Pamela A Geller

Postpartum depression (PPD) is a common childbirth complication that impairs the mother-infant relationship and contributes to long-term developmental challenges among children. Although PPD treatment reduces depressive symptoms, it is not necessarily sufficient to improve maternal-infant interaction. In addition, several barriers preclude timely access to care including mental health stigma, limited specialized providers, and challenges with navigating the healthcare system and securing necessary childcare and transportation. Our team developed a 12-session patient- and clinician-facing digital platform,
that combines evidence-based therapies-- Mother Baby Interaction Therapy and Interpersonal Psychotherapy-- to improve PPD symptoms and mother-infant interaction, address barriers to care, and provide support between therapy sessions. The purpose of this article is to describe the translation of our in-person approach to treating PPD and improving mother-baby interaction to our
digital platform that integrates core psychotherapy components into a user-centered platform.
Our methods were guided by the PRECEDE-PROCEED Model and three stages of a nine-stage digital platform development process. In stage 1, we conducted focus groups to understand the needs of postpartum mothers who had experienced PPD and in-depth interviews to understand the concerns of perinatal mental health clinicians. We analyzed the qualitative data with thematic content analysis. In stage 2, we used component mapping to translate treatment modalities into the digital platform. Finally in stage 3, we used co-design, prototyping, and user-interface design to build the
prototype.
Results from the focus groups identified four themes including (1) barriers to accessing care, (2) preferences and needs in mental health care delivery, (3) feedback on the
App, and (4) broader challenges and experiences. The in-depth interviews with the clinicians resulted in six themes including (1) assessment and early intervention, (2) barriers to care, (3) role of technology in treatment, (4) building a therapeutic alliance, (5) community and social support, and (6) addressing comorbid conditions. Additionally, the team translated the in-person treatment modality to a 12-session format and designed the current version of the
prototype, which has both patient-facing and clinician-facing components.
offers an innovative, accessible approach that combines Mother Baby Interaction Therapy and Interpersonal Psychotherapy to treat PPD and improve the quality of mother-infant interaction. Its digital adaptation provides a treatment platform for mothers and clinicians to work together in real time and communicate between sessions.
may expand access, reduce barriers to care, and inform the broader translation of evidence-based behavioral interventions into scalable, technology-enabled formats. This work has the potential to transform access to perinatal mental health care, improve maternal and infant outcomes, and reduce the long-term sequelae associated with untreated PPD and disrupted early relational experiences for infants.

To promote optimal development for families negatively impacted by traumatic birth experiences, research is needed to understand the potentially unique effects of childbirth-related post-traumatic stress disorder (CB-PTSD) symptoms on early relational health (ERH) in the family system.
To examine the nature and extent of current knowledge on the effect of CB-PTSD on early relational health of the family.
We utilized previously published scoping review framework and followed PRISMA-ScR reporting guidelines. Databases searched included Google Scholar, PubMed, EMBASE, and CINAHL. Search terms included Boolean strings such as "childbirth-related PTSD" AND "mother-infant relationship", OR "early relational health".
Eligible articles quantitatively assessed the predictive relationship between CB-PTSD and an early relational health construct and adequately distinguished PTSD symptoms related to childbirth from symptoms related to other traumatic experiences.
Initial search yielded N = 695 records. The final study sample included N = 22 records published from 2007 to 2023. Data were charted and synthesized based on methodological characteristics and main findings.
Current research specifically examining adverse effects of CB-PTSD symptoms on both the mother-infant relationship and co-parent relational health is limited and has produced conflicting results. Variation in study characteristics and methodology are discussed.
CB-PTSD symptoms may have a significant impact on early relational health, although findings are unclear and vary by methodology used. Clinical relevance of findings related to prevention, screening, and treatment are discussed.

“Mom brain” is a commonly reported phenomenon in pregnant and postpartum women characterized by brain fog, forgetfulness, distractibility, and other cognitive disruptions. However, research on objective cognitive functioning in pregnant and postpartum women is inconclusive and does not necessarily align with mothers’ subjective experiences with mom brain. This review discusses recent developments in the perinatal cognitive neuroscience literature that support a revised narrative in which “mom brain” is conceptualized as a period of functionally adaptive cognitive enhancements. Changing the narrative can shift societal expectations for mothers, thereby reducing social pressure and negative self-evaluation to ultimately enhance mothers’ experiences across the perinatal period.

The PRECEDE-PROCEED model is a comprehensive planning and theoretical framework that incorporates epidemiological, environmental, behavioral, and social factors systematically to design, implement, and evaluate health promotion programs. As such, PRECEDE-PROCEED is a highly effective tool for addressing complex and significant public health concerns like postpartum depression (PPD). PPD negatively impacts mothers and their infants, with studies showing that approximately one in eight mothers experience PPD, leading to adverse effects on maternal functioning and infant development. However, access to specialized evidence-based treatment remains significantly limited due to barriers including social determinants of health. This paper explores the application of the PRECEDE-PROCEED model as a planning and theoretical framework for the design and development of MommaConnect, an innovative digital healthcare platform aimed at reducing PPD symptoms and improving maternal-infant interaction while overcoming barriers to treatment. Key components of the MommaConnect design and development process are mapped onto the steps of the PRECEDE-PROCEED model. MommaConnect features are aligned with specific stages of the model, from assessing, predisposing, enabling, and reinforcing factors to designing, implementing, and evaluating the intervention. By leveraging this model, MommaConnect represents a promising innovative approach to address PPD to improve maternal functioning and infant health in a digitally-enabled era. This paper underscores the importance of utilizing a framework like the PRECEDE-PROCEED model in the design and development of innovative healthcare solutions.

Existing quantitative data is conflicting concerning whether multiparous birthing parents (individuals with an older child(ren)) experience an easier postpartum transition compared to primiparous birthing parents (first time parents).
This convergent mixed methods study leverages the depth of qualitative inquiry to seek a clearer understanding of the way in which acquired parenting experience contributes to observed quantitative differences in outcomes between parity groups. This work can serve as a first step in planning for supportive interventions that effectively address the postpartum needs of both parity groups.
Thirty birthing parents (43.3% multiparous; 46.7% racial minorities) completed measures of postpartum functioning, perceived stress, anxiety symptoms, and depression symptoms as well as an interview inquiring about factors impacting postpartum functioning. Scores on postpartum functioning and emotional wellbeing were compared between parity groups, and these findings were merged with the qualitative data on firsthand parenting experience to clarify how acquired experience impacts functioning and emotional wellbeing during the postpartum transition.
Primiparous parents reported significantly: worse postpartum functioning, higher perceived stress, higher levels of depression symptoms, and higher levels of anxiety symptoms. Participants’ qualitative report of how acquired parenting experience impacts wellbeing suggests that experience grants parents skills, knowledge, and the opportunity to disconfirm maladaptive cognitions about parenting which allows for increased comfort and confidence in the parental role.
The practical and psychological resources gained from acquiring parenting experience during one's first postpartum period appear to be brought forward into subsequent pregnancies and protect against threats to functioning and emotional wellbeing.

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to the COVID-19 pandemic: (1) Adaptations in shopping and cooking behaviors; (2) increases in stress and declines in respite; (3) declines in support and increases in isolation; and (4) low levels of breastfeeding guidance. Our findings confirm the importance of resilience among women with perinatal depression and future research is needed to elucidate the mechanisms connecting resilience and dietary behaviors.

BACKGROUNDWomen with perinatal depression (PD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for women with PD have been developed. The objectives of this study were to identify nutrition-related challenges and needs among women with PD and to elucidate the role that feeding plays in mother-infant interaction, to inform the development of nutrition interventions. METHODSUsing a qualitative study design, in-depth interviews were conducted with 18 mothers with a history of PD and 10 interdisciplinary healthcare providers with expertise in PD. Data were thematically analyzed using a hybrid inductive and deductive coding approach. RESULTSMean age of mothers was 31 ± 6 years, 56% identified as non-Hispanic White, and 33% identified as Black/African American. Eighty percent of healthcare providers practiced for more than five years. Six themes were identified: (a) Time scarcity mindset; (b) Importance of social support; (c) Unrealistic expectations of motherhood; (d) Mom as the last priority; (e) Postpartum body changes and shape ideals; and (f) Contentment associated with infant and young child feeding. CONCLUSIONWomen with PD have several needs pertaining to their nutrition and that of their children. The findings from this study illustrate key considerations and recommendations for addressing these needs.

The first postpartum year presents threats to the mental health of birthing parents and obstacles to accessing care. Digital mental health interventions (DMHIs) hold potential to increase postpartum mental healthcare access. However, DMHIs tend to promote limited engagement particularly when they are self-guided (when they do not involve contact with a provider). Yet, given that provider support is a limited resource, a balance must be struck between accessibility and intervention intensity (i.e., involving more human contact). Towards achieving this balance, this analysis seeks to identify characteristics that are associated with a reported preference for a human-guided introduction to digital resources aimed at promoting postpartum mental health. In a sample of largely White, non-Latinx, employed, married, and graduate school-educated individuals, multivariate logistic regression revealed that age (p = 0.0095), level of postpartum functioning (p = 0.0057), depression symptoms (p = 0.0099), and anxiety symptoms (p = 0.03) were associated with guide preference. Specifically, more anxious or lower-postpartum-functioning individuals were more likely to report preferring a guide while older or more depressed individuals were less likely to report preferring a guide. These findings can inform clinical recommendations surrounding who is most likely to engage with, and thus benefit from, exclusively self-guided DMHIs during the postpartum period.

BACKGROUND: Although infants in Neonatal Intensive Care Units (NICU) are at risk for developmental impairments and parents are at risk for emotional distress, factors that explain outcomes remain unknown. Here, we developed the first biopsychosocial model to explain family adjustment after NICU discharge. METHODS: Participants included 101 families at The Children's Hospital of Philadelphia Neonatal Follow-Up Program who had been discharged 1.5-2.5 years prior. We gathered data using validated assessments, standardized assessments, and electronic medical records.RESULTS: Our structural equation model, informed by the Double ABC-X Model, captured the dynamic relationships among infant, parent, couple, and family factors. Infant medical severity, posttraumatic stress, couple functioning, and family resources (e.g., time, money) were key for family adjustment and child development.CONCLUSIONS: Interventions that target parental posttraumatic stress, couple dynamics, parental perception of time for themselves, and access to financial support could be key for improving NICU family outcomes.