Peer Response

 Giovanna,

According to Wang et al. (2023), maternal mortality is unusually high in the United States compared to other wealthy nations and it is characterized by major disparities in race/ethnicity, geography, and socioeconomic factors. The United States has seen a shift in the underlying causes of pregnancy-related death, with a relative increase in mortality resulting from diseases of the cardiovascular system and preexisting medical conditions.

Prenatal Care: Screening for Hypertension 

According to Agrawal and Wenger (2020), hypertensive disorders of pregnancy affect about 5-10% of pregnancies impacting fetal, neonatal, and maternal outcomes including gestational hypertension, pre-eclampsia, and eclampsia. For example, the USPSTF (2023) recommended screening for hypertensive disorders in pregnant persons with blood pressure measurements throughout pregnancy.

Zhang et al. (2020) explained that black persons experience higher rates of maternal and infant morbidity and perinatal mortality than other racial and ethnic groups and are at greater risk for developing hypertensive disorders of pregnancy than other pregnant persons. The USPSTF (2023) recommended the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in persons at high risk for preeclampsia. However, antihypertensive drugs can have adverse effects on fetuses because they can cross the placental barrier and impact fetal metabolism. Mulrenin et al. (2021) reported that exposure to antihypertensive drugs during pregnancy can increase the risk of adverse outcomes in children, such as low birth weight, preterm birth and congenital malformations. Thus, while treating pregnant women with hypertension, the effectiveness of the antihypertensive agent must be balanced with risks to the fetus.

Additionally, blood pressure measurements should be obtained during each prenatal care visit throughout pregnancy; therefore, if a patient has an elevated blood pressure reading, the reading should be confirmed with repeated measurements (USPSTF, 2023). Munyungula and Shakwane (2021) recommended restricted activity or bed rest and monitor frequently pregnant women’s blood pressure and blood and urine tests, if preeclampsia is diagnosed. Providers also will monitor babies’ condition through regular ultrasounds and fetal heart rate monitoring.

Screening for Post- Partum Depression

According to Premji et al. (2019), post- partum depression (PPD) affects 10–15% of women and it can be debilitating and costly. The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions (USPSTF, 2019).

Agrawal et al. (2022) displayed that assessment of clinical risk factors that may be associated with the development of perinatal depression include a personal or family history of depression, history of physical or sexual abuse, having an unplanned or unwanted pregnancy, current stressful life events, pregestational or gestational diabetes, and complications during pregnancy such as preterm delivery or pregnancy loss. Additionally, social factors such as low socioeconomic status, lack of social or financial support, and adolescent parenthood have also been shown to increase the risk of developing perinatal depression (USPSTF, 2019).

Motrico et al. (2023) showed that counseling interventions to prevent perinatal depression mainly included cognitive behavioral therapy which focuses on the concept that positive changes in mood and behavior can be achieved by addressing and managing negative thoughts, beliefs, and attitudes and by increasing positive events and activities. Common therapeutic techniques include patient education, goal setting, interventions to identify and modify maladaptive thought patterns, and behavioral activation (USPSTF, 2019).

In conclusion, access to prenatal care and education can dramatically improve birth and health outcomes for moms and their babies. New approaches of prenatal care delivery can improve its efficacy, equity, and experience through tailoring prenatal care to meet pregnant people's medical and social needs.

References

Agrawal, I., Mehendale, A.M., & Malhotra, R. (2022). Risk Factors of Postpartum Depression. Cureus, 14(10), e30898. https://doi.org/10.7759/cureus.30898.

Agrawal, A., & Wenger, N.K. (2020). Hypertension During Pregnancy. Current Hypertension Reports, 22(9), 64. https://doi.org/10.1007/s11906-020-01070-0. 

Motrico, E., Bina, R., Kassianos, A.P., Le, H.N., Mateus, V., Oztekin, D., Rodriguez-Muñoz, M.F., Moreno-Peral, P., & Conejo-Cerón, S. (2023). Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis. General Hospital Psychiatry, 82, 47-61. https://doi.org/10.1016/j.genhosppsych.2023.03.007.

Mulrenin, I.R., Garcia, J.E., Fashe, M.M., Loop, M.S., Daubert, M.A., Urrutia, R.P., & Lee, C.R. (2021). The Impact of Pregnancy on Antihypertensive Drug Metabolism and Pharmacokinetics: Current Status and Future Directions. Expert Opinion on Drug Metabolism & Toxicology, 17(11), 1261-1279. https://doi.org/10.1080/17425255.2021.2002845. 

Munyungula, J., & Shakwane, S. (2021). Self-monitoring of blood pressure for preeclampsia patients: Knowledge and attitudes. Curationis, 44(1), e1-e8. https://doi.org/10.4102/curationis.v44i1.2195. 

Premji, S., McDonald, S.W., Metcalfe, A., Faris, P., Quan, H., Tough, S., & McNeil, D.A. (2019). Examining postpartum depression screening effectiveness in well child clinics in Alberta, Canada: A study using the All Our Families cohort and administrative data. Preventive Medicine Reports, 14, 100888. https://doi.org/10.1016/j.pmedr.2019.100888.