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Psychological intervention for prenatal anxiety in women of color

The disproportionate negative impact of sociopolitical stressors on Black women and Latinas in the United States exacerbates prenatal anxiety in these 2 groups, according to a review and recommendations published in the journal Frontiers in Psychiatry.

“In this context of high unmet need, we argue that increased attention to family involvement, pregnancy-specific anxiety, and prevention efforts during preconception are likely to improve engagement and clinical outcomes among ethnic and racial minority pregnant women,” wrote the authors.1

The authors advocate the inclusion of family members as part of perinatal anxiety interventions to increase the woman’s comfort and involvement with treatment.

Despite pregnant women having significant interest in receiving family support during their prenatal health care, no intervention from the systematic review or in past reviews mention partner or extended family participation.

However, there is emerging evidence among samples of mostly White women that brief psychological interventions for pregnant women at risk for anxiety that incorporate partners or family can successfully decrease symptoms in both women and their family members.

Family engagement may be of greater benefit in pregnant Latinas and Black women, who consider close family relationships like familism a key cultural source of resilience during pregnancy.

Interventions that include partners or family members, however, should consider history of family violence and prioritize safety, and ensure that women feel comfortable including their family in those interventions.

Intervention protocols for prenatal anxiety often omit content about labor and delivery, or about common prenatal medical conditions in pregnancy, such as gestational diabetes and preeclampsia.

Unfortunately, fear of childbirth and pregnancy-specific anxiety have largely been treated separately from other anxiety symptoms or disorders; instead, they are often addressed solely via standard prenatal health education.

“Integrating prenatal health education and psychotherapy may increase intervention relevance and improve birth and child outcomes, improving care for pregnant women with anxiety,” wrote the authors.

The authors cited MUMentum, an internet-delivered cognitive behavioral therapy therapy for perinatal depression and anxiety, as a good example of integrating psychotherapy and prenatal education. The therapy’s prenatal education resources include attachment during pregnancy and intrusive thoughts about childbirth.

Australian women randomized to the MUMentum intervention achieved medium to large reductions in anxiety, according to a study published in the Journal of Affective Disorders in 2019.2

A worthy next step is to assess how MUMentum and other interventions might impact pregnancy-specific anxiety, becausepregnancy-specific anxiety has been associated to length of gestation, low-birthweight, and adverse physical and mental health outcomes for offspring.

Psychological intervention studies that target specific and prevalent pregnancy-related concerns could particularly benefit ethnic and racial minority women, who are less likely to report high pregnancy-specific anxiety and face adverse birth outcomes.

Meanwhile, the preconception period has garnered attention for psychological interventions to improve the overall health of women during pregnancy. Symptoms of preconception anxiety have been linked to postpartum anxiety and later mother-infant bonding challenges.

Hence, providing health promotion information and screening for anxiety symptoms during preventive visits may be valuable, especially among women of reproductive age seeking to be pregnant, according to the authors.

References

1. Ponting C, Urizar Jr GG, Schetter CD. Psychological interventions for prenatal anxiety in Latinas and Black women: a scoping review and recommendations. Front Psychiatry. Published online March 15, 2022. doi:org/10.3389/fpsyt.2022.820343

2. Loughnan SA, Sie A, Hobbs MJ, et al. A randomized controlled trial of ‘MUMentum Pregnancy': internet-delivered cognitive behavioral therapy program for antenatal anxiety and depression. J Affect Disord. 2019; 243:381–90. doi:10.1016/j.jad.2018.09.057