Testing the Benefits of Reducing Prenatal Maternal Depression for Maternal and Infant outcomes: A randomized controlled trial

Abstract

Depression is one of the most common prenatal complications affecting 13 to 40 percent of pregnant individuals. Prenatal depression has far-reaching implications for both the mother and for the next generation, including premature birth, dysregulation of stress physiology, developmental delays, and vulnerability to psychopathology. Despite this clear need, there is a dearth of available and efficacious prenatal interventions. Further, few studies have evaluated physiological pathways by which reducing maternal depression may benefit the fetus. The Care Project uses a randomized controlled trial design (RCT) to test a culturally sensitive psychotherapy intervention (brief interpersonal therapy) designed for pregnant individuals (MomCare). Effects of the intervention on both psychological well-being and neurobiological processes will be assessed. This RCT included 234 pregnant participants [119 enhanced usual care (EUC) and 115 active treatment (MomCare)]. Depression symptoms were assessed at baseline and throughout gestation; Symptom Checklist-20. Prenatal maternal cortisol and placental corticotropin releasing hormone and infant brain and behavioral markers also were assessed. Analyses were conducted using an intent to treat design by a biostatistician blind to group condition. Employing hierarchical linear modeling, analyses revealed a significantly faster rate of decrease in depression symptoms over pregnancy between the MomCare (8.9 pts) and EUC (3.1 pts) groups, t(229)=3.77, p=.0002; medium effect size (D=0.50, 95%CI 0.16-0.84). The prenatal intervention, MomCare, resulted in a meaningful reduction in prenatal maternal depression symptoms. Next steps include testing the hypothesis that reducing maternal prenatal depression will influence both prenatal biological pathways and infant neurodevelopment assessed through age 4.