Abstract
BackgroundPostpartum depression (PPD) and poor childbirth outcomes are associated with poverty; these variables should be addressed by an adapted approach. The aim of this research was to evaluate the impact of an antenatal programme based on a novel psychosomatic approach to pregnancy and delivery, regarding the risk of PPD and childbirth outcomes in disadvantaged women.MethodsA multi-centre, randomized, controlled trial comparing a novel to standard antenatal programme. Primary outcome was depressive symptoms (using EPDS) and secondary outcome was preterm childbirth (fewer 37 weeks). The sample comprised 184 couples in which the women were identified to be at PPD risk by validated interview. The study was conducted in three public hospitals with comparable standards of perinatal care. Women were randomly distributed in to an experimental group (EG) or a control group (CG), and evaluated twice: during pregnancy (T1) and four weeks post-partum (T2). At T2, the variables were compared using the chi square test. Data analysis was based on intention to treat. The novel programme used the Tourné psychosomatic approach focusing on body awareness sensations, construction of an individualized childbirth model, and attachment. The 10 group antenatal sessions each lasted two hours, with one telephone conversation between sessions. In the control group, the participants choose the standard model of antenatal education, i.e., 8 to 10 two-hour sessions focused on childbirth by obstetrical prophylaxis.ResultsA difference of 11.2% was noted in postpartum percentages of PPD risk (EPDS ≥ 12): 34.3% (24) in EG and 45.5% (27) in CG (p = 0.26). The number of depressive symptoms among EG women decreased at T2 (intragroup p = 0.01). Premature childbirth was four times less in EG women: three (4.4%) compared to 13 (22.4%) among CG women (p = 0.003). Birth weight was higher in EG women (p = 0.01).ConclusionsThe decrease of depressive symptoms in women was not conclusive. However, because birth weight was higher and the rate of preterm childbirth was lower in the EG, our results suggest that the psychosomatic approach may be more helpful to the target population than the standard antenatal programs.
Highlights
Postpartum depression (PPD) and poor childbirth outcomes are associated with poverty; these variables should be addressed by an adapted approach
Pregnant women at risk of postpartum depression (PPD) and their partners were randomly assigned to a control group (CG) or an experimental group (EG) by a random sampling allocation sequence
The high percentage of postpartum depressive symptoms (39.34% with EPDS score ≥12) among all participating women confirms that socioeconomic status has a high impact on PPD risk
Summary
Postpartum depression (PPD) and poor childbirth outcomes are associated with poverty; these variables should be addressed by an adapted approach. Between 10 and 15% of new mothers show depressive symptoms [1,2] This prevalence justifies prevention of this universal public health problem [3], in women with low socioeconomic status, of whom nearly one in four suffers from postpartum depression (PPD) [4,5]. In the Diagnostic and Statistical Manual of Mental Disorders [8], PPD is categorized as a major depression and is defined as a depressive episode appearing within four weeks after childbirth. Some authors describe it as a medical/psychiatric disorder that includes both psychological and physiological aspects [9]. It is important to differentiate between non-psychotic depression and two other postnatal affective disorders: baby blues and postpartum psychosis
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