Published online Feb 19, 2026. doi: 10.5498/wjp.v16.i2.113734
Revised: October 8, 2025
Accepted: November 13, 2025
Published online: February 19, 2026
Processing time: 148 Days and 22.3 Hours
Perinatal anxiety and depression are prevalent conditions associated with sig
To evaluate the clinical value of a multidisciplinary closed-loop intervention in improving pregnancy outcomes and promoting postpartum recovery in pregnant women with anxiety and depression.
We conducted a randomized controlled trial involving 240 pregnant women with anxiety and depressive symptoms who received regular prenatal care at Shanghai Songjiang Maternal and Child Health Hospital between January 2024 and January 2025. Participants were randomized to an intervention group (multidisciplinary closed-loop intervention) or a control group (routine care). Delivery outcomes, maternal and neonatal complications, and postpartum pelvic floor function were compared.
The intervention group exhibited significantly lower rates of cesarean section (31.7% vs 44.2%, P < 0.05), adverse maternal outcomes (15% vs 32.5%, P < 0.01), and adverse neonatal outcomes (6.7% vs 15.8%, P < 0.05). Additionally, the inter
This integrated multidisciplinary closed-loop intervention model effectively improves maternal and infant out
Core Tip: This pioneering study establishes a multidisciplinary closed-loop psychological intervention model for pregnant women with psychological dysfunction. Key findings demonstrate: 31.7% cesarean rate (vs 44.2% in controls; P < 0.05); 50% reduction in adverse maternal outcomes (15% vs 32.5%; P < 0.01); Improved postpartum pelvic floor recovery (dynamic electromyography activity increase, P < 0.05). The model integrates obstetric, psychological, and nutritional expertise through a “screening-intervention-feedback” loop, providing class A evidence for perinatal mental health guidelines.
- Citation: Shen TT, Zhang YJ, Xie QX. Effect of multidisciplinary closed-loop care on pregnancy outcomes in anxiety and depression. World J Psychiatry 2026; 16(2): 113734
- URL: https://www.wjgnet.com/2220-3206/full/v16/i2/113734.htm
- DOI: https://dx.doi.org/10.5498/wjp.v16.i2.113734
Profound hormonal fluctuations during pregnancy can induce significant physiological and psychological stress responses in expectant mothers[1]. This heightened stress state contributes to the high prevalence of adverse emotional symptoms, such as anxiety and depression, which pose considerable threats to both maternal and infant health. In recent years, aligned with national initiatives like the maternal and infant safety action plan, the Chinese government has increasingly emphasized maternal mental health, explicitly urging maternal and child health institutions to strengthen perinatal mental healthcare systems.
Although psychological counseling has been shown to alleviate pregnancy-related anxiety and depression[2], research in this domain within China remains exploratory. Intervention models are often constrained by limited coverage and inefficient resource allocation, struggling to meet the growing mental health needs of the perinatal population[3]. While traditional one-on-one interventions provide personalized support, their service capacity is limited by the availability of psychological counselors. Moreover, single-discipline interventions frequently overlook the interactions between psychological issues and physiological or social factors, resulting in insufficient intervention depth and sustainability.
Consequently, developing scientific and efficient supportive intervention programs is a practical necessity. Such initiatives are critical not only for reducing adverse pregnancy outcomes (e.g., preterm birth, postpartum depression) and optimizing healthcare resource allocation but also for safeguarding maternal and infant health and alleviating burdens on families and society.
The multidisciplinary collaboration and closed-loop psychological intervention model proposed here addresses these challenges. By establishing a multidisciplinary consultation mechanism involving obstetrics, psychology, neonatology, pelvic floor rehabilitation, internal medicine, traditional Chinese medicine, and nutrition, this model integrates specialized resources across disciplines to develop comprehensive mental health management plans covering the pre-pregnancy, pregnancy, and postpartum periods. Centered on positive group interactions, it leverages experience sharing, emotional support, and behavioral modeling to stimulate individual self-growth, alleviate psychological distress, and enhance adaptive capacities. Its “assessment-intervention-follow-up-optimization” closed-loop management system ensures both the specificity and continuity of interventions while enhancing synergistic effects through group dynamics, offering a more efficient and in-depth solution to maternal psychological issues.
Pregnant women who received regular prenatal care and delivered at Shanghai Songjiang Maternal and Child Health Hospital between January 2024 and January 2025 were enrolled in this study.
Based on national vaginal delivery rates, we assumed vaginal delivery rates of 80% for the intervention group and 60% for the control group, anticipating a 20% difference. With α = 0.05 and β = 0.10 (power = 90%), and referencing f (0.05, 0.10) = 10.5, the minimum required sample size was calculated to be at least 105 cases per group. Accounting for a 12% attrition rate, each group was expanded to 120 participants, resulting in a total sample size of 240.
Study subject selection criteria: Eligible participants were randomly allocated to either the intervention group or the control group in a 1:1 ratio. An independent statistician generated the allocation sequence using the random number generator in SPSS software (Version 22.0). Outcome assessors were blinded to group allocation (single-blind design).
Inclusion criteria: Pregnant women who registered for antenatal care and delivery at this hospital.
Exclusion criteria: (1) Severe pregnancy complications (e.g., placental abruption) affecting delivery mode or safety; (2) Non-indications for vaginal delivery [e.g., abnormal fetal position (breech presentation, transverse lie), central/placenta previa]; (3) Mental or cognitive disorders [e.g., schizophrenia, severe depression (active phase), intellectual disability] impairing self-assessment or follow-up; Major organ dysfunction [e.g., chronic kidney disease ≥ 3, heart failure (New York Heart Association ≥ III), decompensated cirrhosis] increasing delivery risk; (4) Fetal abnormalities [e.g., severe structural malformations (anencephaly, congenital heart disease), chromosomal abnormalities (trisomy 21)] requiring termination; and (5) Pre-pregnancy or prenatal diagnosis of pelvic floor dysfunction (e.g., stress urinary incontinence, hypertonic pelvic floor muscles) with prior rehabilitation treatment or surgery.
Ethical review: This study was approved by the Medical Ethics Committee of Songjiang District Maternal and Child Health Hospital in Shanghai (approval No. 20230728). All procedures complied with ethical standards, and participants’ rights were protected.
This randomized controlled trial assigned eligible pregnant women to a control group (receiving routine perinatal mental health management) or an intervention group (receiving routine care plus multidisciplinary collaboration and closed-loop psychological intervention).
The control group received standardized screening, assessment, and graded management: Screening and assessment: The Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were administered during the first (≤ 13+6 weeks), second (14-27+6 weeks), and third trimesters (≥ 28 weeks). Both scales comprise 20 self-report items. Total raw scores were summed and converted to standard scores (raw score × 1.25, rounded). Mental state grades were defined as: SDS 53-62 (mild depression), 63-72 (moderate), > 72 (severe); SAS 50-59 (mild anxiety), 60-69 (moderate), > 69 (severe). “Anxiety and depression” was defined as ≥ 1 abnormal SAS/SDS screening (using the most severe grade).
Graded education and classified management: For mild symptoms: Healthcare providers advised on self-care: Maintaining a regular sleep cycle; Communicating with family/friends; Practicing relaxation techniques (e.g., deep breathing); Attending antenatal education. For moderate-to-severe symptoms: Referral to the perinatal mental health clinic for individualized plans (e.g., cognitive-behavioral therapy).
The intervention group received additional multidisciplinary closed-loop psychological intervention, implementing a “team collaboration-systematic education-follow-up reinforcement” system for multi-dimensional support.
Multidisciplinary collaboration team: Included: 1 obstetric deputy chief physician (coordination); ≥ 2 obstetric attending physicians (complication management); 1 psychologist (emotional intervention); 1 dietitian (nutritional guidance); 1 head nurse (quality control); Charge nurses (follow-up).
Psychological intervention workflow: A “classroom education + personalized guidance + follow-up reinforcement” model was adopted, with six weekly 1-hour group sessions.
Session 1: Education on physiological and psychological changes: Obstetricians explained hormonal effects, physical changes, and normal emotional fluctuations using clinical cases.
Session 2: Individualized psychological support: Psychologists employed active listening and nonverbal commu
Session 3: Multidisciplinary collaborative discussion: Small groups (6-8) discussed challenges with specialists: Obstetricians (complications), psychologists (fear reduction), dietitians (nutrition/exercise), nurses (self-monitoring).
Session 4: Practical skills and childbirth preparation: Included prenatal yoga, simulated labor drills (birth balls, breathing techniques), and interpretation of prenatal indicators for anxious women.
Session 5: Postpartum adaptation and role transition: Covered pelvic floor screening, breastfeeding techniques, infant care, and building a “family support system”.
Session 6: Emotional management and family support: Addressed cognitive restructuring, stress reduction, and family communication strategies.
Closed-loop follow-up: Obstetricians assessed intervention effectiveness (emotional status, behavior change, health indicators). Suboptimal outcomes triggered reinforced education or re-evaluation at the mental health clinic, establishing a screening, assessment, intervention, follow-up, re-evaluation loop.
Pelvic floor muscle function was assessed at 42 days postpartum using the Mailand Medlander device via surface electromyography (sEMG), evaluating four stages: (1) Pre-resting phase: Assessed resting tone (sEMG > 4 μV indicates hypertonicity, risk of dyspareunia/retention); (2) Fast-twitch phase: Evaluated type II fiber strength/response (reduction risks incontinence); (3) Slow-twitch phase: Measured type I fiber endurance/stability (reduction risks prolapse/defecatory dysfunction); and (4) Post-resting phase: Re-assessed post-contraction recovery (sEMG > 4 μV indicates poor relaxation).
Primary outcomes included: (1) Delivery mode: Cesarean section rate (%); (2) Vaginal delivery outcomes: Vaginal delivery outcomes: Labor duration (hour); Perineal injury (% lacerations/episiotomy); (3) Neonatal outcomes: Incidence of preterm birth (< 37 weeks), macrosomia (≥ 4000 g), asphyxia (Apgar ≤ 7 at 5 minutes), malformations; (4) Maternal outcomes: Incidence of gestational hypertension, gestational diabetes mellitus (International Association of Diabetes and Pregnancy Study Groups criteria), postpartum hemorrhage, polyhydramnios (amniotic fluid index > 25 cm), oligohydramnios (amniotic fluid index ≤ 5 cm); and (5) Postpartum 42-day pelvic floor muscle screening scores: Medlander total score (< 80 unqualified; ≥ 80 qualified).
Data were analyzed using SPSS 22.0. Measurement data are expressed as mean, with intergroup comparisons via t test. Count data are expressed as n (%), with χ2 test. A P < 0.05 was considered statistically significant.
The cesarean section rate was significantly lower in the intervention group than in the control group (31.7% vs 44.2%, P < 0.05). Accordingly, the vaginal delivery rate was higher in the intervention group (68.3% vs 55.8%, P < 0.05) (Table 1).
Among vaginal deliveries, the intervention group had a higher rate of normal labor progression (96.3% vs 86.5%, P < 0.05) and a higher incidence of intact perineum (50.0% vs 32.8%, P < 0.05) (Table 2).
Maternal outcomes: The overall incidence of adverse maternal outcomes was significantly lower in the intervention group (15% vs 32.5%, P < 0.01) (Table 3).
| Group | Cases | Gestational hypertension | Gestational diabetes mellitus | Postpartum hemorrhage | Oligohydramnios | Polyhydramnios | Total |
| Control group | 120 | 8 | 18 | 4 | 5 | 4 | 39 (32.5) |
| Intervention group | 120 | 3 | 11 | 1 | 2 | 1 | 18 (15.0) |
| χ2 value | 10.15 | ||||||
| P value | 0.0014a |
Neonatal outcomes: The overall incidence of adverse neonatal outcomes was significantly lower in the intervention group (6.7% vs 15.8%, P < 0.05) (Table 4).
The intervention group demonstrated significantly better pelvic floor muscle function, based on both dynamic and resting electromyographic parameters, compared to the control group (all P < 0.05) (Table 5).
Pregnant and postpartum women constitute a psychologically vulnerable population, a status attributable to the complex interplay of physiological changes, psychological stress, and socio-environmental factors characteristic of the perinatal period. China has a high rate of prenatal depression and anxiety compared to other countries. Studies have shown the prevalence of prenatal anxiety to be between 1.8% to 42.1%[4]. The pooled prevalence rate of perinatal depression was 16.3%. The prevalence of perinatal depression has demonstrated a significant increasing trend[5]. Estimates of the rates of antenatal depression in China have ranged from 6% to 28%, while depression rates in the first postpartum year have ranged from 10% to 28%[6]. Analyses indicated higher postnatal depression prevalence in low-income and lower middle-income countries[7]. These conditions pose significant threats to maternal health, elevating the risks of postpartum hemorrhage, prolonged labor, and postpartum depression, while also predisposing neonates to adverse outcomes such as preterm birth and low birth weight[8,9]. Despite the established risks, a substantial care gap persists; approximately half of affected women do not receive standardized psychological care, often hindered by mental health stigma and insufficient awareness[10,11].
Although evidence-based strategies including early prevention, systematic screening, and interventions such as interpersonal psychotherapy, cognitive-behavioral therapy, and mindfulness-based approaches have demonstrated efficacy in improving perinatal mental health[12-15], their real-world implementation faces considerable obstacles. Conventional one-on-one psychological support is inherently limited in scalability, while standard group interventions often fail to provide systematic personalization, resulting in inadequate population coverage and suboptimal inter
To address these limitations, a multidisciplinary collaborative and closed-loop psychological intervention model has emerged as a promising alternative. This model, operationalized through a structured “consultation-assessment-recommendation-support-follow-up” management cycle, integrates expertise from obstetrics, psychology, nutrition, and other relevant disciplines to formulate and deliver individualized care plans. By leveraging closed-loop feedback mechanisms and interdisciplinary coordination, this approach enhances both the precision and effectiveness of psychological support, representing an advanced paradigm in perinatal mental health care[16-18].
Evidence suggests that anxiety can dysregulate labor progression by activating the sympathetic nervous system (SNS) and stress hormone pathways, leading to impaired uterine contractility and contributing to prolonged labor[19]. Elevated catecholamine levels, particularly via β2-adrenergic receptor signaling, directly inhibit myometrial activity, reducing the frequency and intensity of uterine contractions and potentially resulting in dystocia[20]. Furthermore, anxiety and fear can activate the hypothalamic-pituitary-adrenal axis, increasing circulating levels of catecholamines and cortisol[21]. The fear of labor pain can also intensify maternal tension, establishing a vicious cycle of “anxiety-prolonged labor-increased anxiety”, which may ultimately increase the likelihood of cesarean delivery.
A principal mechanism through which psychological interventions may improve labor outcomes is the attenuation of the maternal stress response. In the present study, the multidisciplinary closed-loop care model likely mitigated SNS overactivation, corresponding to the observed significant reduction in cesarean section rates and the higher success rates and reduced trauma associated with vaginal deliveries in the intervention group.
This beneficial effect may be attributed to two core components of the intervention. First, systematic education regarding the medical indications and potential risks (e.g., bleeding, infection) of cesarean section likely helped to reduce requests for cesarean delivery driven by non-medical factors or cognitive biases. Second, detailed explanations of the vaginal birth process, combined with training in emotion regulation techniques and instructed use of abdominal pressure during the second stage of labor, appeared to enhance parturient cooperation. These elements collectively contributed to a lower incidence of precipitate labor and perineal injury, promoted efficient labor progression, bolstered confidence in natural childbirth, and thereby reduced rates of prolonged labor. Psychological support can alleviate negative maternal emotions and reduce cesarean delivery rates[22].
Prenatal anxiety and depression are significantly associated with an increased risk of adverse obstetric events, including spontaneous abortion, preterm birth, fetal growth restriction, and congenital anomalies[23-26]. Multidisciplinary collaborative model can improve maternal and neonatal outcomes[27]. The multidisciplinary closed-loop psychological intervention evaluated in our study appears to exert its positive effects through a dual-pathway mechanism: It enhances pregnant women’s awareness of obstetric risks thereby promoting active engagement in self-management behaviors such as blood pressure[28] and glucose monitoring while also providing individualized guidance on diet, gestational weight management, physical activity (e.g., prenatal yoga), and cessation of unhealthy behaviors like smoking and alcohol use. These combined actions help to mitigate adverse pregnancy events at their origin. Corroborating these mechanisms, our data indicate that the incidence of a composite outcome encompassing both maternal and neonatal complications was significantly lower in the intervention group, supporting the overall effectiveness of this integrated approach.
The psychological state during the puerperium is a significant of pelvic floor functional recovery[29]. The superior pelvic floor muscle function observed in the intervention group at the 42-day postpartum assessment can be explained by a dual mechanism: A reduction in baseline muscular tonicity and an enhancement of neuromuscular coordination.
Psychological distress can involve the pelvic floor. Anxiety may contribute to pelvic floor dysfunction, characterized by associated symptoms such as dyspareunia, urinary retention, and constipation[30]. The continuous psychological support provided through the closed-loop intervention, which incorporated stress management and relaxation training, likely promoted generalized muscle relaxation[31]. Mechanistically, this effect can be attributed to the role of relaxation techniques in enhancing parasympathetic nervous system activity, thereby counterbalancing sympathetic arousal and facilitating muscle release.
By reducing both pre- and post-rest sEMG values, the intervention may have alleviated ischemia and pain related to pelvic floor hypertonicity, creating more favorable conditions for tissue healing and functional recovery postpartum. In the present study, the enhanced pelvic floor recovery in the intervention group may therefore be attributed to the sustained psychological support during pregnancy, which helped maintain emotional stability, reduced anxiety-driven pelvic floor tension, and consequently supported the postpartum rehabilitation process.
This study has several limitations. First, the single-center design and modest sample size may constrain the generalizability of the findings. Second, the multifactorial and integrated nature of the intervention complicates the identification of its most active components. Third, the reliance on self-reported psychological scales (e.g., SAS/SDS) introduces the potential for reporting bias. Finally, the follow-up period was limited to 42 days postpartum, leaving the long-term effects on maternal mental health and pelvic floor recovery uncertain. Future studies should seek to validate these results through larger, multi-center trials with prolonged follow-up and more objective outcome measures. Subsequent research may also focus on refining multidisciplinary collaboration mechanisms such as by developing integrated information platforms and standardized team training protocols to support the scalable implementation of this intervention model.
The multidisciplinary collaborative, closed-loop psychological intervention, delivered through a systematic and full-cycle service model, not only effectively alleviates anxiety and depression among perinatal women but also demonstrates synergistic benefits across multiple outcomes including delivery experience, maternal and infant health, and postpartum recovery. This approach provides integrated psychological, physiological, and social support for pregnant women with psychological distress and represents a promising strategy for improving perinatal health outcomes.
We sincerely thank all the pregnant women who participated in this study for their time and commitment. We are also deeply grateful to the members of the multidisciplinary team including colleagues from the Department of Obstetrics and Gynecology, Psychology Unit, Nutrition Section, and Nursing Team for their professional collaboration and unwavering support throughout this project.
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