Munich, Germany: Researchers have shown that prenatal training may reduce the risk of postnatal depression in women, - but only if they have previously had a baby. This surprising finding is presented for the first time at the ECNP Congress in Munich.
Postpartum depression is a serious mood condition which affects around 1 in 7 women after giving birth, and may have important consequences for maternal wellbeing and family functioning, including suicide or infanticide. It is distinct from the more common 'baby blues', which typically involve short-lived emotional changes in the first days after birth and usually resolve spontaneously.
The randomised controlled trial enrolled 147 pregnant women considered at heightened risk of postpartum depression. Participants, all from the Copenhagen area, received either prenatal affective cognitive training (PACT) or care as usual. Follow-up data were available for 121 participants: 54 in the PACT group and 67 in the usual-care group.
The training consists of individual computerised and virtual reality-based sessions over a period of 5 weeks. The expectant mothers were given training on how to notice, interpret, and respond to emotional cues from babies, and then to practise different ways of responding in challenging situations. The aim was to prepare the expectant mothers for difficult situations before they arose.
The researchers saw that across all participants women who received training had better outcomes than those who did not receive training, but overall this did not reach statistical significance. However they found that women who had previously given birth had significantly better outcomes after a course of training; in these women, only 5.3% of participants suffered from post-birth depression, as opposed to 34.6% of women who had not received the training.
Study author Anne Juul Bjertrup (of the NEAD Centre, Copenhagen) said: "The strongest finding was among women who had previously given birth, which was something we didn't expect. One possible explanation is that the intervention asked participants to imagine their future infant and interactions with their baby while completing emotional and cognitive exercises. Women who already have had the experience of giving birth may have had a more concrete reference point for these tasks".
"Our results lead us to believe that that postpartum depression may not only be associated with how women feel during pregnancy, but also with how they process emotional information and that pregnancy may offer a window for preventive treatment before the baby is born," Bjertrup said. "They also raise the possibility that prevention may work differently in first and subsequent pregnancies. We need larger trials to confirm the parity-specific result, identify which parts of the intervention matter, and understand which women are most likely to benefit.
"There are several things which need clarification before we can think about introducing this training on a wider scale. For example, we know that there is no single reason for experiencing postpartum depression, and that this condition is significantly influenced by biological and psychosocial factors. So we need to treat the findings as interesting, but indicative".
Commenting, Dr Benedetta Vai, adjunct professor in Psychiatry at Università Vita-Salute San Raffaele in Italy, and core member of the ECNP network in perinatal psychiatry, said,
"This is an encouraging study, suggesting that pregnancy may be a window to prevent postpartum depression with a brief training that could reach many women. The training appeared to help women read their baby's cues more positively. This can start a virtuous circle, making mutual regulation between mother and baby easier from the very start." "This can be especially important for women who already have a child: some carry difficult experiences from a first pregnancy, and tuning in to a newborn with a toddler around isn't easy. The study needs to be confirmed in larger trials, also measuring the mother–infant relationship. But it's a promising direction."
