Perinatal Mental Health Care for Women With Severe Mental Illness During the COVID-19 Pandemic in India—Challenges and Potential Solutions Based on Two Case Reports

Nagendrappa, Sachin; Vinod, Pratibha; Pai, Naveen Manohar; Ganjekar, Sundarnag; Desai, Geetha; Kishore, M. Thomas; Thippeswamy, Harish; Vaiphei, Kimneihat; Chandra, Prabha S.

doi:10.3389/fgwh.2021.648429

Front. Glob. Womens Health

2021

DOI: 10.3389/fgwh.2021.648429

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Perinatal Mental Health Care for Women With Severe Mental Illness During the COVID-19 Pandemic in India—Challenges and Potential Solutions Based on Two Case Reports

Sachin Nagendrappa

Pratibha Vinod

Naveen Manohar Pai

et al.

Abstract: The ongoing COVID-19 pandemic in India has created several challenges in the care of women with perinatal mental illness. Access to healthcare has been disrupted by lockdowns, travel restrictions, and the unavailability of outpatient services. This report aims to discuss the challenges faced by women with severe mental illnesses during the perinatal period with the help of two case reports. Accordingly, we have highlighted the role of COVID-19 infection as a traumatic event during childbirth and its role in tr… Show more

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Cited by 4 publications

References 37 publications

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COVID-19 Public Health Restrictions and New Mothers’ Mental Health: A Qualitative Scoping Review

Abdul-Fatah,

Bezanson,

Lopez Steven

et al. 2024

Qual Health Res

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Public health restrictions to protect physical health during the COVID-19 pandemic had unintended effects on mental health, which may have disproportionately affected some potentially vulnerable groups. This scoping review of qualitative research provides a narrative synthesis of new mothers’ perspectives on their mental health during COVID-19 pandemic restrictions through pregnancy to the postpartum period. Database searches in PubMed, CINAHL, and PsycINFO sought primary research studies published until February 2023, which focused on new mothers’ self-perceived mental health during the pandemic ( N = 55). Our synthesis found that new mothers’ mental health was impacted by general public health restrictions resulting in isolation from family and friends, a lack of community support, and impacts on the immediate family. However, public health restrictions specific to maternal and infant healthcare were most often found to negatively impact maternal mental health, namely, hospital policies prohibiting the presence of birthing partners and in-person care for their infants. This review of qualitative research adds depth to previous reviews that have solely examined the quantitative associations between COVID-19 public health restrictions and new mothers’ mental health. Here, our review demonstrates the array of adverse impacts of COVID-19 public health restrictions on new mothers’ mental health throughout pregnancy into the postpartum period, as reported by new mothers. These findings may be beneficial for policy makers in future public health emergency planning when evaluating the impacts and unintended consequences of public health restrictions on new mothers.

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COVID-19 Public Health Restrictions and New Mothers’ Mental Health: A Qualitative Scoping Review

Abdul-Fatah,

Bezanson,

Lopez Steven

et al. 2024

Qual Health Res

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Women’s awareness of perinatal mental health conditions and the acceptability of being asked about mental health in two regions in India: a qualitative study

Fellmeth,

Kanwar,

Sharma

et al. 2023

BMC Psychiatry

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Background Mental health conditions are common during pregnancy and the first year after childbirth. Early detection allows timely support and treatment to be offered, but identifying perinatal mental health conditions may be challenging due to stigma and under-recognition of symptoms. Asking about symptoms of mental health conditions during routine antenatal and postnatal appointments can help to identify women at risk. This study explores women’s awareness of perinatal mental health conditions, their views on the acceptability of being asked about mental health and any preference for specific assessment tools in two regions in India. Methods Focus group discussions (FGDs) were conducted with pregnant, post-partum and non-perinatal women in Kangra, Himachal Pradesh (northern India) and Bengaluru, Karnataka (southern India). Settings included a hospital antenatal clinic and obstetric ward, Anganwadi Centres and Primary Health Centres. FGDs were facilitated, audio-recorded and transcribed. Narratives were coded for emerging themes and analysed using thematic analysis. Results Seven FGDs including 36 participants were conducted. Emerging themes were: manifestations of and contributors to mental health conditions; challenges in talking about mental health; and the acceptability of being asked about mental health. Difficult familial relationships, prioritising the needs of others and pressure to have a male infant were cited as key stressors. Being asked about mental health was generally reported to be acceptable, though some women felt uncomfortable with questions about suicidality. No preference for any specific assessment tool was reported. Conclusions Women face many stressors during the perinatal period including difficult familial relationships and societal pressure to bear a male infant. Being asked about mental health was generally considered to be acceptable, but questions relating to suicidality may be challenging in a community setting, requiring sensitivity by the interviewer. Future studies should assess the acceptability of mental health assessments in ‘real world’ antenatal and postnatal clinics and explore ways of overcoming the associated challenges in resource-constrained settings.

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Impact of COVID-19 pandemic on maternal and neonatal outcomes: A narrative review and evidence from the PregCovid registry

Zala

Munshi

Mahajan

et al. 2023

JRHM

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More than 533 million Coronavirus Disease 2019 (COVID-19) cases and associated 6 million fatalities were reported globally whereas 43 million cases and 0.5 million deaths in India were reported till June 2022. Maharashtra state alone reported about one-third of the total cases of COVID-19 in India in the early period of COVID-19 pandemic. The lack of epidemiological, demographic, and impact data of COVID-19 on pregnant women and newborns, advocated the need for recording and documenting population specific data for clinical management and policy decisions in India. The PregCovid registry was launched in April 2020 by the Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health, Mumbai, in collaboration with the Medical Education and Drugs Department, Government of Maharashtra, and Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital to gain insights into clinical and socio-epidemiological characteristics of pregnant women with lab confirmed COVID-19 and assess its impact on maternal and neonatal outcomes. The registry has collected data of 8428 pregnant and postpartum women with COVID-19 from 19 participating centers across Maharashtra in a near real-time manner. The registry first reported that the delta variant (B.1.617.2) dominant second wave was more lethal (case fatality rate 5.7%) to pregnant and postpartum women than the alpha (0.7%) dominant wave of COVID-19 in India. There was also a higher incidence of moderate to severe cases, intensive care admissions and maternal complications including pre-eclampsia, low birth weight and preterm deliveries during the delta wave. The omicron dominant third wave of the COVID-19 pandemic exhibited a higher transmission rate compared to the previous two waves, causing a surge in cases but minimally impacting adverse outcomes. The registry further analyzed and reported the impact of COVID-19 on pregnant and postpartum women with comorbidities, coinfections, twin pregnancies, and neonatal outcomes, while providing crucial policy inputs to improve maternal and newborn health during the pandemic. The registry model can be replicated at tertiary care hospitals across India to understand various maternal-neonatal outcomes. The evidence generated from PregCovid registry was useful for improved clinical management and also contributed to a policy decision on COVID-19 vaccination in pregnant women in India. The registry envisions a collaboration with similar regional, national and international registries to form an international consortium for data sharing and reporting to promote global policy level interventions and advocates a sustainable and collective response to improve the COVID-19 global vaccination coverage.

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Perinatal Mental Health Care for Women With Severe Mental Illness During the COVID-19 Pandemic in India—Challenges and Potential Solutions Based on Two Case Reports

Cited by 4 publications

References 37 publications

COVID-19 Public Health Restrictions and New Mothers’ Mental Health: A Qualitative Scoping Review

COVID-19 Public Health Restrictions and New Mothers’ Mental Health: A Qualitative Scoping Review

Women’s awareness of perinatal mental health conditions and the acceptability of being asked about mental health in two regions in India: a qualitative study

Impact of COVID-19 pandemic on maternal and neonatal outcomes: A narrative review and evidence from the PregCovid registry

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