Association between maternal and neonatal outcomes and psychosocial risk levels in pregnant women: a convergent parallel mixed methods study protocol

Perinatal psychosocial health has gained significant attention due to its impact on maternal and neonatal health outcomes. Elevated rates of mental health disorders during pregnancy and the initial postpartum year, particularly pronounced in low- and middle-income countries (LMICs), have been consistently linked to women’s heightened exposure to psychosocial risk factors. In response to this evidence, the current investigation is designed to evaluate psychosocial risk status among pregnant women and to explore its associations with both maternal and neonatal outcomes, employing a convergent mixed-methods design. A convergent parallel mixed‑methods design will be employed for this investigation. The quantitative strand comprises a prospective cohort study that will enroll 260 pregnant women at 12–14 weeks of gestation. Based on their ANRQ‑R total scores, participants will be divided into two groups: those scoring 23 or above (high‑risk) will form the exposed cohort, while those scoring below 23 (low‑risk) will constitute the non‑exposed cohort. Both groups will be followed prospectively until six weeks postpartum. At enrolment, a sociodemographic and obstetric characteristics form will be completed. A second data collection point at 31–34 weeks of gestation will involve administration of the Wijma Delivery Expectancy/Experience Questionnaire (W‑DEQ, version A), the Edinburgh Postnatal Depression Scale (EPDS), and the Pregnancy Experience Scale (PES). Postnatally, within six weeks after birth, the following instruments will be administered: a Maternal and Neonatal Outcomes Checklist, the EPDS, the Childbirth Experience Questionnaire version 2.0 (CEQ‑2), the Postpartum Specific Anxiety Scale Research Short‑Form, the Barkin Index of Maternal Functioning (BIMF), and a measure of Breastfeeding Self‑Efficacy. Running concurrently with the quantitative follow‑up, the qualitative phase will recruit participants through purposive sampling from both high‑ and low‑risk groups. Data will be generated via in‑depth, semi‑structured individual interviews using open‑ended questions, allowing for rich exploration of participants’ experiences. Finally, the findings from both the qualitative and quantitative strands will be integrated in the discussion section. Identifying psychosocially vulnerable mothers before the onset of mental health disorders during pregnancy, coupled with a deep understanding of the maternal and neonatal outcomes of these risk factors, can provide a roadmap for designing a healthcare system that preemptively safeguards maternal mental health. Furthermore, this approach can contribute to reducing healthcare system costs through timely screening, early intervention, and the effective management of psychosocial conditions. Contrary to past beliefs, mental health issues during pregnancy are as common as, and sometimes even more prevalent than, in the postpartum period. While pregnancy can be a vulnerable time for mental health, it also provides a unique “window of opportunity” for identifying and treating psychological and social challenges. For a mother who has experienced past trauma, pregnancy offers a chance to form a new, secure, and loving bond with her child—essentially providing a way to “rewrite” her own past experiences. Therefore, the objectives of this study include assessing psychosocial risk levels, determining their impact on maternal and neonatal outcomes, alongside an exploration of women’s perceived experiences of pregnancy, achieved by merging quantitative statistical data with in-depth qualitative accounts. This research uses a multi-phase “mixed-methods” approach in three stages: 1. Quantitative Phase: We will examine how psychosocial risk levels during pregnancy relate to maternal outcomes (such as the pregnancy and childbirth experience, and depression) and newborn outcomes (such as low birth weight); 2. Qualitative Phase: We will conduct in-depth, personal interviews with women to understand their individual stories and perceptions; 3. Mixed Phase: We will merge the statistical findings with the personal insights from the interviews to create a complete and clear picture of the situation. Given the lack of multifaceted screening tools and the critical gaps in prenatal mental health care, this research holds significant importance. It emphasizes the need for a proactive healthcare roadmap to safeguard maternal mental health, aligning with the goal of preventing adverse outcomes and ensuring comprehensive support for both mothers and newborns.