While joyful for many women, pregnancy can also be a time of increased vulnerability to emotional distress, anxiety, and mood disorders. Roughly 23 percent of pregnant women have self-reported anxiety symptoms and 15 percent have a clinically diagnosable anxiety disorder (Dennis et al., 2017).
However, half of pregnant women who experience anxiety are never diagnosed (Task Force to Study Maternal Mental Health, 2016). This gap in reported symptoms and clinical diagnosis presents a significant shortcoming in research and clinical knowledge about anxiety and how it affects pregnancy outcomes.
Increased risk factors for childbirth associated with anxiety include preterm birth, substance abuse, disruption of fetal neurological development, and other adverse effects on the mother and child. Early detection can lead to appropriate care and better outcomes, but study findings and insights from patient-centered outcomes research (PCOR) are not yet ingrained in practice measures. These measures are also not tailored to prenatal anxiety detection or increasing patient awareness of the value proposition of early detection and possible treatment options; however, mobile technology can be used as a platform to educate women. The American College of Obstetricians and Gynecologists (ACOG) believes that these gaps in research and practice must be urgently addressed.
The organization’s goal is to create an integrated Perinatal Anxiety Tool Kit (iPAT) that will provide stakeholders with patient-centered resources that are useful for early detection, assessment of treatment options, and shared decision making for prenatal anxiety. The project team will identify PCORI projects focused on labor and delivery (Gregory et al., 2014) and the postnatal period (Tully et al., 2017) that address behavioral and mental health issues during pregnancy, along with PCOR and comparative effectiveness research (CER) that informs detection and effective anxiety-reduction interventions (Hoffman et al., 2010; Hoge et al., 2018; Nierenberg et al., 2016). Patients and providers regularly use digital tools to access health information, and the team will leverage existing research, patient partnerships, and ACOG’s membership base to build iPAT, a digital toolkit available on the ACOG website and suitable for incorporation into mobile apps.
Focus groups will be conducted to explore women’s attitudes toward and suggestions for patient-facing iPAT content and physician–patient interactions. Likewise, physician-centered focus groups will be conducted to explore provider perspectives on prenatal anxiety screening, treatment, and shared decision making. An advisory board comprised of patients and advocates, obstetric mental health subject matter experts, providers, and maternity-focused app developers will evaluate data collected from the patient and physician focus groups to determine needs and strategize iPAT resources. The advisory board will meet to inform the project process and assimilate PCOR/CER, patient-reported outcome measures, and focus group input into the iPAT. ACOG will host one webinar to promote relevant digital distribution channels through which to disseminate the iPAT and enhance understanding of prenatal anxiety. ACOG will make the iPAT and the webinar recording available on its website.
ACOG believes that providing resources and connecting patients and providers around prenatal anxiety will build support for patient engagement and shared decision making.
The novel coronavirus poses unique challenges for pregnant women. The impact of COVID-19-related health issues on pregnant women may be exacerbated for communities of color that are suffering from inequitable access to treatment and potential increased susceptibility to the virus.
The enhancement to this project will add toolkit subcomponents to the Integrated Perinatal Anxiety Toolkit (iPAT) to address health disparities in the care of perinatal anxiety for communities of color and telemedicine for assessing and treating perinatal anxiety. It will use the current project infrastructure to build capacity to conduct engagement in patient-centered outcomes research.