Institute of Economic Growth, New Delhi, India.
UNICEF Regional office for South Asia, Kathmandu, Nepal.
Int J Gynaecol Obstet. 2023 Sep;162(3):792-801. doi: 10.1002/ijgo.14728. Epub 2023 Mar 5.
Pregnancy is a period of major physiologic, hormonal, and psychological change, increasing the risk of nutritional deficiencies and mental disorders. Mental disorders and malnutrition are associated with adverse pregnancy and child outcomes, with potential long-standing impact. Common mental disorders during pregnancy are more prevalent in low- and middle-income countries (LMICs). In India, studies suggest the prevalence of depression is 9.8%-36.7% and of anxiety is 55.7%. India has seen some promising developments in recent years such as increased coverage of the District Mental Health Program; integration of maternal mental health into the Reproductive and Child Health Program in Kerala; and the Mental Health Care Act 2017. However, mental health screening and management protocols have not yet been established and integrated into routine prenatal care in India. A five-action maternal nutrition algorithm was developed and tested for the Ministry of Health and Family Welfare, aiming to strengthen nutrition services for pregnant women in routine prenatal care facilities. In this paper, we present opportunities and challenges for integration of maternal nutrition and mental health screening and a management protocol at routine prenatal care in India, discuss evidence-based interventions in other LMICs including India, and make recommendations for public healthcare providers.
妊娠是一个重大的生理、激素和心理变化时期，增加了营养缺乏和精神障碍的风险。精神障碍和营养不良与不良的妊娠和儿童结局有关，并可能产生长期影响。在中低收入国家（LMICs），妊娠期间常见的精神障碍更为普遍。在印度，研究表明抑郁的患病率为 9.8%-36.7%，焦虑的患病率为 55.7%。近年来，印度取得了一些令人鼓舞的进展，如扩大地区精神卫生计划的覆盖范围；将孕产妇心理健康纳入喀拉拉邦的生殖和儿童健康计划；以及 2017 年的《精神卫生保健法》。然而，精神卫生筛查和管理方案尚未在印度常规产前保健中建立和整合。为了加强常规产前保健设施中孕妇的营养服务，为卫生部和家庭福利部制定并测试了一个孕产妇营养五步骤算法。本文介绍了在印度常规产前保健中整合孕产妇营养和精神健康筛查以及管理方案的机遇和挑战，讨论了包括印度在内的其他 LMICs 中的循证干预措施，并为公共卫生保健提供者提出了建议。
