Previous research has shown that higher levels of depressive symptoms during pregnancy may be associated with lower levels of maternal-fetal attachment (MFA).  Other studies have indicated that poor MFA is a significant predictor of worse outcomes in terms of mother-infant interactions and infant attachment security.  A new study looks at an intervention designed to treat maternal depression and assesses the impact of this intervention on maternal sensitivity and attachment.  

This pilot study used a group-based perinatal depression intervention, the Mothers and Babies (MB) Course.  This is a CBT-based intervention that has been developed for the treatment of perinatal depression in low-income and minority populations and has demonstrated effectiveness when delivered in a group-based format. The MB course has also been assessed for its effectiveness as an adjunct to home visiting services.  In contrast to traditional CBT, which emphasizes techniques to take control of their depression, the MB course is focused on helping participants manage their daily experiences and challenges and is cognizant of the fact that many low income women have little control over environmental challenges (e.g., poverty, housing instability, neighborhood violence).The MB course focuses on how to control negative thoughts, enhance supportive and enjoyable contacts with others, and increase engagement in pleasant activities.

The study was conducted in a low-income predominantly Aftrican-American clinical setting.  A total of 60 pregnant women with moderate to severe depressive symptoms were randomized to this 6-week intervention or to usual care at their first prenatal care visit. Measures of depressive symptoms and maternal-fetal attachment were collected at baseline and at 36 weeks gestation. At 12 weeks postpartum, the Nursing Child Assessment Satellite Training-Feeding Scale (NCAST-Feeding) was used to objectively assess maternal sensitivity during breast or bottle feeding in the participant’s home.

Participants randomized to the intervention group completed an average of 5.2 out of 6 sessions, and 70% of the women completed all six sessions.  At 12 weeks postpartum, participants randomized to the intervention group had an 8.32-point decrease from baseline on the Edinburgh Postnatal Depression Scale (EPDS) as compared to a 4.59-point decrease among participants receiving usual care. Participants randomized to the intervention group had a mean change score of 12.60 in maternal-fetal attachment (measured with the Maternal Fetal Attachment Scale) as compared to 4.60 among participants in the usual care group. Maternal sensitivity scores (assessed using NCAST-Feeding) were higher at 12 weeks postpartum for women in the intervention group compared to women in usual care (59.2 and 51.8, respectively). 

This pilot study provides preliminary support for the benefits of a CBT-based perinatal depression intervention delivered in a group setting.  Not only did this intervention reduce depressive symptoms among moderately to severely depressed women, it resulted in improved maternal-fetal attachment during pregnancy and increased maternal sensitivity at 12 weeks postpartum.  

Many women who are at risk for depression during pregnancy are reluctant to take antidepressants during pregnancy; however, we see high rates of depressive relapse in women who discontinue antidepressant treatment during pregnancy. Few studies have assessed the effectiveness of psychotherapeutic interventions for either the prevention or treatment of perinatal depression. While there is evidence to support the use of interpersonal therapy (IPT) or cognitive-behavioral therapy in this setting, it can be difficult to find treaters with expertise in these modalities.  The MB Course is thus an attractive option as it is manual-driven and can also be delivered in a group setting.   

 

Ruta Nonacs, MD PhD

 

Alhusen JL, Hayat MJ, Borg L. A pilot study of a group-based perinatal depression intervention on reducing depressive symptoms and improving maternal-fetal attachment and maternal sensitivity.  Arch Womens Ment Health. 2020 May 15.