The Mind–Heart Connection in the Perinatal Period 🧠❤️
- Dr. Kesha Nelson
- 22 hours ago
- 2 min read
1. Physiological Pathways: Stress & the Cardiovascular System
Perinatal mood and anxiety disorders (PMADs) — including depression, anxiety, PTSD, and perinatal bipolar disorder — directly impact cardiovascular functioning.
Chronic stress and untreated mental health conditions:
Increase cortisol and catecholamines
Activate the sympathetic nervous system
Promote inflammation
Contribute to endothelial dysfunction
This can elevate risk for:
Gestational hypertension
Preeclampsia
Peripartum cardiomyopathy
Arrhythmias
Long-term cardiovascular disease
The perinatal period is essentially a cardiovascular stress test. When layered with untreated psychological stress, the burden multiplies.
2. Depression, Anxiety & Cardiac Risk
Research consistently links:
Perinatal depression → higher blood pressure
Anxiety disorders → increased heart rate variability disruption
PTSD → elevated inflammatory markers
Sleep disruption (common in PMADs) further:
Increases insulin resistance
Worsens blood pressure regulation
Raises cardiovascular risk
As PMHNPs, we assess beyond mood — we assess:
Sleep patterns
Appetite changes
Psychomotor changes
Medication adherence
Stress load
All of these influence cardiac outcomes.
3. Psychotropic Medications & Cardiovascular Considerations
From a prescribing lens, PMHNPs must balance:
SSRIs and blood pressure effects
SNRIs and potential BP elevation
Antipsychotics and metabolic risk
Mood stabilizers and cardiac conduction considerations
Careful collaboration with OB, cardiology, and primary care is essential when:
Hypertension is present
There is a history of cardiomyopathy
The patient is on antihypertensives
There are metabolic risk factors
This is integrated care — not siloed prescribing.
4. Structural & Racial Disparities
Cardiovascular disease is the leading cause of pregnancy-related death in the U.S.
Black women experience:
Higher rates of hypertensive disorders of pregnancy
Increased maternal mortality
Higher rates of untreated perinatal mood disorders
Chronic exposure to racism-related stress:
Elevates allostatic load
Accelerates vascular aging
Increases the inflammatory response
From a PMHNP lens, racial trauma is a cardiovascular risk factor.
5. Behavioral Mediators
Untreated perinatal mental illness may contribute to:
Missed prenatal appointments
Poor nutrition
Substance use
Reduced physical activity
Medication non-adherence
All of which compounds cardiac risk.
6. Postpartum Period: A High-Risk Window
The postpartum period is:
A peak time for mood disorders
A peak time for cardiomyopathy
A peak time for hypertensive crises
Symptoms like:
Fatigue
Shortness of breath
Sleep disturbance
Can be misattributed to “normal postpartum adjustment” when they may signal:
Depression
Anxiety
Or cardiac decompensation
PMHNPs play a critical role in differentiating psychiatric vs. medical red flags.
Clinical Implications for PMHNP Practice
Screening
EPDS / PHQ-9 + blood pressure review
Trauma screening
Sleep assessment
Social determinants screening
Collaboration
OB
Cardiology
Maternal–fetal medicine
Primary care
Prevention Framing
We should conceptualize perinatal mental health treatment as:
Cardiovascular prevention.
Treating depression is not just improving mood — it may be reducing future heart disease.
“The heart and the mind do not operate independently in the perinatal period. When we treat one without the other, we miss the whole patient.”
Kesha Nelson, PhD, MSN/Ed, RN, APRN-CNP, PMHNP-BC, ADHD-CCSP
Director of Mental Health – BLACK BERRY & JUICE
The BLACK Collaborative Inc.
Yesssssss! All of this!