Antenatal mobile-delivered mindfulness-based intervention to reduce perinatal depression risk and improve obstetric and neonatal outcomes: A randomized controlled trial

Abstract

<p><strong><em>Introduction:</em></strong> Around one in four mothers will experience symptoms of depression during pregnancy and within the first year postnatal. The implications of perinatal mental health on obstetric and birth outcomes are also profound, making it a crucial public health issue worldwide. The stigma surrounding perinatal mental health, perceived social pressure and familiar obligation, and the physical constraint during this special life circumstance underscores the importance of intervention studies addressing the management of perinatal mental health outside of traditional clinic settings.</p><p><strong><em>O</em></strong><strong><em>bjective:</em></strong> The present study aimed to test whether a guided mobile-delivered mindfulness-based intervention (MBI) conducted during pregnancy could reduce the risk of postpartum depression, and whether this would lead to improvements in obstetric and neonatal outcomes.</p><p><strong><em>Methods: </em></strong>We compared a mobile-delivered MBI to a structurally matched web-based perinatal education program in a parallel-arm, randomized controlled trial amongst 75 pregnant women in the early 2020. The primary outcome included the severity and presence of postpartum depression, while secondary outcomes were anxiety, pregnancy-related stress, general stress, mindfulness, obstetric and neonatal outcomes 1-month postpartum.</p><p><strong><u>Results:</u></strong> In intention-to-treat analyses, pregnant women receiving the intervention showed a greater reduction in depressive symptom from baseline to 1-month postpartum (β=-6.3; 95%CI -8.46 to -4.12; d=-1.0) and reduced the risk of having a clinical depression (odds ratio =0.003, 95%CI= [ 0.00 to 0.04]), compared to those in control groups. Pregnant women in intervention group also reported significantly reduced risk of having an emergent cesarean section (odd ratio = 0.1) and gave birth to infants with higher Apgar scores (β=-0.5; 95%CI 0.00 to 1.13). Improvements from baseline to 1-month postpartum follow-up were statistically significant on anxiety, pregnancy-related stress, general stress and mindfulness. </p><p><strong><u>Conclusions:</u> </strong>The mobile-delivered MBI can be an acceptable and effective preventive intervention for reducing depression from pregnancy to postpartum period. This is the first study that suggests the potential of preventive psychological intervention for the expectant mothers in mitigating the risk of emergent cesarean section, and enhancing neonatal health.</p>