About 10% to 15% of women experience clinically significant depressive symptoms during pregnancy. Many studies have shown exposure to maternal depression and anxiety during pregnancy may be associated with various outcomes in the child, including delays in cognitive and motor development,  altered infant temperament and behavioural stress reactivity.  Depression during pregnancy has also been associated with sleep problems in the infant, including shorter sleep duration and higher number of awakenings.

As we are increasing our efforts to identify and treat women who experience depression during pregnancy, it is important to understand how treatment affects infant outcomes.  In a recent report, researchers used data from a pilot randomized clinical trial (RCT) of women with antenatal depression to examine the impact of treatment during pregnancy on infant sleep patterns and temperament.  Women were randomized to receive either Cognitive Behavioural Therapy (CBT, n=14) or Treatment as Usual (TAU, n=11).  

In this small study, the researchers did not observe any statistically significant differences in depressive symptoms between the two groups (CBT vs. TAU).  They did note, however, that improvement in depression scores during pregnancy was associated with easier temperament and shorter nocturnal sleep duration in the infant.  These findings were more pronounced in the CBT group compared to the TAU group.

Despite the small size of this study, it is the first RCT to examine the impact of a psychological intervention on infant outcomes and the first to demonstrate that improvement in maternal depressive symptoms is associated with improved child outcomes observed at 2 months of age.  It is unclear at this point whether the observed associations with infant temperament and sleep are the consequences of improvement in maternal depressive symptoms or a combination of skills learned through CBT and improved depressive symptoms.  Future studies are needed to replicate these findings and should attempt to further delineate the mechanisms behind these associations.

Ruta Nonacs, MD PhD

Netsi E, Evans J, Wulff K, O’Mahen H, Ramchandani PG.  Infant outcomes following treatment of antenatal depression: Findings from a pilot randomized controlled trial.  J Affect Disord. 2015 Dec 1;188:252-6.

Netsi E, van IJzendoorn MH, Bakermans-Kranenburg MJ, et al.  Does Infant Reactivity Moderate the Association Between Antenatal Maternal Depression and Infant Sleep?  J Dev Behav Pediatr. 2015 Jul-Aug;36(6):440-9.