Abstract
BackgroundMaternal antenatal depression has long-term consequences for children’s health. We examined if home visits by community health workers (CHW) can improve growth outcomes for children of mothers who are antenatally depressed.MethodsA cluster randomized controlled trial of all pregnant, neighbourhood women in Cape Town, South Africa. Almost all pregnant women (98 %, N = 1238) were recruited and assessed during pregnancy, two weeks post-birth (92 %) and 6 months post-birth (88 %). Pregnant women were randomized to either: 1) Standard Care (SC), which provided routine antenatal care; or 2) an intervention, The Philani Intervention Program (PIP), which included SC and home visits by CHW trained as generalists (M = 11 visits). Child standardized weight, length, and weight by length over 6 months based on maternal antenatal depression and intervention condition.ResultsDepressed mood was similar across the PIP and SC conditions both antenatally (16.5 % rate) and at 6 months (16.7 %). The infants of depressed pregnant women in the PIP group were similar in height (height-for-age Z scores) to the children of non-depressed mothers in both the PIP and the SC conditions, but significantly taller at 6 months of age than the infants of pregnant depressed mothers in the SC condition. The intervention did not moderate children’s growth. Depressed SC mothers tended to have infants less than two standard deviations in height on the World Health Organization’s norms at two weeks post-birth compared to infants of depressed PIP mothers and non-depressed mothers in both conditions.ConclusionsA generalist, CHW-delivered home visiting program improved infant growth, even when mothers’ depression was not reduced. Focusing on maternal caretaking of infants, even when mothers are depressed, is critical in future interventions.Trial registrationClinicalTrials.gov registration # NCT00996528. October 15, 2009
Highlights
Maternal antenatal depression has long-term consequences for children’s health
In the most recent analyses of the Global Burden of Disease by the World Health Organization, mental and behavioural disorders are the largest contributors to the years lived with disability (YLD), accounting for 22.7 % of all YLD [1]
This study focuses on infants of antenatally depressed mothers in a community sample of pregnant women in South Africa over the first six months of life
Summary
Maternal antenatal depression has long-term consequences for children’s health. We examined if home visits by community health workers (CHW) can improve growth outcomes for children of mothers who are antenatally depressed. Depression is the most common of the mental health challenges [2] with the highest YLD (3.7 %), and is Maternal depression has repeatedly been demonstrated to negatively impact both mothers and their children [7, 8]. Children of depressed mothers consistently demonstrate mental health problems [10], yet the infant developmental outcome most affected by maternal depression remains unclear [11, 12]. Infant growth is more complex than being based solely on food security and caloric intake. Factors such as the health environment, availability of health care, and feeding and care practices of the mother influence infants’ growth
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