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

backgroundPerinatal 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. METHODS/

designA 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. DISCUSSION: 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.