Importance: Maternal depression and anxiety may not only increase vulnerability for the development of postpartum depression and anxiety but may increase the perception of obstetric pain.Objective: This review focuses on the relationship among depression, anxiety, and pain during pregnancy and postpartum. We will first review common clinical screening tools for depression, anxiety, and pain. Then, the existing evidence describing the relationship of depression, anxiety, and pain will be covered.Evidence Acquisition: Queries for publications in PubMed, Google Scholar, and the CINAHL (Cumulative Index to Nursing and Allied Health Literature) were completed. Both searches were limited to publications within the last 20 years. Literatures on subtopics obtained from the references of publications identified in the initial search were not limited by publication year.Results: A total of 19 total publications were identified regarding postpartum depression and pain; 17 were identified in the initial search, and 2 related to postpartum depression, anxiety, and pain were found by reviewing references. Eleven studies were identified regarding postpartum anxiety and pain; 4 were found in the original search, and 7 were identified by reviewing the references.Conclusions and Relevance: The relationship between postpartum depression and pain is well characterized in the literature. However, the relationship between postpartum anxiety and pain is less well defined, and further research is needed. The interaction between maternal mental health and pain emphasizes the importance of screening for these conditions and also counseling and educating patients about expectations regarding intrapartum and postpartum pain.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After participating in this activity, the reader should be better able to identify the high prevalence of anxiety and depression in the pregnant and postpartum population; describe the strengths and limitations of the existing tools to screen for depression, anxiety, and pain during pregnancy and the postpartum period; explain the existing literature describing the relationship between depression and pain during pregnancy and the postpartum period, and recommend interventions to reduce the amplifying effect of these 2 exposures; and summarize the limited existing literature describing the relationship between anxiety and pain during pregnancy and the postpartum period, with a goal of designing future interventions to reduce the effect of these 2 exposures.

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Objective-To assess the average duration of detailed fetal anatomic surveys in pregnancy in relation to gestational age (GA) and the maternal body mass index (BMI) to determine optimal timing of the examination.Methods-This was a retrospective cohort study of gravidae presenting for detailed fetal anatomic examinations between January 1, 2010, and June 30, 2017. After excluding examinations expected to have longer duration (ie, multifetal, major fetal anomalies), there were a total of 6522 examinations performed between GAs of 18 weeks 0 days and 22 weeks 0 days. Women were grouped by BMI, and results were analyzed by logistic regression.Results-Gravidae of normal weight (BMI, 18.5-24.9 kg/m 2 ) had a decrease of 47.47 seconds of the examination time with each increasing week of gestation (P = .036). Overweight (BMI, 25-29.9 kg/m 2 ) gravidae similarly had a decrease of 66.31 seconds of the examination time with each additional week of gestation (P = .017). Underweight (BMI, 8.5 kg/m 2 ) and obese (BMI, ≥30 kg/m 2 ) gravidae did not have differences in the examination time with increasing GA. Increases in suboptimal examinations were noted with an increasing BMI (P < .001). There was a decreased frequency of suboptimal examinations in obese gravidae with a BMI of 40 kg/m 2 or higher with increasing GA (P = .037).Conclusions-The duration of detailed fetal anatomic examinations decreased with increasing GA in normal-weight and overweight gravidae but not in obese gravidae. Performing the anatomy scan earlier in class I and II obese gravidae (BMI, 30-40 kg/m 2 ) may enable improved pregnancy management options without increasing the examination duration or likelihood of a suboptimal evaluation.

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