Lauren M. Osborne

Background Perinatal obsessive–compulsive (OC) symptoms are common and distressing, yet their impact on early parenting outcomes such as maternal-infant bonding remains poorly understood. Although prior research links maternal depression and anxiety to bonding difficulties, less is known about how perinatal OC symptoms relate to maternal-infant bonding over time, or the extent to which maternal-partner relationship quality is associated with these outcomes, and whether depressive symptoms explain observed associations. Methods Data were drawn from a longitudinal study of 256 pregnant women recruited from two U.S. sites between 2020 and 2023. Participants completed self-report and clinician-administered assessments at 20 weeks (PGWK20), 34 weeks gestation (PGWK34), and at 6 weeks (PP6WK) and 6 months postpartum (PP6MO). OC symptoms were measured using the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) and the Perinatal Thoughts and Behaviors Checklist (PTBC), depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS), maternal-partner relationship quality with the Dyadic Adjustment Scale (DAS), and maternal-infant bonding with the Postnatal Bonding Questionnaire (PBQ). Results Prenatal OC symptom severity (PGWK34) and OC symptom severity assessed at PP6WK did not directly predict maternal-infant bonding difficulties at PP6WK or PP6MO. Depressive symptoms at PP6WK significantly mediated the association between prenatal OC symptoms and bonding difficulties at PP6MO. Higher maternal-partner relationship quality during pregnancy (PGWK34) predicted fewer bonding difficulties at PP6MO but was not associated with the strength of associations between OC symptoms and bonding outcomes. Conclusions Perinatal OC symptoms may indirectly influence maternal-infant bonding through co-occurring depressive symptoms, highlighting the importance of mood-focused assessment and personalized intervention during pregnancy. Maternal-partner relationship quality emerged as a general protective factor associated with fewer bonding difficulties but did not moderate associations between OC symptoms and bonding outcomes. Integrated screening and intervention approaches targeting both mood and OC features may enhance maternal well-being and early relational outcomes.

This study assessed resident psychiatrist clinical confidence regarding women’s mental health (WMH) topics and interest in receiving WMH education. The authors analyzed cross-sectional survey data from 152 Postgraduate year (PGY) 1–4 Residents in U.S. Adult Psychiatry Residency Training Programs between 12/3/2024-5/29/2025. Relative within-individual confidence in perinatal-focused WMH practice compared to general practice was assessed using paired Wilcoxon signed rank tests. Predictors of the relative confidence gap between perinatal and general practice were evaluated using multiple regression analyses. Resident interest in WMH education and preferred educational interventions was summarized using descriptive statistics. Residents were significantly less confident prescribing to pregnant and lactating individuals and counseling patients about risks and benefits of treatment in pregnancy and lactation compared to general practice (all p < 0.001). More self-reported WMH didactic hours attenuated the confidence gap for perinatal prescribing and counseling during pregnancy and lactation. The majority (62.5%) were not confident they would receive adequate WMH exposure by the end of residency, including 58.8% of PGY-4 residents. All (100%) expressed support for formal requirements for WMH education during residency. Residents were most interested in additional interactive WMH didactics (78.3%), followed by additional clinical electives (75.7%) or a national or program-specific women’s mental health track (65.8%). Many residents are not getting the WMH training they need to serve women across the lifespan. When they do get it, it increases their self-efficacy to provide WMH care. Residents need and are recommending more WMH training so they can provide adequate mental health care to women across the lifespan.

Purpose Mother-infant bonding is crucial for the child’s development and the parent’s well-being, but research in this area in low- and middle-income countries is rare. We sought to evaluate the psychometric properties of the Urdu version of the Postpartum Bonding Questionnaire (PBQ) among women with prenatal anxiety symptoms in Pakistan. Methods This validation study used cross-sectional data within the context of a large randomized clinical trial, called Happy Mother, Healthy Baby (HMHB), conducted from April 2019 to October 2022 among women with at least mild prenatal anxiety symptoms receiving antenatal care from a large tertiary care hospital in Rawalpindi, Pakistan. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and analysis of convergent validity were performed. Results The analysis included 720 mothers with a mean age of 25.23 years (SD = 4.61). The EFA suggested that 19 items (the five-factor model) out of 25 original items (the four-factor model) provided a good fit for the data, explaining a total variance of 64.7%. The CFA demonstrated poor fit for the four-factor model, but acceptable fit for the five-factor model of the PBQ (i.e., Love and affection [eight-item], Rejection [four-item], Withdrawal [two-items], Anger [three-items], and Irritation [two-items]) (CFI = 0.94, TLI = 0.93, RMSEA = 0.07, SRMR = 0.04), with good reliability (ordinal alpha = 0.71–0.93). A moderate positive correlation between impaired bonding and depressive symptoms supported convergent validity; and a negative correlation between impaired bonding and maternal-infant responsiveness supported convergent validity. Potential limitations are that test-retest validity and cutoff specification were not carried out. Conclusions Findings indicate that the 19-item Urdu version of the PBQ is valid and reliable to assess postpartum bonding among Pakistani women with prenatal anxiety symptoms.

Purpose This study investigates Vitamin D levels across the perinatal period and relationships with perinatal anxiety and immune markers in women in Pakistan. Methods We analyzed plasma levels of 25-hydroxyvitamin D and cytokines and chemokines from 117 participants from the “Happy Mother-Healthy Baby” trial, which evaluated a non-specialist delivered cognitive behavioral therapy intervention for perinatal anxiety. Blood samples were collected at four timepoints: T1 (10–22 weeks), T2 (22–26 weeks), T3 (34–38 weeks), and T4 (six weeks postpartum). Participants were categorized into anxiety groups using K-means clustering. Mixed-effect models were used to examine Vitamin D trajectories, and moderation analysis explored the impact of immune markers on the Vitamin D-anxiety relationship. Results Vitamin D levels were severely deficient across all timepoints (< 5 ng/ml) and declined significantly from T1 to T2 (β = -0.549, p = .006) before rebounding postpartum (β = 1.492, p < .0001). Despite this widespread Vitamin D deficiency, no significant differences in Vitamin D trajectories were observed across anxiety groups. Higher innate immune activity correlated with higher Vitamin D levels at T1. IL-6 and CXCL-8 levels moderated the Vitamin D and anxiety relationship at T2 (IL-6: β = 2.98, p = .015; CXCL-8: β = 0.72, p = .030); among those with higher levels of IL-6 and CXCL-8, higher Vitamin D levels were associated with higher levels of anxiety. Conclusions These findings indicate the need for further research on maternal Vitamin D deficiency and its relationship with immune function in low- and middle-income countries.

Background: In the United States, mental health complications and cardiovascular events are the 2 leading causes of death for birthing parents in the year following delivery. Most of these deaths are preventable, with Black and Latinx individuals experiencing higher rates of these postpartum complications. Current postpartum care has not reduced these disparities. Objective: This randomized controlled trial aims to train nonmedical professionals in a novel intervention to prevent postpartum depressive symptoms and improve cardiovascular health following childbirth in a low-income New York City (NYC) birthing population. Methods: We aim to recruit 600 birthing individuals over 3 sites across NYC. After screening and consent, participants will be randomized to the Living Healthy for Moms intervention (doula-delivered cognitive behavioral therapy and cardiovascular behavioral health intervention) or attention control (a variation of standard postpartum doula care). Daily telephone contacts for the first 7 days immediately after hospital discharge are followed by 12 doula-led video sessions conducted over 6 months. The primary outcomes are postpartum depressive symptoms and cardiovascular health, with secondary outcomes of psychosocial status, health behaviors, health care use, and patient satisfaction. All outcomes are measured via REDCap (Research Electronic Data Capture; Vanderbilt University) surveys administered at baseline, 2 weeks, 6 weeks, 3 months, and 6 months post discharge. Physiological measurements of glycated hemoglobin (hemoglobin A1c), lipids, and blood pressure will be collected at baseline, 3 months, and 6 months. Doulas, hospital staff, and birthing individuals will be recruited to evaluate the implementation of the intervention following the conclusion of recruitment at each site. A mixed methods triangulated approach will be used, including electronic health record data extraction, web-based surveys, key informant interviews, and focus groups. Results: Recruitment and data collection began at the first site in Brooklyn on January 23, 2025. Data collection for participants from each of the 3 recruitment sites will be concluded by November 30, 2027, February 29, 2028, and August 31, 2029, respectively, for Brooklyn, Queens, and upper Manhattan. Thus, all data for the total expected 600 participants will be collected by the end of the grant year 6, August 31, 2029. Trial results will not be analyzed until grant year 7, beginning September 1, 2029. Data will be analyzed on an intention-to-treat basis by study team members blinded to participant conditions. Conclusions: This hybrid type 1 effectiveness-implementation randomized controlled trial will test a novel nonspecialist intervention to prevent mental health and cardiovascular health complications of childbirth, culturally adapted to our local population in NYC. We expect that our findings will contribute to knowledge on the effectiveness and implementation of nonspecialist postpartum interventions in low-resourced settings and the expansion of doula care in the post partum. Trial Registration: ClinicalTrials.gov NCT06666400; https://clinicaltrials.gov/study/NCT06666400 International Registered Report Identifier (IRRID): DERR1-10.2196/76871

Background: While biomarkers are widely used in other medical fields, psychiatry has yet to introduce reliable biological diagnostic tools. Female reproductive transitions provide a unique window of opportunity for investigating psychiatric biomarkers. Hormonal changes across menstruation, pregnancy, parturition and perimenopause can have dramatic effects on mental health in vulnerable individuals, enabling the identification of unique biomarkers associated with these fluctuations.Aims: This review integrates current evidence concerning potential biomarkers, with focus on recent human studies in perinatal depression, anxiety and obsessive–compulsive disorder, postpartum psychosis, premenstrual dysphoric disorder and perimenopausal depression.Method: We identified potential articles to be included in this narrative review by using PubMed to obtain articles in English since 2010 on the six conditions listed above, with the additional keywords of ‘biomarker’, ‘epigenetics’, ‘neuroactive steroid’, ‘immune’, ‘inflammatory’ and ‘neuroimaging’.Results: There is substantial published evidence regarding potential biomarkers of reproductive psychiatric disorders in the areas of epigenetics, neuroactive steroids, immune function and neuroimaging. This body of research holds significant potential to advance biomarker development, uncover disease mechanisms and improve diagnostic and therapeutic strategies, but there is as yet no clinically useful biomarker in commercial development for any reproductive psychiatric disorder.Conclusion: There is an urgent need for longitudinal, large-scale and multi-modal studies to examine potential biomarkers and better understand their functions across various stages of reproduction.

BACKGROUND In the United States, mental health complications and cardiovascular events are the 2 leading causes of death for birthing parents in the year following delivery. Most of these deaths are preventable, with Black and Latinx individuals experiencing higher rates of these postpartum complications. Current postpartum care has not reduced these disparities. OBJECTIVE This randomized controlled trial aims to train nonmedical professionals in a novel intervention to prevent postpartum depressive symptoms and improve cardiovascular health following childbirth in a low-income New York City (NYC) birthing population. METHODS We aim to recruit 600 birthing individuals over 3 sites across NYC. After screening and consent, participants will be randomized to the Living Healthy for Moms intervention (doula-delivered cognitive behavioral therapy and cardiovascular behavioral health intervention) or attention control (a variation of standard postpartum doula care). Daily telephone contacts for the first 7 days immediately after hospital discharge are followed by 12 doula-led video sessions conducted over 6 months. The primary outcomes are postpartum depressive symptoms and cardiovascular health, with secondary outcomes of psychosocial status, health behaviors, health care use, and patient satisfaction. All outcomes are measured via REDCap (Research Electronic Data Capture; Vanderbilt University) surveys administered at baseline, 2 weeks, 6 weeks, 3 months, and 6 months post discharge. Physiological measurements of glycated hemoglobin (hemoglobin A1c), lipids, and blood pressure will be collected at baseline, 3 months, and 6 months. Doulas, hospital staff, and birthing individuals will be recruited to evaluate the implementation of the intervention following the conclusion of recruitment at each site. A mixed methods triangulated approach will be used, including electronic health record data extraction, web-based surveys, key informant interviews, and focus groups. RESULTS Recruitment and data collection began at the first site in Brooklyn on January 23, 2025. Data collection for participants from each of the 3 recruitment sites will be concluded by November 30, 2027, February 29, 2028, and August 31, 2029, respectively, for Brooklyn, Queens, and upper Manhattan. Thus, all data for the total expected 600 participants will be collected by the end of the grant year 6, August 31, 2029. Trial results will not be analyzed until grant year 7, beginning September 1, 2029. Data will be analyzed on an intention-to-treat basis by study team members blinded to participant conditions. CONCLUSIONS This hybrid type 1 effectiveness-implementation randomized controlled trial will test a novel nonspecialist intervention to prevent mental health and cardiovascular health complications of childbirth, culturally adapted to our local population in NYC. We expect that our findings will contribute to knowledge on the effectiveness and implementation of nonspecialist postpartum interventions in low-resourced settings and the expansion of doula care in the post partum. CLINICALTRIAL ClinicalTrials.gov NCT06666400; https://clinicaltrials.gov/study/NCT06666400 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/76871

Background: Postpartum mood and anxiety disorders (PMADs) are higher among pregnant military service women (26%) and military spouses (12.2%) compared to the civilian population (10%-15%). This is partly due to military-specific factors, including deployment, which are known to increase risk. Important risk factors for PMADs include sleep disturbances, defined as sleep deprivation, insomnia, or poor sleep quality, which are more are common among military-affiliated pregnant women. Objective: This study describes a protocol for a new randomized controlled trial that aims to ameliorate the risk for PMADs through improving infant sleep or maternal sleep during the first 6 postdelivery months in a sample of military-affiliated women. Methods: This study is a 6-month, parallel-arm, randomized controlled trial. Pregnant women (N=342) in the third trimester will be randomized at 1:1 ratio to use a smart bassinet (SB) or a standard commercially available bassinet (HALO BassiNest Swivel Sleeper 3.0; traditional bassinet [TB]) for up to 6 months after delivery. Participants will have their infants sleep in the bassinet, complete monthly web-based questionnaires, and record sleep data with diary and actigraphy for both the participants and their infants for 1 week each postpartum month. Blood samples will also be collected at baseline (late pregnancy) and at 3 months and 6 months post partum to assess immune functioning. The primary outcomes for this study will be postpartum mood (depressive and anxiety symptoms) and infant and maternal sleep. In addition, we are evaluating whether SB has a significant impact on immune functioning—a marker that physiologically connects sleep and mood symptoms. Results: Recruitment for this study began in January 2025. Six separate mixed 2 (treatment vs control) × 6 (assessment period) multivariate analysis of variance and analysis of variance models will be conducted to test the hypotheses that SB will have a greater impact on infant and maternal sleep than TB, SB will be associated with a greater reduction in postpartum mood symptoms than TB, and immune system function will be less dysregulated in birthing individuals using SB compared to those using TB. Lastly, we will evaluate whether the elevated risk demonstrated by previously identified postpartum depression epigenetic biomarkers in the TTC9B and HP1BP3 genes can be modified with an SB. We hypothesize that the elevated risk will be reduced in SB compared to that in TB. Conclusions: At the conclusion of this project, we will have gained a thorough understanding of the capability of SB to positively affect infant and maternal sleep compared to the traditional sleep arrangement and its impact on maternal mood through 6 months post partum in military-affiliated women. The promotion of sleep health in both mothers and infants may be an accessible and amenable method to prevent PMADs. Trial Registration: ClinicalTrials.gov NCT06544941; https://clinicaltrials.gov/study/NCT06544941 International Registered Report Identifier (IRRID): PRR1-10.2196/66439