Offspring outcomes after prenatal interventions for common mental disorders: a meta-analysis

Marlies E Brouwer,Claudi L H Bockting,Sam E Van Grinsven,Alishia D Williams,Mijke P Lambregtse-Van Den Berg,Pim Cuijpers,Huibert Burger

doi:10.1186/s12916-018-1192-6

Abstract

BackgroundIt is presumed that pharmacological and non-pharmacological treatment of prenatal common mental disorders can mitigate associated adverse effects in offspring, yet strong evidence for the prophylactic benefits of treatment is lacking. We therefore examined the effect of prenatal treatments for common mental disorders on offspring outcomes.MethodsFor this meta-analysis, articles published up to August 31, 2017, were obtained from PubMed, PsycInfo, Embase, and Cochrane databases. Included studies needed to be randomized controlled trials (RCTs) on the effect of treatment of prenatal common mental disorders comparing an intervention to a control condition, including offspring outcome(s). Random effects models were used to calculate Hedges’ g in the program Comprehensive Meta-Analysis© (version 3.0).ResultsSixteen randomized controlled trials among 2778 pregnant women compared offspring outcomes between prenatal interventions and control groups. There were zero pharmacological, 13 psychological, and three other interventions (homeopathy, relaxation interventions, and short psycho-education). Birth weight (mean difference 42.88 g, g = 0.08, 95% CI −0.06 to 0.22, p = 0.27, n = 11), Apgar scores (g = 0.13, 95% CI −0.28 to 0.54, p = 0.53, n = 4), and gestational age (g = 0.03, 95% CI −0.06 to 0.54, p = 0.49, n = 10) were not significantly affected. Other offspring outcomes could not be meta-analyzed due to the inconsistent reporting of offspring outcomes and an insufficient number of studies.ConclusionsNon-pharmacological interventions had no significant effect on birth outcomes, although this outcome should be considered with caution due to the risk of biases. No randomized controlled trial examined the effects of prenatal pharmacological treatments as compared to treatment as usual for common mental disorders on offspring outcomes. Present clinical guidelines may require more research evidence on offspring outcomes, including child development, in order to warrant the current recommendation to routinely screen and subsequently treat prenatal common mental disorders.Trial registrationPROSPERO CRD42016047190

Highlights

It is presumed that pharmacological and non-pharmacological treatment of prenatal common mental disorders can mitigate associated adverse effects in offspring, yet strong evidence for the prophylactic benefits of treatment is lacking
Citations and references of included articles and 207 reviews resulted in 129 additional articles
Seven studies focused on depression only [44,45,46,47,48,49,50], two on both depression and anxiety [51, 52], three on anxiety only [53,54,55], two on fear of childbirth [56, 57], one on posttraumatic stress disorder (PTSD) [58], one on stress in general [59], and one on various common mental disorders [60]

Summary

Introduction

It is presumed that pharmacological and non-pharmacological treatment of prenatal common mental disorders can mitigate associated adverse effects in offspring, yet strong evidence for the prophylactic benefits of treatment is lacking. Similar to the effects of low birth weight, children from women who had a mental disorder during pregnancy have a two to three times increased risk for the development of psychopathology [9]. This includes an increased risk of symptoms of depression in (late) adolescence [10], an increased risk of anxiety in the ages 6 to 9 years old, and internalizing and externalizing (psychiatric) problems at the ages 2 to 6 [2, 11, 12]. Theoretical accounts of the associations between prenatal mental health and offspring outcomes focus on a cascade of processes, such as activation of the stress-response (hypothalamic-pituitary-adrenal [HPA] axis), (epi)genetics, e.g., methylation of “stress” genes, elevated levels of intrauterine cytokines or glucocorticoids, and poor self-care during pregnancy (e.g., smoking, disturbed appetite) or poor mother-child attachment in the postpartum period due to the disabling nature of mental health problems [10, 14,15,16,17,18]

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