use by health professionals. Aims: This study aims to identify the most effective, acceptable and feasible method for assessing anxiety in women during pregnancy and after birth. Methods: This will be achieved through 4 work packages (WP) that compare 4 different tools for assessing anxiety: 2 anxiety-specific measures and 2 mental health measures (GAD, SAAS, CORE-10, Whooley questions) selected on the basis of research and clinical evidence that suggest they may be effective. To ensure relevance to different UK health services the project will be conducted in NHS services in England and Scotland. WP1 will identify which assessment tools are acceptable to women using a purposive sample of 40 pregnant and postpartum women. Cognitive interviews and in-depth qualitative interviews will be used to determine which assessment measures are most acceptable, and obtain women's views and experiences of perinatal anxiety and mental health assessment. WP2 will identify which assessment tool best identifies women who need treatment, as well as the optimal time to assess women during pregnancy. A systematic sample of 1915 women will be recruited in pregnancy and complete assessment tools at 12 weeks, 22 weeks and 31 weeks gestation and 6 weeks postpartum. Effectiveness of measures will be examined in terms of identifying women with poor daily functioning, quality of life, or those who need treatment. Potential confounding factors such as psychological treatment will be controlled for. Diagnostic accuracy will be established using gold standard clinical interviews on a randomly selected subsample of 401 women who score positive or negative for perinatal anxiety. WP3 will determine which assessment tool is acceptable and feasible to use in health services by implementing anxiety assessment in 2 services and evaluating the acceptability and feasibility of use in these services. A theoretically-informed implementation guide will be developed, with targeted versions for maternity, psychological and primary care services to enable wide scale implementation of assessment of perinatal anxiety. WP4 is a study within a project which will examine anxiety during pregnancy and after birth in two regions with a high prevalence of mental health conditions in the general population. This will use data from WP2 to determine the prevalence of perinatal anxiety, key sociodemographic risk factors and need for treatment in these regions. Anticipated impact: This research will identify and implement evidence-based assessment of perinatal anxiety in health services, which is acceptable to women and health professionals. This will help identify women early, which will increase the chances for early intervention to improve maternal and child outcomes. This research was developed through our partnerships with women who have experience of perinatal mental illness, health professionals and service managers. They have identified this as a priority problem and will work with us through the project to ensure its relevance to women and families and the NHS

Additional file 3. GRIPP2 short form reporting checklist. A completed GRIPP2 checklist (Guidance for Reporting Involvement of Patients and the Public).

Additional file 1. Refinement and development of the Well-being in Pregnancy (WiP) questionnaire interview topic guides. File included women living with LTCs and healthcare professional’s topic guides for Phase 1.

Additional file 2: Supplementary Table 2. Detailed list of questions for future research on direct breastfeeding for preterm infants. A table listing detailed questions for future research on direct breastfeeding, submitted by 675 respondents to an online questionnaire for parents of premature babies.

Additional file 1: Supplementary Table 1. Detailed list of questions for future research on breastmilk expression. A table listing detailed questions for future research on breastmilk expression, submitted by 675 respondents to an online questionnaire for parents of premature babies [50].

Additional file 4:. Deeks funnel plot asymmetry test for publication bias.

Additional file 2:. Data extraction form.

Additional file 1: S1. Description of training tasks and performance indicators. S2. Multilevel growth models of performance Z scores. S3. Results of multilevel growth models on trained infants (n = 5). S3.1. Z scores in the Goal Maintenance task. Table S3.1. Model parameters of the random intercept model of Z performance scores in the goal maintenance task. S3.2. Z scores in the Target Search tasks. Table S3.2. Model parameters of the random slope model of Z performance scores in the target search tasks. S3.3. Z scores in the Short Term Memory tasks. Table S3.3. Model parameters of the random slope model of Z performance scores in the short term memory tasks

Additional file 3:. Quality assessment (QADAS-2) tool.

Additional file 1.

Additional file 1: S1. Description of training tasks and performance indicators. S2. Multilevel growth models of performance Z scores. S3. Results of multilevel growth models on trained infants (n = 5). S3.1. Z scores in the Goal Maintenance task. Table S3.1. Model parameters of the random intercept model of Z performance scores in the goal maintenance task. S3.2. Z scores in the Target Search tasks. Table S3.2. Model parameters of the random slope model of Z performance scores in the target search tasks. S3.3. Z scores in the Short Term Memory tasks. Table S3.3. Model parameters of the random slope model of Z performance scores in the short term memory tasks

Additional file 1:. Search strategies.

Supplemental material, Additional_file_1 for First-Time Mothers’ Expectations and Experiences of Postnatal Care in England by Jenny McLeish, Merryl Harvey, Maggie Redshaw, Jane Henderson, Reem Malouf and Fiona Alderdice in Qualitative Health Research

Additional file 2. Training tasks.

Supplemental material, Additional_file_2 for First-Time Mothers’ Expectations and Experiences of Postnatal Care in England by Jenny McLeish, Merryl Harvey, Maggie Redshaw, Jane Henderson, Reem Malouf and Fiona Alderdice in Qualitative Health Research

Additional file 1. Pre- and Post-test Tasks and Questionnaires.

Figure S1. Line graph to show the cumulative weekly response rates to pilot surveys 1 and 2 in relation to the mail out periods. (DOCX 194 kb)

Figure S2. Line graph to show the weekly response rates to pilot surveys 1 and 2 in relation to the mail out periods. (DOCX 189 kb)

A national survey of mothers and babies: maternity, health and care. Pilot survey 1 questionnaire. (PDF 1623 kb)

Additional file 1. Survey form.

Table S1. a: Mediation by Perceived control of the association between mode of delivery and maternal adjustment. b: Mediation by Expectations of the association between mode of delivery and maternal adjustment. c: Mediation by Holding baby of the association between mode of delivery and maternal adjustment. d: Mediation by HCP support of the association between mode of delivery and maternal adjustment. (DOCX 28 kb)

MEDLINE search strategy. Description of data: Full details of MEDLINE search strategy. (DOCX 17Â kb)

Articles and Systematic Reviews from Tables 3-6. (DOCX 40Â kb)

BRIEF ethics protocol. (PDF 109Â kb)

Additional file 2. Mapping systematic reviews.

Additional file 6. Reasons for excluding submissions.

Additional file 5. Submissions formatted as research questions.

Additional file 4. Organisations invited to participate.

Additional file 4. Organisations invited to participate.

Additional file 6. Reasons for excluding submissions.

Additional file 2. Mapping systematic reviews.

Additional file 3. Long list of questions sent for voting.

Additional file 5. Submissions formatted as research questions.

Additional file 3. Long list of questions sent for voting.

Funder: Nuffield Department of Population Health, University of Oxford, AIMS: To undertake a Priority Setting Partnership (PSP) to establish priorities for future research in diabetes and pregnancy, according to women with experience of pregnancy, and planning pregnancy, with any type of diabetes, their support networks and healthcare professionals. METHODS: The PSP used established James Lind Alliance (JLA) methodology working with women and their support networks and healthcare professionals UK-wide. Unanswered questions about the time before, during or after pregnancy with any type of diabetes were identified using an online survey and broad-level literature search. A second survey identified a shortlist of questions for final prioritisation at an online consensus development workshop. RESULTS: There were 466 responses (32% healthcare professionals) to the initial survey, with 1161 questions, which were aggregated into 60 unanswered questions. There were 614 responses (20% healthcare professionals) to the second survey and 18 questions shortlisted for ranking at the workshop. The top 10 questions were: diabetes technology, the best test for diabetes during pregnancy, diet and lifestyle interventions for diabetes management during pregnancy, emotional and well-being needs of women with diabetes pre- to post-pregnancy, safe full-term birth, post-natal care and support needs of women, diagnosis and management late in pregnancy, prevention of other types of diabetes in women with gestational diabetes, women's labour and birth experiences and choices and improving planning pregnancy. CONCLUSIONS: These research priorities provide guidance for research funders and researchers to target research in diabetes and pregnancy that will achieve greatest value and impact.