Effects of Maternal Mental Health on Both Mother and Child

Maternal mental health is a critical aspect of pregnancy and birth that can often be overlooked. While the birth of a child is a momentous occasion, it can also be a challenging time for many mothers. In fact, the World Health Organization estimates that approximately 10% of pregnant women and 13% of women post-birth experience a mental disorder. These disorders can have a significant impact on a mother's well-being, as well as the development and health of her child8.

There are two significant periods where maternity is categorized: prenatal and postnatal. Prenatal period refers to the period before birth (during pregnancy), whereas postnatal refers to the period post birth (after pregnancy). Lastly, perinatal refers to the short period of time, usually weeks, before and after birth. It is important to distinguish these periods pre and post birth because they generate disparate effects for the mother—and for the child, as well6.

The article “Prenatal mental health and the effects of stress on the fetus and the child. Should psychiatrists look beyond mental disorders?” by Vivette Glover discusses the impact of prenatal stress on the neurodevelopment of the child and the potential role of mental health professionals in addressing this issue. Glover highlights various types of prenatal stress, including the mother's exposure to natural or man-made disasters, emotional cruelty, and domestic abuse by her partner, among others2.

Recent data suggests external and internal stressors can increase the risk of emotional, behavioral, and cognitive problems in the child. Early childhood maltreatment of the mother has been found to be associated with altered brain structure in the newborn, with reduced cortical gray matter2. This association was independent of the mother's prenatal mood, and of other potential confounding variables. This suggests that such early trauma may affect the mother's biology in a way that in turn alters the development of the brain of her fetus and may indicate vulnerability to later depression and other problems for the child. Even more, research has consistently shown that postpartum depression can have negative effects on child development. For example, a systematic review of 28 studies found that children of mothers with postpartum depression were at higher risk of cognitive and behavioral problems3. Another study conducted in the US found that maternal depression in the postpartum period was associated with lower cognitive and language scores in children at age three8. A longitudinal study conducted in the UK found that maternal depression in the postpartum period was associated with lower academic achievement in children at age 16 7.

Maternal mental health postnatal has become a priority for hospitals and health systems in the United States. One in five women experience maternal mental health conditions, such as perinatal and postpartum depression, birth-related PTSD, and anxiety, yet 75% go untreated, with suicide and substance abuse being the leading causes of maternal deaths in the first year after childbirth 7. Women of color are more likely to experience these conditions but are less likely to seek help. The recent partnership between the American Hospital Association (AHA) and the national non-profit organization 2020 Mom aims to improve maternal mental health care by producing tools and resources specifically for hospitals and health systems.

Hospitals are the hub for 98% of births in the country and are therefore critical in improving maternal mental health outcomes. Efforts to improve maternal mental health vary depending on the patients and communities served . For example, Common Spirit Health engaged obstetrics providers, perinatal nursing staff, and social workers in a screening program to identify the mental health conditions of pregnant and postpartum women 4. Providers receive mental health training, and patients with identified risk of depression and anxiety relate to a social worker to assess their condition. Similarly, the integrated maternal mental health initiative at SCL Health administers a universal mental health screening, connects patients with mental health resources, and provides mental health training to obstetrics providers and staff.

Furthermore, it is important to identify and treat postpartum depression. A systematic review of 19 studies found that depression screening during pregnancy and the postpartum period was associated with increased rates of treatment and improved maternal and child outcomes5. Similarly, a study conducted in the US found that maternal depression screening and referral to mental health services was associated with lower rates of depression and improved maternal and child outcomes 3. As highlighted in various studies, maternal mental health issues can have long-lasting effects on the child's development and health, and therefore, addressing this prevalent issue in society should be a top priority. By providing access to mental health resources, promoting strategies that support maternal mental health, and engaging healthcare providers in screening programs, we can improve outcomes for both the mother and the child and create a healthier and happier society.

It is crucial to recognize and address maternal mental health concerns to ensure the best possible outcomes for both mother and child. In this context, it is important to explore and understand the various factors that contribute to maternal mental health and promote strategies that can support and improve it.

Edited by: Deven Gupta

Graphic Designed by: Eugene Cho

References

1) American Hospital Association. “AHA, 2020 Mom Partner to Improve Maternal Mental Health.” AHA News, 27 Apr. 2020, www.aha.org/news/headline/2020-04-27-aha-2020-mom-partner-improve-maternal-mental-health.

2) Glover, Vivette. “Prenatal mental health and the effects of stress on the fetus and the child. Should psychiatrists look beyond mental disorders?” British Journal of Psychiatry, vol. 208, no. 5, May 2016, pp. 399-400. doi: 10.1192/bjp.bp.115.172057.

3) Goodman, Sherryl H. “Depression in Mothers.” Annual Review of Clinical Psychology, vol. 9, no. 1, 2013, pp. 379-407, doi:10.1146/annurev-clinpsy-050212-185612.

4) “Improving Maternal Mental Health.” CommonSpirit Health, www.commonspirit.org/stories/improving-maternal-mental-health. Accessed 28 Mar. 2023.

5) “Maternal Mental Health Initiative.” SCL Health,

www.sclhealth.org/campaigns/mom/better-mental-health. Accessed 28 Mar. 2023.

6) Natalist. "The Importance of Prenatal and Postnatal Care." Natalist, Natalist, 16 Oct. 2020, https://natalist.com/blogs/learn/the-importance-of-prenatal-and-postnatal-care.

7) Sabo, T., Brown, A., Eckenrode, J., & Zimmerman, M. (2005). Gender differences in perceived social support and stress at entry into substance abuse treatment. Evaluation and program planning, 28(4), 391-398.

8) World Health Organization. (2013). Mental health action plan 2013–2020. World Health Organization.https://apps.who.int/iris/bitstream/handle/10665/89966/9789241506021_en. g.pdf;jessionid=9B9B101E0C324F2713F3E67A91F841D2?sequence=1

The Ethics of Genetic Manipulation and Designer Babies

Imagine a world in which humans could manipulate embryo DNA to prevent disease. Every parent could guarantee that their child would be born as healthy as possible. While it may sound too good to be true, recent genetic technology has turned this far-fetched idea into a reality and has sparked debate regarding the ethics of this novel technology.

With tremendous development in the field of genetics, scientists have enhanced their knowledge on manipulation of the human genome. CRISPR/Cas9 is a new technology that edits genes by precisely cutting DNA and either disrupting, deleting, or correcting and inserting new DNA into a target position (1). In embryos, this technique could be used to target genes associated with disease and correct them in order to create a healthier embryo.

On the surface, this seems like a very positive idea. Yet, CRISPR also has the potential to be used for much more than just disease prevention. What if a parent could design a baby with a high IQ, a height of 6 '10, and perfect pitch? This child would have an advantage in school with their high IQ, in sports like basketball because of their height, and in music with their perfect pitch. Many scientists question the uses of this technology and the ways in which it challenges human ethics. For example, genetic modification has a clear potential to create a larger divide between social and economic classes, as access to CRISPR is not cheap. Therefore, the only people who could afford to create children without disease or with certain life advantages are those with extreme wealth.

Furthermore, we as a society dream about creating the “perfect offspring,” but who defines that? Should humans be allowed to create a generation of “superior” beings that are outstanding mathematicians, athletes, or musicians?

Gene editing has been in the news for quite some time, especially with the recent announcement of the first genetically designed babies in 2018. Jiankui He, a researcher from the Southern University of Science and Technology of China, announced at the Second International Summit on Human Genome Editing in Hong Kong that he had created the world's first genetically altered babies (3). This caused an uproar because his research had not been approved and it brought to life many of the previously intangible problems with genetic testing on embryos; now these children could grow up as experiments and researchers would constantly want to monitor them to understand the implications of this groundbreaking technology. Many countries already have implemented more strict guidelines regulating human embryo experiments (3).

The future of gene editing has also been explored in the media through the creation of the 1997 movie “Gattaca.” Set in the U.S. in a futuristic society, “Gattaca” follows two brothers’ experiences in a world where people are defined by their genetic code. One brother is a designer baby, created in a petri dish, while the other was conceived naturally. Their lives differ in many ways, including access to certain types of jobs and one brother having more advantages and opportunities (4). The ‘designer’ brother works for the equivalent of NASA while his brother cannot work for them due to his genetic inferiority. The film explores the complex societal issues that this kind of technology creates and examines potential consequences of letting genetic modification control the future.

While there are clear drawbacks to embryo editing, there are also the previously stated advantages of eliminating certain life-threatening diseases. There is no clear answer on whether this technology will or should be utilized going forward, but it is something that should continue to be discussed, as it will likely play an important role in the near future.

Edited by: Reena Kagan

Graphic Designed by: Makayla Gorski

References

1. https://crisprtx.com/gene-editing/crispr-cas9

2. https://www.bioexplorer.net/designer-babies-pros-and-cons.html/

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431114/

4. https://embryo.asu.edu/pages/gattaca-1997

Detention of Pregnant Women at the US-Mexico Border

Every year, thousands of migrants are detained at the US-Mexico border, of which a small proportion are pregnant women. However, this proportion has significantly increased throughout the past decade and continues to be a significant problem today. The U.S. Immigration and Customs Enforcement (ICE) and Removal Operations reported that pregnant women accounted for roughly 0.3% of all detainees (965 detainees) in 2008, which had risen to roughly 0.4% (1377 detainees) and 0.5% (2094 detainees) in 2016 and 2018, respectively. Although these proportions may not be very large, the sheer number of mothers affected is cause for concern. Furthermore, investigations have found evidence of frequent mistreatment and abuse in ICE detention centers and U.S. Immigration Facilities, leading to miscarriages, adverse birth outcomes, and serious physical and mental impacts on the mothers (Immigration Detention: Care of Pregnant Women in DHS Facilities, 2021).

In 2018, the Trump administration gave immigration authorities full jurisdiction regarding the detainment and detention of pregnant women when they did away with presumptive release guidelines that required all pregnant detainees to be immediately released under another federal law or when deemed a national security threat. As a result, the number of detained pregnant individuals nearly doubled, decreasing available resources at facilities and posing serious health risks for expectant mothers and their babies. Although the Biden Administration has reimplemented presumptive release guidelines through executive order, it has failed to address numerous reports of inadequate and improper care at border facilities. (U.S. Immigrations and Customs Enforcement, 2017).

For example, while Customs and Border Protection (CBP) policy explicitly prohibits detention of individuals longer than 72 hours, an American Civil Liberties Union (ACLU) report found that pregnant women are regularly held beyond this limit and experience improper living conditions, verbal abuse, poor medical care, and even separation from their newborns (ACLU, 2020). Additional investigations by Human Rights Watch revealed CBP admitting to being unable to provide sleeping mats, basic hygienic products, and clean food and water. Furthermore, families are often separated when adults and children are held in different cells, which has adverse mental and physical effects on the childrens’ well-being (Rabin, 2009). In some cases, this mistreatment has become inhumane: detainees have reported being denied breast pumps and being shackled during labor despite physician orders, which patients have described as horrifying and causing feelings consistent with post-traumatic stress disorder (Preston, 2008).

The United States has long stated its commitment to uphold principles of basic human rights, yet such reports of mistreatment of pregnant migrants have persisted for decades. The Biden Administration’s Executive Order significantly reduced many detentions of pregnant women, yet the lack of consistent health standards has made additional progress difficult (Spiegel, 2019). While rewriting health standards may have some impact, the lack of accountability and oversight of US Immigration Centers and ICE-CBP officers further complicates matters.

Immigration policy has been the center of a long political debate. However, the humane treatment of detainees and asylees—especially pregnant women—should not be controversial. As the United States pursues new immigration policy, it is crucial that there is a focus on the proper treatment of pregnant women, who are experiencing one of the most vulnerable and risky periods of their lives and require sufficient medical care. Ensuring the safe and respectful treatment of pregnant women at the border is not only a moral obligation, but a necessary step towards building a just and compassionate immigration system.

Edited by: Reena Kagan

Graphic Designed by: Simone Nabors

References

1. ACLU. (2020, January 22). ACLU of San Diego and Imperial Counties. https://www.aclu-sdic.org/wp-content/uploads/2020/01/2020-01-22-OIG-Complaint-1-FINAL-1.pdf

2. Immigration Detention: Care of Pregnant Women in DHS Facilities. (2021, April 21). U.S. GAO. https://www.gao.gov/products/gao-20-330

3. Preston, J. (2008, July 19). Immigrant, Pregnant, Is Jailed Under Pact. The New York Times. https://www.nytimes.com/2008/07/20/us/20immig.html

4. Rabin, N. (2009). Unseen Prisoners: A Report on Women in Immigration Detention Facilities in Arizona. Social Science Research Network.

5. Spiegel P, Kass N, Rubenstein L. Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath? JAMA. 2019;322(15):1445–1446. doi:10.1001/jama.2019.12567

6. U.S. Immigrations and Customs Enforcement. (2017, December 14). ICE Directive 11032.3: Identification and Monitoring of Pregnant Detainees [Press release]. https://immpolicytracking.org/policies/ice-ends-presumption-of-release-for-pregnant-detainees/#/tab-policy-documents