DOI: 10.17605/osf.io/jcn5f
title: Investigating the effects of having access to a perinatal psychologist (PEPO) in perinatal care on children’s birth outcomes

description: According to the World Health Organisation (WHO) 15-20% of all births worldwide are low birth weight (&lt;2500 g) and more than 1 in 10 children are born preterm (&lt;37 weeks gestation) (Bilgin et al 2028; Voit et al. 2022). These adverse birth outcomes are known to be associated with lifelong consequences, such as an increased risk of disability, health issues, neurocognitive impairment, and mental health problems (Voit et al. 2022; Bilgin et al. 2018; Talge et al 2010). While this has led to the WHO aiming to decrease low birth weight by 30% in 2025, the related risk factor of maternal mental health has not been properly addressed as an important focus for prevention (Dadi et al. 2020). Research shows that poor maternal mental health during pregnancy is a risk factor for preterm birth and low birth weight in offspring (Voit et al. 2022; Dadi et al. 2020). Postpartum MMH problems are also linked to decreased care-giving behavior, mother-infant bonding, and earlier discontinuation of breastfeeding (Field 2010, Slomian et al. 2019, Dubber et al. 2015). Moreover, maternal mental health (MMH) symptoms have previously been related to impaired physical and mental child development in the short- and long-term (Kingston et al.2012; Slomian et al. 2019). 

The potential impact of improving MMH is substantial, as 1 in 5 women from community populations experience clinically relevant MMH problems such as anxiety, stress and depression (Browne et al. 2020). As these problems still frequently go unnoticed, only 15% of women experiencing MMH problems receive sufficient treatment or support (Browne et al. 2020). For some of the women receiving no treatment these symptoms will increase, possibly developing into psychiatric disorders with far-reaching consequences for both mother and child. Maternal mental health problems and their associated consequences also have an impact on society as a whole, as a study in the United Kingdom (UK) showed that perinatal anxiety, depression and psychosis add up a total cost for society of 8.1 billion pounds per year. This amounts to a little under 10.000 pounds for each birth (Bauer et al. 2016). This study also showed that 60% of these costs were related to child outcomes (Bauer et al. 2016). Early prevention and treatment of MMH problems is therefore both efficient and of large societal value.

Previous research on (early) prevention and treatment of MMH problems show promising outcomes in reducing perinatal mental health problems (Kohlhoff et al. 2023; de Graaff et al. 2020; Werner et al. 2024; Haga et al. 2019; Lau et al. 2022). However, the overall quality of evidence found in the various studies was low (Lau et al. 2022), and while there is sufficient evidence for the effectiveness of these interventions for women at risk and women with severe psychological symptoms, effectiveness of these interventions for universal perinatal populations remains unclear (Missler et al. 2021). Bauer et al (2016) estimate that the cost of perinatal mental health problems is 5 times higher than it would be if the services to reduce perinatal mental health problems were improved. However, they also state that research on the effectiveness of interventions aimed at improving perinatal mental health to reduce long-term effects on child outcomes are sparse (Bauer et al. 2016). 

This study aims to investigate the effects of having access to a perinatal psychologist (PEPO; in Dutch ‘PErinatale Psychische Ondersteuner’) in standard perinatal care. This PEPO is a newly developed professional. The roles of this PEPO entail an introductory meeting at 18-20 weeks pregnancy, and screening for mental health problems using short screening questionnaires at three times in the peripartum period (at 13 weeks and 32 weeks pregnancy and at 6 weeks postpartum). Moreover, if needed, the PEPO offers support in the form of psychoeducation, evidence-based supportive care, and referrals to more specialized care, and if the pregnant woman agrees, communicating with the other professionals in the perinatal care to offer more personalized care. These roles and the working method of the PEPO were specified during focus groups with all stakeholders involved. Based on the outcomes of these focus groups a protocol with the roles and working methods of the PEPO was specified. 

This current intervention study used a two-period cross-over design to investigate whether belonging to the PEPO intervention group as compared to care-as-usual (CAU) resulted in better birth outcomes. Specifically, we will look at potential effects on gestational age, birth weight and the 5-min Apgar score. In addition, we will investigate whether, within the intervention group, women receiving actual PEPO care, meaning at least one session after the introductory meeting, compared to women receiving CAU, give birth to children with better birth outcomes. Finally, we will determine whether potential effects are moderated by demographics (ethnicity, marital status, socio-economic status, and parity), and characteristics of PEPO care (number of prenatal sessions, online or in-person sessions, and the person carrying out the PEPO role).