O2044: Expanding Perinatal Mental Health Screening to a Fetal Cardiology Clinic: A Quality Improvement Project

Purpose/Objectives: Perinatal Mental Health PMH conditions are the most common complication of pregnancy and one of the leading causes of pregnancy-related deaths. One in 5 mothers are affected. Rates are nearly double for women of color and those experiencing poverty. Maternal psychological distress is aggravated by a prenatal diagnosis of congenital heart disease with increased levels of anxiety, stress, and depression. PMH conditions affect birth outcomes, fetal brain development, child neurodevelopment, and socioemotional health. Despite ACOG and AAP guidelines recommendations for PMH screening, less than 50% of affected mothers are screened nationally. The purpose of this Quality Improvement project is to standardize and increase the screening rate for PMH from 0 to 75% by administering validated questionnaires to all mothers referred to fetal cardiology clinic.

Design/Methods: A Model for Improvement method was selected and a multidisciplinary team was created including pediatric cardiologist, psychologists, social workers and fetal coordinators. During the 6-month study period, the Plan-Do-Study-Act framework was implemented to identify screening barriers and test changes. Validated questionnaires for depression (Edinburgh Postpartum Depression Scale, EPDS) anxiety (General anxiety Disorder 7, GAD-7), and stress (Perceived Stress Scale, PSS-10) were offered to all mothers referred for fetal echocardiogram. If declined, the reason for declining was noted to understand barriers. Maternal answers were reviewed by a psychologist or social worker to provide appropriate support, resource recommendations, and a safety planning if indicated. Mothers with abnormal fetal echocardiogram were screened independently of the initial evaluation response, and not sooner than 4 weeks after the previous evaluation. Mothers with a normal fetal echocardiogram who screened positive were assessed, referred for appropriate services, and the referring physician was notified (Figure 1).

Results: Screening was offered to 99% of patients with one missed screening opportunity due to language barrier. The median PMH screening rate was 94% (graph 1). The most common reason for refusal was considering the screening “not pertinent to the visit”. The average screening and assessment times were 6 min 45 sec, and 21 min respectfully. Abnormal PMH screening was identified in 37% of the mothers who completed the questionnaire and 49% of the mothers with an abnormal fetal echocardiogram. Referring physician notification was achieved for all the mothers with abnormal screening. On follow up phone call, 97% of mothers expressed that the PMH screening was either “helpful” or “very helpful”.

Conclusion/Discussion: Extending PMH screening to the fetal Cardiology clinical workflow is feasible with a multidisciplinary team to increase maternal awareness, provide resources, and establish a referral network. Given the multiple barriers for universal PMH screening, all provider who interact with the perinatal population are invited to screen and collaborate with community providers. Next steps include PMH screening for partners, providing local interventions and continuing support after birth.