The transition to parenthood in obstetrics: enhancing prenatal care for 2-generation impact

Monk, Catherine; Dimidjian, Sona; Galinsky, Ellen; Gregory, Kimberly D.; Hoffman, M. Camille; Howell, Elizabeth A.; Osborne, C. Kent; Rogers, Cynthia; Saxbe, Darby; D’Alton, Mary E.

doi:10.1016/j.ajogmf.2022.100678

Cited by 8 publications

(6 citation statements)

References 105 publications

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“…Prenatal maternal depression is one of the strongest contributors to intergenerational transmission of depression, other forms of psychopathology, and neurodevelopmental delays. [4][5][6][7][8][9][10] However, the literature demonstrating such associations, including several impressive prospective longitudinal naturalistic studies examining potential risk mechanisms, are almost exclusively correlational. As such, these studies are "inherently limited for drawing causal conclusions" without the necessary "experimental control gained through intervention."…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 17% of pregnant individuals meet criteria for major depressive disorder (MDD) diagnosis, and up to 37% report elevated symptoms during pregnancy . Prenatal maternal depression confers intergenerational risks, including preterm birth as well as developmental delays, and enhanced vulnerability to psychopathology in offspring . The Perinatal Depression Task Force of the American College of Obstetricians and Gynecologists highlighted the need for early screening of depression and intervention during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

“…3 Prenatal maternal depression confers intergenerational risks, including preterm birth as well as developmental delays, and enhanced vulnerability to psychopathology in offspring. [4][5][6][7][8][9][10] The Perinatal Depression Task Force of the American College of Obstetricians and Gynecologists 11 highlighted the need for early screening of depression and intervention during pregnancy. Still, most published work and current health care policy has emphasized preventing postpartum depression with scant attention focused on reducing prenatal depression.…”

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confidence: 99%

“…There is a critical need to reduce depression within the prenatal period because both depression diagnosis and dimensional symptom elevations are risks for important health outcomes, including obstetric complications, preterm birth, decreased likelihood of breastfeeding, and child developmental delays. [20][21][22][23] Thus, reducing depression prenatally can benefit maternal health (eg, risk for postpartum depression) and improve offspring outcomes given links between prenatal depression and childhood developmental outcomes (eg, brain development, stress regulation, and psychopathology 5,6,[24][25][26][27] ). We report data from this RCT (the Care Project) in which we compared an evidence-based brief IPT (MOMCare [28][29][30] ) with enhanced usual care (EUC).…”

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Effect of Brief Interpersonal Therapy on Depression During Pregnancy

et al. 2023

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ImportancePrenatal depression is prevalent with negative consequences for both the mother and developing fetus. Brief, effective, and safe interventions to reduce depression during pregnancy are needed.ObjectiveTo evaluate depression improvement (symptoms and diagnosis) among pregnant individuals from diverse backgrounds randomized to brief interpersonal psychotherapy (IPT) vs enhanced usual care (EUC).Design, Setting, and ParticipantsA prospective, evaluator-blinded, randomized clinical trial, the Care Project, was conducted among adult pregnant individuals who reported elevated symptoms during routine obstetric care depression screening in general practice in obstetrics and gynecology (OB/GYN) clinics. Participants were recruited between July 2017 and August 2021. Repeated measures follow-up occurred across pregnancy from baseline (mean [SD], 16.7 [4.2] gestational weeks) through term. Pregnant participants were randomized to IPT or EUC and included in intent-to-treat analyses.InterventionsTreatment comprised an engagement session and 8 active sessions of brief IPT (MOMCare) during pregnancy. EUC included engagement and maternity support services.Main Outcomes and MeasuresTwo depression symptom scales, the 20-item Symptom Checklist and the Edinburgh Postnatal Depression Scale, were assessed at baseline and repeatedly across pregnancy. Structured Clinical Interview for DSM-5 ascertained major depressive disorder (MDD) at baseline and the end of gestation.ResultsOf 234 participants, 115 were allocated to IPT (mean [SD] age, 29.7 [5.9] years; 57 [49.6%] enrolled in Medicaid; 42 [36.5%] had current MDD; 106 [92.2%] received intervention) and 119 to EUC (mean [SD] age, 30.1 [5.9] years; 62 [52.1%] enrolled in Medicaid; 44 [37%] had MDD). The 20-item Symptom Checklist scores improved from baseline over gestation for IPT but not EUC (d = 0.57; 95% CI, 0.22-0.91; mean [SD] change for IPT vs EUC: 26.7 [1.14] to 13.6 [1.40] vs 27.1 [1.12] to 23.5 [1.34]). IPT participants more rapidly improved on Edinburgh Postnatal Depression Scale compared with EUC (d = 0.40; 95% CI, 0.06-0.74; mean [SD] change for IPT vs EUC: 11.4 [0.38] to 5.4 [0.57] vs 11.5 [0.37] to 7.6 [0.55]). MDD rate by end of gestation had decreased significantly for IPT participants (7 [6.1%]) vs EUC (31 [26.1%]) (odds ratio, 4.99; 95% CI, 2.08-11.97).Conclusions and RelevanceIn this study, brief IPT significantly reduced prenatal depression symptoms and MDD compared with EUC among pregnant individuals from diverse racial, ethnic, and socioeconomic backgrounds recruited from primary OB/GYN clinics. As a safe, effective intervention to relieve depression during pregnancy, brief IPT may positively affect mothers’ mental health and the developing fetus.Trial RegistrationClinicalTrials.gov Identifier: NCT03011801

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Brief Interpersonal Therapy on Depression During Pregnancy

et al. 2023

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“…The promotion of optimal neurobehavioral development with respect for both typically developing and neurodiverse individuals ultimately is the responsibility of regional governments (including legislation, guided by updated guidelines of global health organization [175,228–232]), which in turn need input from (progress made in) science [19]. It is proposed that public health policy and pediatric [16,20,233,234] and obstetrical care [15 ▪ ,235] jointly address the first 1001 critical days. However, this challenging task can only be achieved when responsibility is shared not only by governments, global health organizations and science but within and between groups of healthcare professionals (in primary, secondary and tertiary care), parents and other stakeholders, research communities, health and social policy leaders and the general public [28 ▪▪ ,195].…”

Section: Global Mental Health and The Promotion Of Neurobehavioral De...mentioning

confidence: 99%

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation

Van den Bergh,

Antonelli,

Stein

2024

Current Opinion in Psychiatry

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Purpose of review Perinatal mental health research provides an important perspective on neurobehavioral development. Here, we aim to review the association of maternal perinatal health with offspring neurodevelopment, providing an update on (self-)regulation problems, hypothesized mechanistic pathways, progress and challenges, and implications for mental health. Recent findings (1) Meta-analyses confirm that maternal perinatal mental distress is associated with (self-)regulation problems which constitute cognitive, behavioral, and affective social-emotional problems, while exposure to positive parental mental health has a positive impact. However, effect sizes are small. (2) Hypothesized mechanistic pathways underlying this association are complex. Interactive and compensatory mechanisms across developmental time are neglected topics. (3) Progress has been made in multiexposure studies. However, challenges remain and these are shared by clinical, translational and public health sciences. (4) From a mental healthcare perspective, a multidisciplinary and system level approach employing developmentally-sensitive measures and timely treatment of (self-)regulation and coregulation problems in a dyadic caregiver-child and family level approach seems needed. The existing evidence-base is sparse. Summary During the perinatal period, addressing vulnerable contexts and building resilient systems may promote neurobehavioral development. A pluralistic approach to research, taking a multidisciplinary approach to theoretical models and empirical research needs to be fostered.

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