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Background: The Perinatal Integrated Psychosocial Assessment (PIPA) tool screens for anxiety, depression, and psychosocial factors in pregnancy. We aimed to assess the association between PIPA‐determined psychosocial risk and obstetric and neonatal outcomes. Methods: Cohort study of all pregnant women who gave birth at ≥20 weeks of gestation in 2017‐2019 at a tertiary maternity hospital in, Sydney, Australia. Women completed PIPA at their first antenatal visit and were assigned a PIPA risk category. At‐risk women were reviewed and referred for support. The association between PIPA risk category and obstetric and neonatal outcomes was evaluated using multivariable logistic regression adjusting for sociodemographic and pregnancy factors. Results: In all, 5969 women completed PIPA; 71.4% were assessed no/low risk, 17.5% medium risk, and 11.1% medium‐high/high risk. Compared with no/low‐risk women, medium‐high/high‐risk women were more likely to remain in hospital for >72 hours (aOR 1.47 [95% CI 1.33‐1.64]); to not be breastfeeding at discharge (aOR 1.77 [95% CI 1.20‐2.61]); to have their infants experience birth complications (aOR 1.24 [95% CI 1.03‐1.50]); and to be admitted to the NICU (aOR 1.63 [95% CI 1.26‐2.11]). There was a modest increase in odds of cesarean birth (aOR 1.12 [95% CI 1.00‐1.27]), and no association with preterm birth or low birthweight. The risk of adverse outcomes disappeared for medium‐high/high‐risk women referred for support. Conclusions: The PIPA tool identified one in 10 women at high psychosocial risk with increased risk of adverse obstetric and neonatal outcomes. Adverse outcomes were attenuated for high‐risk women who were referred for extra support, suggesting that psychosocial review and referral for high‐risk women may reduce the risk of adverse obstetric and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Studies continue to show that women who give birth in the private maternity sector are less likely to receive depression screening and psychosocial assessment as a routine component of maternity care. However, examples of successfully implemented routine psychosocial assessment programs are beginning to emerge, and there is great value in better understanding the factors that can contribute to the successful delivery of emotional health care in this context. Aim: The aim of this study was to identify factors that facilitated successful implementation of antenatal psychosocial assessment in a private hospital setting. Methods: This study employed a qualitative research design. Semi‐structured interviews were used to explore the views and experiences of health professionals involved in implementation of the program at the participating site. Results: Nine health professionals participated in the study (three midwives, three obstetricians, two managers and one mental health worker). Factors that facilitated successful implementation of the program were reflected in five key themes: (i) multidisciplinary support for the program; (ii) training and clinical supervision; (iii) allocation of sufficient resources; (iv) availability of local referral pathways; and (v) normalisation of the process. Conclusion: This study shows that barriers to implementation of perinatal depression screening and psychosocial assessment are surmountable and will provide confidence to other services, that routine 'mental health assessment' as required under updated Medical Benefits Scheme items for obstetric services, can be successfully implemented and sustained in private hospital settings. [ABSTRACT FROM AUTHOR]

Background: There is limited information relating to routine depression screening and psychosocial assessment programs in private maternity settings in Australia. Aims: To describe the psychosocial profile of a sample of private maternity patients who participated in a depression screening and psychosocial risk assessment program as part of routine antenatal care, and to explore women's experience of receiving this component of pregnancy care. Materials and methods: We conducted a retrospective medical records audit of 455 consecutive women having a routine psychosocial assessment and referral. Assessment was undertaken using the Edinburgh Postnatal Depression Scale (EPDS) and the Antenatal Risk Questionnaire (ANRQ) for psychosocial risk; 101 women completed a feedback survey about their experience of receiving routine psychosocial care. Results: Of the 87.7% of women who completed both EPDS and ANRQ, 4.3% scored 13 or more on the EPDS. On the ANRQ, 25.3% of women endorsed one risk factor, 11.6% two risk factors and 10.5% three or more risk factors. Elevated EPDS scores were associated with major stresses in the last 12 months, high trait anxiety and significant past mental health issue/s. Acceptability of depression screening and psychosocial risk assessment was high. Conclusions: This study highlights the need for, and acceptability of, depression and psychosocial assessment in the private maternity sector. These findings are particularly timely given the provision of new Medicare Benefits Scheme items for obstetricians to undertake psychosocial assessment (both antenatally and postnally) in line with recommended clinical best practice. [ABSTRACT FROM AUTHOR]

Background Psychosocial assessment and depression screening are recommended for all pregnant and postnatal women in Australia. However, women who give birth in private maternity settings remain less likely to participate in psychosocial assessment programs, making it difficult to comment on the potential resource implications. Aims To describe the psychosocial profile of a sample of women who had recently given birth in a private hospital and to examine the acceptability and feasibility of introducing psychosocial assessment as a routine component of maternity care. Materials and Methods Two hundred and twenty participants were recruited in a four-month period from a private tertiary hospital located in Murdoch, Western Australia. All participants completed the Edinburgh Depression Scale ( EDS) and a Antenatal Risk Questionnaire ( ANRQ) prior to discharge via an iPad. Results The mean total score for the EDS was 4.77 ( SD = 3.93), with 5% of women scoring above the recommended cut-off of 13 or more. The mean total score for the ANRQ was 17.73 ( SD = 10.72). 45.0% of all women endorsed no significant risk factors. The proportion of women scoring above the recommended ANRQ cut-off of 23 or more was 32.3%. Approximately 11% of women were referred for additional support or treatment. Acceptability of the ANRQ was high at 97.3%. Conclusions This study describes the psychosocial profile of a sample of women who recently gave birth in an Australian private maternity hospital and demonstrates that with additional resources, the implementation of psychosocial assessment as a routine component of maternity care was feasible and highly acceptable in this setting. [ABSTRACT FROM AUTHOR]

Background There exists little evidence that routine assessment of current or past mental health in the perinatal period positively impacts on rates of referral for emotional health issues. This study aimed to evaluate the impact of this early intervention approach on reported referrals for emotional health issues during pregnancy and the first postpartum year. Method A subsample of women ( N = 1,804) drawn from the Australian Longitudinal Study on Women's Health participated in the study. Results Multivariate analyses showed that predictors of being given a referral for emotional health issues during pregnancy and the postnatal period, respectively, included assessment of past mental health (Adjusted Odds Ratio [AOR] = 4.40, p < 0.001, and A OR = 5.69, p < 0.001), assessment of current mental health (A OR = 2.47, p < 0.001, and A OR = 2.72, p < 0.001), and reported experience of significant emotional distress (A OR = 2.58, p < 0.001, and A OR = 2.83, p < 0.001). The odds of receiving a referral were up to 16 times greater for women who were asked about both their past and current mental health than for women who did not receive any form of mental health assessment. Conclusions This study highlights that enquiry into risk factors such as past history (in addition to current mental health) enhances initiation of referrals. Importantly, results suggest that enquiry about current mental health is associated with appropriate rates of referral rather than a nonspecific inflation of referrals. In line with Australia's Clinical Practice Guidelines for Perinatal Mental Health, the value of a comprehensive approach to mental health assessment to aid decision making around referral for further assessment or care is particularly evident. [ABSTRACT FROM AUTHOR]

Aim To examine the impact of pregnancy exposure to antidepressants on infant neurodevelopment. Methods A prospective, longitudinal study in which antidepressant-exposed (n = 35) and nonexposed (n = 23) infants were administered the Bayley Scales of Infant Development ( BSID- III) at 18 months, which measures neurodevelopment across five domains. Data on obstetric and perinatal complications, maternal IQ, presence of mood disorder in pregnancy and up to and including 18 months, and psychosocial status were also collected. Results Almost 90% of infants were exposed throughout the second and third trimesters to therapeutic antidepressant doses. Bivariate analysis showed no difference between exposed and unexposed infants in any of the neurodevelopmental outcomes. Maternal depression around birth or up to time of developmental testing was not associated with neurodevelopmental outcomes. Conclusion Our results suggest that pregnancy antidepressant exposure (mostly serotonin reuptake inhibitors) is not associated with poorer cognitive, motor or language development outcomes in infants at 18 months. This information supports earlier studies and adds into the available data used by clinicians and mothers making key decisions around the use of antidepressants in pregnancy. However, given the small sample size, and some degree of heterogeneity in terms of antidepressant exposure, these results need to be treated with caution. [ABSTRACT FROM AUTHOR]

Background Alcohol use disorders ( AUD) during pregnancy can have profound lifelong effects on the baby, including fetal alcohol spectrum disorders ( FASD). Hospital admission for AUD during pregnancy provides an opportunity for intervention. Characterization of women along the AUD spectrum during pregnancy aids the development of prevention strategies, policy, and clinical management guidelines aimed at this population. This study describes the hospital admission levels for AUD between the sixth month before pregnancy and the first year after birth and explores risk factors associated with the hospital admissions. Methods This study was based on linked population data between 2002 and 2005 using the New South Wales ( NSW) Midwives Data Collection ( MDC) and the NSW Admitted Patients Data Collection ( APDC), Australia. The study subjects included primiparous mothers who were admitted to hospital in the period from the sixth month before pregnancy to 1 year after birth with at least 1 of the following diagnoses ( ICD-10- AM): mental and behavioral disorders due to the use of alcohol ( MBDA) (F10.0-10.9); toxic effects of alcohol (T51.0-51.9); maternal care for suspected damage to fetus from alcohol (O35.4); or alcohol rehabilitation (Z50.2). Results A total of 175 new mothers had 287 hospital admissions with the principal or stay AUD diagnoses during the study period in NSW. Of the 287 admissions, 181 admissions (63.07%) were reported for an alcohol-related disorder as the principal diagnosis. The hospital admission rate for AUD was 1.76/1,000 person-years ( PY) (95% CI: 1.45 to 2.07) during the 6 months prepregnancy. The rate decreased to 0.49/1,000 PY (95% CI: 0.36 to 0.63) during pregnancy and to 0.82/1,000 PY (95% CI: 0.67 to 0.97) in the first year after birth. Women who smoked during pregnancy, lived in a remote area and were younger than 25 years, were more likely to be admitted to hospital with AUD diagnoses. Women in the middle disadvantaged quintile and born in other countries were less likely to be admitted to hospital with AUD diagnoses. Conclusions Hospital admission for AUD decreased significantly in pregnancy and the first year postpartum compared to the prepregnancy period. [ABSTRACT FROM AUTHOR]

This study prospectively examined the separate and combined influences of maternal prenatal anxiety disorder and postnatal caregiving sensitivity on infants' salivary cortisol responses to the still-face procedure. Effects were assessed by measuring infant salivary cortisol upon arrival at the laboratory, and at 15-, 25-, and 40-min following the still-face procedure. Maternal symptoms of anxiety during the last 6 months of pregnancy were assessed using clinical diagnostic interview. Data analyses using linear mixed models were based on 88 women and their 7-month-old infants. Prenatal anxiety and maternal sensitivity emerged as independent, additive moderators of infant cortisol reactivity, F (3, 180) = 3.29, p = .02, F (3, 179) = 2.68, p = .05 respectively. Results were independent of maternal prenatal depression symptoms, and postnatal symptoms of anxiety and depression. Infants' stress-induced cortisol secretion patterns appear to relate not only to exposure to maternal prenatal anxiety, but also to maternal caregiving sensitivity, irrespective of prenatal psychological state. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 625–637, 2009 [ABSTRACT FROM AUTHOR]

The article examines mental health reform for perinatal care in Australia. It highlights several approaches to improve mental health outcomes for mothers, children and families. It details the National Postnatal Depression Research Program which studied the feasibility of widespread screening for depression in the perinatal period. It also reports on the establishment of the National Perinatal Depression Initiative by the Australian Department of Health and Ageing.

Venlafaxine (Efexor), a selective noradrenergic reuptake inhibitor, is an important therapeutic option in the treatment of perinatal depression, but its effects on the newborn are uncertain. We present a report of two infants with neonatal seizures attributed to maternal use of venlafaxine. The first infant was hypotonic and required resuscitation at birth. The second was born in a good condition but developed clinically apparent seizures after the second day of life. Both infants responded rapidly to treatment with phenobarbitone that was weaned uneventfully by the first and second week of life. Both remain well at 1 year of age. Other causes of neonatal seizures were excluded and neurological investigations on these two infants were unremarkable. We suggest that all infants exposed to maternal venlafaxine, no matter their condition at birth, be monitored in hospital for at least 3 to 4 days in order to pre-empt and treat adverse neurological events. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the pharmacological treatment of postpartum depression (PPD).

Comments on the latest breakthroughs in perinatal mental health. Indications of the broadening frames of reference; Recognition of the impact of disorders; Strategies for screening, prevention, early intervention and treatment.

A letter to the editor is presented in response to an article on postnatal depression which was published in the September 7, 2009 issue.

Background: The Perinatal Integrated Psychosocial Assessment (PIPA) tool screens for anxiety, depression, and psychosocial factors in pregnancy. We aimed to assess the association between PIPA-determined psychosocial risk and obstetric and neonatal outcomes., Methods: Cohort study of all pregnant women who gave birth at ≥20 weeks of gestation in 2017-2019 at a tertiary maternity hospital in, Sydney, Australia. Women completed PIPA at their first antenatal visit and were assigned a PIPA risk category. At-risk women were reviewed and referred for support. The association between PIPA risk category and obstetric and neonatal outcomes was evaluated using multivariable logistic regression adjusting for sociodemographic and pregnancy factors., Results: In all, 5969 women completed PIPA; 71.4% were assessed no/low risk, 17.5% medium risk, and 11.1% medium-high/high risk. Compared with no/low-risk women, medium-high/high-risk women were more likely to remain in hospital for &gt;72 hours (aOR 1.47 [95% CI 1.33-1.64]); to not be breastfeeding at discharge (aOR 1.77 [95% CI 1.20-2.61]); to have their infants experience birth complications (aOR 1.24 [95% CI 1.03-1.50]); and to be admitted to the NICU (aOR 1.63 [95% CI 1.26-2.11]). There was a modest increase in odds of cesarean birth (aOR 1.12 [95% CI 1.00-1.27]), and no association with preterm birth or low birthweight. The risk of adverse outcomes disappeared for medium-high/high-risk women referred for support., Conclusions: The PIPA tool identified one in 10 women at high psychosocial risk with increased risk of adverse obstetric and neonatal outcomes. Adverse outcomes were attenuated for high-risk women who were referred for extra support, suggesting that psychosocial review and referral for high-risk women may reduce the risk of adverse obstetric and neonatal outcomes., (© 2022 Wiley Periodicals LLC.)

Background: There exists little evidence that routine assessment of current or past mental health in the perinatal period positively impacts on rates of referral for emotional health issues. This study aimed to evaluate the impact of this early intervention approach on reported referrals for emotional health issues during pregnancy and the first postpartum year., Method: A subsample of women (N = 1,804) drawn from the Australian Longitudinal Study on Women's Health participated in the study., Results: Multivariate analyses showed that predictors of being given a referral for emotional health issues during pregnancy and the postnatal period, respectively, included assessment of past mental health (Adjusted Odds Ratio [AOR] = 4.40, p < 0.001, and AOR = 5.69, p < 0.001), assessment of current mental health (AOR = 2.47, p < 0.001, and AOR = 2.72, p < 0.001), and reported experience of significant emotional distress (AOR = 2.58, p < 0.001, and AOR = 2.83, p < 0.001). The odds of receiving a referral were up to 16 times greater for women who were asked about both their past and current mental health than for women who did not receive any form of mental health assessment., Conclusions: This study highlights that enquiry into risk factors such as past history (in addition to current mental health) enhances initiation of referrals. Importantly, results suggest that enquiry about current mental health is associated with appropriate rates of referral rather than a nonspecific inflation of referrals. In line with Australia's Clinical Practice Guidelines for Perinatal Mental Health, the value of a comprehensive approach to mental health assessment to aid decision making around referral for further assessment or care is particularly evident., (© 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.)