Dreux Simone R, Ramsey Natalie, Gissandaner Tre D, Alarcon Nicole, Duarte Cristiane S
From Columbia University Irving Medical Center and the New York State Psychiatric Institute (Mss. Dreux and Alarcon, and Drs. Ramsey, Gissandaner, and Duarte), New York, NY.
Harv Rev Psychiatry. 2025;33(2):90-101. doi: 10.1097/HRP.0000000000000424.
After participating in this CME activity, the psychiatrist should be better able to:• Discuss the effects of structural racism on pregnancy and obstetric care and their contributions to maternal mental health challenges and inequitable outcomes.• Outline the current understanding of interventions initiated during pregnancy or childbirth that use reproductive justice principles to improve Black maternal perinatal and intergenerational mental health outcomes.
There are significant racial disparities in maternal outcomes for Black compared to White birthing people in the United States (US). Maternal mental health problems negatively affect mothers and their infants. Effects of structural racism during pregnancy and obstetric care may contribute to inequitable maternal mental health challenges and negative offspring outcomes. A reproductive justice framework provides a path for addressing these inequities. This systematic review examines whether pregnancy care interventions driven by reproductive justice principles have successfully improved Black maternal perinatal and intergenerational mental health outcomes.
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies identified in November 2024 in PubMed, PsycInfo, and CINAHL. The studies included randomized clinical trials of Black birthing parents in the US and their offspring. Interventions incorporating reproductive justice principles were defined as those explicitly designed to increase autonomy, community input, racial equity, and/or cultural relevance.
The search revealed 619 unique records. After screening and full-text review, 12 studies were included. Of these, 7 studies reported statistically significant effects on mental health outcomes. The interventions included interpersonal therapy, culturally tailored cognitive behavioral therapy, group prenatal care, community health worker home visits, and an educational online platform. Six studies reported positive effects on maternal mental health outcomes (e.g., depressive symptoms or anxiety). One study reported positive infant mental health or developmental effects.
The effects of reproductive justice-driven interventions on Black maternal and offspring mental health outcomes are promising, but studies are limited. Future studies should further identify active intervention components and assess mental health-related outcomes in both generations to improve the mental health of Black mothers and prevent negative intergenerational effects.
在参与本继续医学教育活动后，精神科医生应能够更好地：
• 讨论结构性种族主义对妊娠和产科护理的影响及其对孕产妇心理健康挑战和不公平结果的作用。
• 概述目前对在妊娠或分娩期间启动的、运用生殖正义原则改善黑人孕产妇围产期及代际心理健康结果的干预措施的理解。
在美国，与白人分娩者相比，黑人孕产妇结局存在显著的种族差异。孕产妇心理健康问题会对母亲及其婴儿产生负面影响。妊娠和产科护理期间的结构性种族主义影响可能导致不公平的孕产妇心理健康挑战和不良后代结局。生殖正义框架为解决这些不公平问题提供了一条途径。本系统评价考察了由生殖正义原则驱动的妊娠护理干预措施是否成功改善了黑人孕产妇围产期及代际心理健康结果。
本评价遵循系统评价与Meta分析的首选报告项目指南，对2024年11月在PubMed、PsycInfo和CINAHL中检索到的研究进行筛选。纳入的研究为美国黑人分娩父母及其后代的随机临床试验。纳入那些明确旨在增强自主性、社区参与、种族公平和/或文化相关性的、纳入生殖正义原则的干预措施。
检索共得到619条独特记录。经过筛选和全文审查，纳入12项研究。其中，7项研究报告了对心理健康结局有统计学意义的影响。干预措施包括人际治疗、文化定制的认知行为治疗、团体产前护理、社区卫生工作者家访以及一个在线教育平台。6项研究报告了对孕产妇心理健康结局（如抑郁症状或焦虑）有积极影响。1项研究报告了对婴儿心理健康或发育有积极影响。
由生殖正义驱动的干预措施对黑人孕产妇及其后代心理健康结局的影响很有前景，但研究有限。未来的研究应进一步确定有效的干预成分，并评估两代人的心理健康相关结局，以改善黑人母亲的心理健康并预防不良代际影响。
