Open research questions in Maternal Mental Health During Pregnancy and Postpartum

What the literature leaves open

• Future research should consider randomized controlled trials with larger and more diverse samples to further evaluate the effectiveness of guided imagery interventions. In addition, the sample size was relatively small and limited to a specific urban setting, which may affect the generalizability of the findings.

  Effect of guided imagery on anxiety among pregnant working women · 2026 · DOI

• The cross- sectional design precludes causal inference; it remains unclear whether psychopathology and family scapegoating abuse lead to orthostatic hypotension, whether recurrent or- thostatic symptoms worsen mental health, or whether shared upstream factors drive both. The FSA-25, although validated in Zambian students (17), has not been extensively evaluated in postpartum populations, raising the possibility of construct non-equivalence and measurement error in this context. Finally, sparse data within some stress and employment subgroups reduced the stability of interaction estimates, and the single urban setting, restricted age range, and parity strata limit generalisability to other postpartum populations.

  Orthostatic Hypotension and Psychosocial Adversity Among Postpartum Women in Zambia: A Cross-Sectional Analysis. · 2026 · DOI

• Future research should examine whether specific facets of mindfulness (e. By examining maternal mindfulness as a moderator, the study provides a nuanced look at how regulatory capacities interact in shaping early child out- comes—an area that remains underexplored in the develop- mental literature.

  Prenatal Emotion Dysregulation, Respiratory Sinus Arrhythmia, and Mindfulness Predict Toddler Socioemotional Development · 2026 · DOI

• This study aimed to further elucidate the mecha- nisms through which maternal perceptions of discrimination are related to child EBP and extend previous findings to an understudied demographic. While expected, this finding is important given the limited research on discrimination and mental health in Jewish adults and the lack of established research linking antisemitism to psychopathology.

  Perceived Antisemitism and Mental Health in Jewish Mothers and Their Children · 2026 · DOI

• A notable limitation of this study is the omission of protective factors which may moderate the impact of dis- crimination on child psychopathology, such as cultural and religious socialization, a dimension of racial socialization (Hughes & Chen, 1997).

  Perceived Antisemitism and Mental Health in Jewish Mothers and Their Children · 2026 · DOI

• BACKGROUND While hypertensive disorders of pregnancy (HDP) are well-known for physical risks, their psychological impact, particularly regarding anxiety and depression, remains inadequately examined.

  Status and influencing factors of anxiety and depression in pregnant women with hypertensive disorders of pregnancy · 2026 · DOI

• Although this study iden- tified several challenges related to psychotropic medication use during breastfeeding, specific solutions could not be determined, and further investigation is warranted. Consequently, disorder severity and treatment effectiveness could not be assessed.

  Perinatal mental health issues in consultations regarding medication use during breastfeeding: Insights from the Japan Drug Information Institute in Pregnancy (JDIIP) · 2026 · DOI

• Based on the findings and limitations of this study, several important recommendations can be proposed for future research and clinical practice. Firstly, future investigations should incorporate comparative control groups consisting of non-Garbhsanskar participants to strengthen the evidence base and establish clearer causal relationships between Garbhsanskar activities and health outcomes. www.wjpps.com │ Vol 15, Issue 7, 2026. │ ISO 9001:2015 Certified Journal │ 655 Vrundan. World Journal of Pharmacy and Pharmaceutical Sciences Secondly, there is a pressing need to standardize the Garbhsanskar protocol, including clearly defined activities, duration, frequency, and evaluation methods. This would allow for consistent implementation across various settings and enable meaningful comparisons across studies and institutions. Lastly, it is strongly recommended that long-term, longitudinal studies be conducted to assess the cognitive, emotional, and behavioral development of children born to mothers who practiced Garbh Sanskar. Such data would be instrumental in evaluating the sustained impact of these prenatal interventions and their role in shaping a child's future well-being. 9. REFERENCES 1. Charaka Samhita, Sharira Sthana. 2. Sushruta Samhita. 3. Kashyapa Samhita, Garbhopanishad. 4. Patil, P. et al. (2020). Garbh Sanskar: An Ayurvedic Approach to Maternal Wellbeing. Journal of Ayurveda and Integrative Medicine. 5. AYUSHDHARA. (2022). Garbhasanskara: A Miracle to Woman. www.wjpps.com │ Vol 15, Issue 7, 2026.

  EFFECT OF GARBHSANSKAR ACTIVITIES ON MATERNAL AND NEONATAL OUTCOMES: A CROSS-SECTIONAL STUDY · 2026 · DOI

• It is important to note the following limitations of the review presented here. Homogeneity across many of the samples suggests that this review primarily captures the experiences of a particular population (i.e., this literature skewed toward white, higher educated samples). Whether that is represen- tative of others’ experiences with PPD is difficult to say. There were also a wide variety of methodologies, foci, and measures across the literature. For example, some studies focused on psychoeducation (e.g., Dafei et al., 2021; Ngai et al., 2020) with a partner present and others were focused on family support and interpersonal dynamics (e.g., Battle 1 3Contemporary Family Therapy et al., 2023; Giallo et al., 2022). While this variety across studies offers considerable perspective, it is challenging to make broad comparisons. It is apparent, however, that any level of family inclusion is better than nothing.

  Examining the Role of Family Members in Perinatal Interventions Targeting Postpartum Depression: A Decade in Review · 2026 · DOI

• Given the well-established mental- and physical- health disparities for Black, Indigenous, People of Color (BIPOC) mothers, this literature could also benefit from the applica- tion of an intersectional or culturally specific framework (Hoang et al., 2022). According to Hill et al. (2022), for example, Black and AI/AN mothers experience higher rates of maternal mortality compared to non-Hispanic White mothers in the U.S., who can be better understood vis-a-vis the intersection of social and economic factors (e.g., gender, race, socioeconomic status, environment) shaping health outcomes. Further, an inclusive framework (e.g., social determinants of health) would allow for the integration of extended family into care by recognizing family diver- sity and the importance of kinship ties in communities of color (Bernardes, 1999; Gerstel, 2011; Herman & Newland, 2022). By applying an intersectional framework to this liter- ature, researchers can increase diverse family participation and address systemic inequalities that contribute to maternal health disparities. All but one study examined in this review included self-report measures. Battle et al. (2023) used a clinician- rated instrument (i.e., Modified Hamilton Rating Scale for Depression) to assess participants’ symptoms. In this popu- lation, there is an opportunity to utilize other approaches (e.g., observational, archival, physiological) to measure aspects of the perinatal period (Leary, 2016). Relying pri- marily on self-report measures does not fully capture the complexity of interpersonal dynamics in dyadic research. By addressing issues of validity for diverse populations, interdependence of data, and standardization of dyadic measures, future studies can enhance rigor and relevance of dyadic research within the perinatal population. While this literature demonstrated the importance of partner-involvement, future studies can examine levels of family inclusion (Pratt & Sonney, 2020) to provide more nuanced evaluations of how family involvement impacts perinatal health. Examining the role of extended support for mothers (e.g., relatives, friends, peers) could reveal criti- cal information about improving maternal mental health. Additionally, longitudinal studies to determine long-term outcomes of perinatal interventions could provide valu- able insight into the effectiveness of early interventions and whether families are better equipped to navigate future par- enting challenges.

  Examining the Role of Family Members in Perinatal Interventions Targeting Postpartum Depression: A Decade in Review · 2026 · DOI

• Several limitations of this study should be ac- knowledged. First, the cross-sectional, self-reported design and recruitment exclusively through social me- dia platforms limit causal inference and may have in- troduced selection bias, as participation was restricted to women who were active social media users. While the online questionnaire limited opportunities to clar- ify ambiguous responses, it enabled efficient recruit- ment of women from across the country and reduced logistical challenges. Another limitation is the over- representation of women with higher education (83% of the sample), a common pattern in open online re- cruitment that tends to attract individuals with great- er digital literacy, higher health awareness, and active engagement in parenting communities [26]. Conse- quently, mothers with limited internet access or lower health literacy may be underrepresented. Future stud- ies should aim to include more socio-demographically diverse populations to better reflect the educational and digital diversity of mothers aged 35 and older. Re- liance on retrospective self-assessment introduces the potential for recall bias and social desirability effects. Additionally, parity in the sample was relatively low, raising questions about whether social media exerts similar influence on multiparous women. Finally, types of social media content were not differentiated (e.g. professional educational material versus peer narra- tives), limiting the ability to identify which exposures were most influential. Future longitudinal research, combined with content-specific analyses, would pro- vide greater insight into these dynamics. Nursing Problems 1/2026 41 Maja Gdula, Anna Szablewska conclusIons This study demonstrated that both clinical factors and digital experiences contribute to whether wom- en’s expectations of childbirth are fulfilled. Positive or neutral emotional responses to perinatal social media content, physiological birth and higher Apgar scores were associated with greater satisfaction. From an interpretative perspective, while physi- ological birth and favourable neonatal outcomes re- main closely aligned with fulfilled expectations and greater maternal satisfaction, the findings highlight a disconnect between idealized or dramatized por- trayals of birth and clinical realities. The lower fulfil- ment reported by women who recognized social me- dia as shaping their expectations suggests that such content may foster rigid or unrealistic anticipations, potentially undermining satisfaction even in the pres- ence of positive clinical outcomes. Based on the findings, antenatal education pro- grammes should explicitly incorporate structured guidance on social media use, including discussion of idealised online narratives, emotional engagement with digital content, critical appraisal of commercial messages, and promotion of flexible, evidence-based expectations regarding childbirth. Midwives can use antenatal classes to educate women about the in- fluence of social media on childbirth expectations, highlighting that online perinatal content is often idealised and may not reflect the full range of nor- mal experiences. Encouraging mindful engagement with social media, flexible expectations, and an un- derstanding of clinical outcomes can help women interpret their birth experiences more positively. Pro- moting critical evaluation of commercially driven con- tent and prioritising evidence-based information may further support realistic expectations and fulfilment. acknowledgeMents The authors would like to thank the women who participated in this study and generously devoted their time to providing their views and perceptions.

  Association between social media use and women’sperceptions of perinatal experiences · 2026 · DOI

• However, whether routine postpartum blood indices can serve as early predictors of PPD has not been systematically evaluated in South Indian obstetric populations.

  Exploring Hematologic Predictors of Postpartum Depression in Postnatal Mothers - A Retrospective Observational Study · 2026 · DOI

• Objective This study examined the psychometric properties of the Perceived Stress Scale (PSS-10) using Explanatory Item Response Models (EIRMs) to better understand the factors influencing self-reported stress in an understudied population: Black pregnant and postpartum women in the U.

  Examining the Psychometric Properties of the Perceived Stress Scale in Black Women During the Perinatal Period Using Explanatory Rasch Models · 2026 · DOI

• Clinical screening of PND remains challenging due to obstacles in early detection, symptom overlap with normal perinatal experiences, lack of standardized screening protocols, and considerable interpatient variability.

  Advances in Perinatal Depression: A Focus on Screening and Treatment · 2026 · DOI

• The most common purpose across the research was to examine the onset patterns of OCD during pregnancy and in the postpartum months Conclusion: The major takeaway from this analysis is that there are still large gaps in research on OCD in pregnant and postpartum women.

  The Mysteries of Postpartum OCD: A Systematic Review · 2026

• 682 683 684 685 686 687 688 689 690 691 692 693 694 695 696 697 698 699 700 701 702 703 704 705 This study has several important limitations. First, the cross-sectional design limits the ability to infer causal relationships between maternal depression and child behavioral outcomes. Second, the use of purposive selection of tea estates and supervisor-provided sampling frames may have introduced selection bias, potentially affecting the representativeness of the sample. The purposive selection of tea gardens required management cooperation, which introduces gatekeeper influence at the site selection level, gardens with more progressive or cooperative management may differ systematically from those not included, limiting generalisability to the broader tea garden population in Bangladesh. Similarly, the sampling frames were prepared with input from garden supervisors, who may have introduced systematic bias in the lists of eligible mothers, despite cross-checking against village council records. These limitations should be considered when interpreting the findings. Third, both maternal depression and child behavioral difficulties (SDQ parent version) relied on self-reported data, raising concerns about reporting bias. In particular, common method bias is a significant concern, as mothers experiencing psychological distress may be more likely to perceive and report their children’s behaviors negatively. This is especially relevant given the high proportion (87.8%) of abnormal scores observed in the parent-reported SDQ. Additionally, the generalizability of the findings is limited to the four tea gardens included in the study and may not extend to other tea garden populations or similar settings. The cultural validity and contextual appropriateness of the measurement scales used, including the SDQ, remain uncertain in this specific population, which may have influenced the accuracy of the findings. Finally, the qualitative component has limitations in representativeness. All FGD participants were permanent leaf pickers, and thus the perspectives of temporary workers, factory workers, and other occupational groups represented in the quantitative sample were not captured. This imbalance limits the breadth of insights from the qualitative data.

  Between Leaves and Lives: Maternal Mental Health Among Tea Garden Workers in Bangladesh and Its Association with Children’s Behavioural Difficulties · 2026 · DOI

• There are limitations in our study. We were unable to examine the effect of miscarriage, abortion, child death, and gender-based violence on females’ mental health in the current study. Past literature for instance, has sug- gested a link between gender-based violence (including emotional and physical abuse) during pregnancy and the incidence of psychiatric disorders [4, 49]. Relatively prevalent among socially and economically disadvan- taged women, factors such as bias against female ba- bies, role restrictions, as well as multi-generational households in which the daughter-in-law has little au- tonomy have been identified as possible risk factors for gender-based violence [4]; these factors however were not explored in this study. We were also unable to de- tect the cases of subclinical levels of depression, and panic disorder as the study did not establish these diag- noses. Estimation of age at first pregnancy was an ap- proximate made from subtracting the age of the first biological child from the respondent’s age and further deducting 1 year (as opposed to 9–10 months to ac- count for pregnancy). Given that not all pregnancies this may have resulted in an over- last 9 months, estimation of the prevalence of mental disorders during the postnatal period. Furthermore, as the CIDI does not contain a specific question targeted at female re- spondents with regards to reproductive events, we were not able to gauge a more precise pregnancy age. Add- itionally, we were not able to differentiate the effect of ageing and child birth on respondents’ mental health factors that can status, all of which are important impact women’s mental health [50]. The retrospective design of the current study also limits inference of causality. The low prevalence in the current sample warrants careful interpretation of results given the in- sufficient statistical power. Future studies can look into utilizing a prospective study design to better understand the impact of pregnancy on women’s mental health.

  Mental health, coping strategies and help-seeking behaviours among women petty traders in Nsukka, Enugu State, Nigeria: a cross-sectional survey · 2026 · DOI

• Several limitations should be noted. Our sample, drawn from a single southeastern U.S. metropolitan area, was predominantly middle-class and non-Hispanic White, which may limit generalizability to other contexts. Examining dyadic symptom processes in families with greater racial, ethnic, socioeconomic, and cultural variability would allow assessment of whether timing-specific spillover effects reflect universal features of the perinatal transition or are shaped by contextual stress exposure and available supports. In addition, we did not examine contextual moderators such as social support, relationship quality, or caregiving burden, which may condition the strength or direction of within-dyad spillover effects.

  Bidirectional associations between maternal and paternal depressive symptoms across the postpartum period: Contributions of maternal prenatal depression and childhood neglect · 2026 · DOI

• Some strengths and limitations have to be considered. First, while the definition of stress was narrow, it was based on eight different questions about adverse life events, which might potentially be an indicator of stress in the family. We were also able to distinguish between the timing of the expo- sure in the three different trimesters of pregnancy and we were able to include equal proportions of girls and boys in our study. Some limitations include a potential misclassifi- cation of the exposure, as we were not able to detect stress in the working environment or informal care work, among others. There are several factors that might have contributed to perceived stress that we were not able to capture. By ask- ing about adverse life events, we hypothesised that we might have been able to measure a high severity of stress. There is also a potential for recall bias when assessing the exposure, as this was reported in a questionnaire when the children were 4 years old. Additionally, there might be some tempo- ral misclassification in which trimester an adverse life event was experienced. We assume that the misclassification of the exposure might be non-differential, and as we included different categorisations in the analysis, the most important measure is whether or not an ALE was experienced or not. We believe that this might affect the results minimally. Fur- ther, we were not able to control the analysis for any stress that the family might have experienced after birth, which might have affected the neurodevelopment of the child. Also, resilience was not measured in our study and while we did not consider it a confounding factor, it might have contributed to child neurodevelopment by mediating the association and potentially attenuating the results. Other factors that could have potentially affected our results are postnatal stress and maternal, as well as paternal, mental health. These factors could affect the results, and potentially lead to some residual confounding. Lastly, the sample size of some subgroup analy- ses was small, which limited statistical power. As a result, the analyses were likely underpowered and results are not fully reliable and should be replicated in a larger sample.

  Prenatal adverse life events and their association with neurodevelopmental outcomes in 7-year-old children · 2026 · DOI

• Strengths and limitations of this study Strengths include: • This is among the first studies to evaluate a stepped care intervention for perinatal mental health that has been inte- grated into routine public maternal child health services in a low-resource setting • This is among the first studies to evaluate telepsychiatry as part of an integrated care model in a low-resource setting.

  Integration of stepped care for perinatal mood and anxiety disorders among women attending maternal and child health clinics in Kenya: Protocol for a cluster randomized controlled trial · 2026 · DOI

• Frontiers in Global Women’s Health 08 frontiersin.org Belay et al. 10.3389/fgwh.2026.1721113 assessment, and the provision of adequate, timely, and familycentred follow-up care and support in community settings to prevent and mitigate the impact of maternal mental health issues on child outcomes. Importantly, effective identification and responses to maternal mental health issues in the perinatal period must go beyond treating the individual mother alone. Screening before, during, and after pregnancy, combined with a whole family approach that addresses both parental mental health issues and improves mother-child interaction, is essential (56–58). However, some women may be reluctant to disclose their parenting or family circumstances due to stigma or fear of child protection involvement (59). Therefore, effective support requires a sensitive, respectful, and holistic approach that the complexities of parental mental health acknowledges conditions and priorities the needs of both mothers, children, and their families (60). to specialist inpatient care and Where hospitalisation is considered necessary, it is important that mothers have access to holistic, multidisciplinary care through specialist mother-baby units, where co-admission of children is supported (61). This ensures that mothers have access treatment, whilst remaining with and being supported to continue providing care for their child. Mother-baby units deliver comprehensive, wholefamily-centred care aimed at strengthening mother-infant relationships and supporting parenting capacity. Within the unit, ongoing physical, developmental, and socio-emotional identification of assessments of developmental timely enabling interventions (62). However, access to such services remains limited, particularly due to the scarcity of publicly funded inpatient mother-baby units (61). facilitate early problems, the and related infant follow-up procedures, and While this systematic review has integrated the latest evidence on the association between maternal postnatal MHrH and child development and educational outcomes, it is crucial to consider certain limitations. In this review, all included studies were evaluated using the JBI quality assessment tool and found to be of high quality, with scores ranging from 55% to 80%.

  Association between postnatal mental health-related hospitalisation and child development and education outcomes: a systematic review and meta-analysis · 2026 · DOI

• This is the first study to compare clinical identification of psychosocial problems in antenatal care in Ethiopia with detection using several locally validated measures in a large, representative sample. Limitations include the potential for under-disclosure of IPV and mental health symptoms due to stigma as well as under-detection of anxiety and trauma symptoms due to use of scales not extensively validated in this setting .We also lacked data on the ethnicity of the women. It is possible that ANC providers detect psychosocial problems but do not routinely document them in clinical records, highlighting the need for interventions to improve the quality of data recording alongside clinician training and referral pathways for treatment and support.

  Identification of psychosocial problems in routine antenatal care in Ethiopia: a facility-based cross-sectional study · 2026 · DOI

• This study enrolled a heterogeneous group of women with a history of PP, including some who had pre-existing diagnoses of psychiatric conditions prior to the PP episode, such as depression or bipolar disorder. Thus, the possibility that the findings of this study are linked to these psychiatric diagnoses, rather than their histories of PP specifically, cannot be excluded. However, the changes in midbrain NM-MRI signal and functional connectivity detected in the PP group in this study correlated specifically with subclinical psychotic symptoms, not with mania, levels of depression or anxiety, suggesting that this marker may be selectively linked to psychosis or psychosis risk. It is also important to note that causal relationships between the MRI findings and subclinical psychotic symptoms in the PP group cannot be inferred in this cross-sectional study; follow-up longitudinal studies can investigate the sequence of changes by measuring midbrain NM-MRI signal, midbrain functional con- nectivity and subclinical psychotic symptoms in women who are at risk for postpartum illness, before and during pregnancy, and postpartum, and follow them over time. Such a study and related investigations could then directly test the clinical utility of these candidate objective markers of psychosis vulnerability.

  Postpartum psychosis is associated with elevated neuromelanin-MRI signal in the midbrain · 2026 · DOI

• opportunities. The participants of the HC group were recruited via online advertisement posted on the Massachusetts General Hospital Rally Website, printed flyers posted in public spaces and MGH facilities, and virtual copies of the flyer posted in Facebook groups.

  Postpartum psychosis is associated with elevated neuromelanin-MRI signal in the midbrain · 2026 · DOI

• Despite the prevalence of this comorbidity, the combined effects of maternal depressive symptoms and ADHD on child development remain underexplored, particularly in early childhood, a critical period marked by heightened brain plasticity and reliance on external regulation.

  The Interplay between Maternal Depression and ADHD Symptoms in Predicting Emotional and Attentional Functioning in Toddlerhood · 2025 · DOI

Most-cited papers in Maternal Mental Health During Pregnancy and Postpartum

• Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis · The British Journal of Psychiatry · 2017 · 1,269 citations
• Psychiatric Disorders in Pregnant and Postpartum Women in the United States · Archives of General Psychiatry · 2008 · 817 citations
• Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic · Journal of Affective Disorders · 2020 · 795 citations
• Postpartum Depression Help‐Seeking Barriers and Maternal Treatment Preferences: A Qualitative Systematic Review · Birth · 2006 · 669 citations
• Depressive Symptoms among Pregnant Women Screened in Obstetrics Settings · Journal of Women s Health · 2003 · 561 citations
• Impact of Maternal Depression on Infant Nutritional Status and Illness · Archives of General Psychiatry · 2004 · 548 citations
• Fetal Origins of Mental Health: The Developmental Origins of Health and Disease Hypothesis · American Journal of Psychiatry · 2016 · 537 citations
• Individual and Combined Effects of Postpartum Depression in Mothers and Fathers on Parenting Behavior · PEDIATRICS · 2006 · 494 citations
• Depression, anxiety, and resting frontal EEG asymmetry: A meta-analytic review. · Journal of Abnormal Psychology · 2006 · 489 citations
• Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice · Journal of Epidemiology & Community Health · 2006 · 477 citations

Most recent work

• Prepregnancy Care and Counseling · JAMA · 2026
• Identification, Prevention, and Treatment of Perinatal Depression in Low- and Middle-Income Countries: A Narrative Review · Biological Psychiatry · 2026
• Maternal mental health resources · British Journal of Midwifery · 2026
• Complexities in perinatal mental health care: a salutogenic approach · British Journal of Midwifery · 2026
• Comment on “Comparative Safety of Antipsychotic Medications and Mood Stabilizers During Pregnancy: A Systematic Review and Network Meta-analysis of Congenital Malformations and Prenatal Outcomes” · CNS Drugs · 2026
• Testing the Energetics of Gestation and Growth Hypothesis for Human Secondary Altriciality · Evolutionary Anthropology Issues News and Reviews · 2026
• Prophylactic esketamine to reduce postpartum depression in primiparae · European Journal of Anaesthesiology · 2026
• Pregnancy, Birth, Neonatal, and Mental Health Outcomes Are Minimally Associated with Pregnancy Ambivalence · Studies in Family Planning · 2026
• Reciprocal Adaptation in Postpartum Fathers · Advances in Nursing Science · 2026
• A Gap Analysis in Therapeutic Services for Birthing Individuals with Perinatal Mental Health Disorders · Social Work in Public Health · 2026

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