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Archives of Women's Mental Health

, Volume 20, Issue 2, pp 333–344 | Cite as

A randomized controlled trial: effects of a prenatal depression intervention on perinatal outcomes among Chinese high-risk pregnant women with medically defined complications

Original Article

Abstract

Prenatal psychosocial health has been linked with health behaviors, maternal health, and birth outcomes. This randomized controlled trial evaluated the effects of a prenatal depression intervention on birth outcomes and maternal physical and psychological status at 42 days postpartum. Three hundred fifty-two high-risk pregnant women exposed to obstetric complications with an Edinburgh Postnatal Depression Scale (EPDS) ≥ 9 or a Postpartum Depression Screening Scale (PDSS) ≥ 60 were randomly assigned to the intervention group (n = 176) and control group (n = 176). The intervention group underwent a six-session couple-separated psycho-educational program; the control group received the usual care. All participants were asked to complete questionnaires at late pregnancy (>28 weeks), 3 days postpartum, and 42 days postpartum. The intervention group had a significantly lower cesarean rate and shorter third stage of labor (p < .05). At 42 days after delivery, only 5.1% of participants were lost to follow-up, and the intervention group had significantly less minor and major depression, more sleep time, more satisfaction with their husband and other family members, less concern about taking care of baby, and less breast milk insufficiency than the control group (p < .05). A prenatal psychological intervention model for high-risk pregnant women holds potential as a preventive program that addresses maternal health and birth outcomes.

Trial registration: Chinese Clinical Trial Registry (ChiCTR-IOR-15006433), http://www.chictr.org.cn/enIndex.aspx (retrospectively registered).

Keywords

Group intervention Postpartum depression Obstetrical complications Birth outcome 

Notes

Acknowledgements

This work was supported by the China Medical Board (CMB) (No. 10-020-201206). We gratefully acknowledge the important contributions of our consultants: Cai Yiyun and Chen Jing. We also thank our research staff: Ding Yan and Tao Hua as well as all high-risk pregnant women who participated in the present study. There are no personal, organizational, or financial conflicts of interest.

Compliance with ethical standards

This randomized single-blind controlled trial was conducted from November 1, 2014 to August 31, 2015. It was approved by the ethical committee of the Fudan University affiliated Obstetrics and Gynecology Hospital in 2013 and 2015 (24-C-2015-24, [2013]24) and registered in the Chinese Clinical Trial Registry (ChiCTR-IOR-15006433). After providing their written informed consents, the participants were randomly assigned into the intervention and control groups and asked to complete questionnaires on depressive symptomatology and psychosocial correlates.

References

  1. Anderson CA, Lieser C (2015) Prenatal depression: early intervention. Nurse Pract 40(7):38–46CrossRefPubMedGoogle Scholar
  2. Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam K, åStröm M (2003) Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 189:148–154CrossRefPubMedGoogle Scholar
  3. Bayrampour H, Salmon C, Vinturache A, Tough S (2015) Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions. J Obstet Gynaecol Res 41(7):1040–1048CrossRefPubMedGoogle Scholar
  4. Beck CT, Gable RK (2001) Comparative analysis of the performance of the Postpartum Depression Screening Scale with two other depression instruments. Nurs Res 50(4):242–250CrossRefPubMedGoogle Scholar
  5. Benute GR, Nomura RM, Reis JS, Fraguas Junior R, Lucia MC, Zugaib M (2010) Depression during pregnancy in women with a medical disorder: risk factors and perinatal outcomes. Clinics 65(11):1127–1131CrossRefPubMedPubMedCentralGoogle Scholar
  6. Chan J, Natekar A, Einarson A, Koren G (2014) Risks of untreated depression in pregnancy. Can Fam Physician 60(3):242–243PubMedPubMedCentralGoogle Scholar
  7. Claridge AM (2014) Efficacy of systemically oriented psychotherapies in the treatment of perinatal depression: a meta-analysis. Arch Womens Ment Health. 17(1):3–15CrossRefPubMedGoogle Scholar
  8. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786CrossRefPubMedGoogle Scholar
  9. Dai ZE (2014) Impact analysis of nursing intervention on bad mood of the high-risk pregnant woman. Guide of China Medicine 12:375–376Google Scholar
  10. Dayan J, Creveuil C, Marks MN, Conroy S, Herlicoviez M, Dreyfus M, Tordjman S (2006) Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early and regular care. Psychosom Med 68:938–946CrossRefPubMedGoogle Scholar
  11. Dhobale MV, Pisal HR, Mehendale SS, Joshi SR (2013) Differential expression of human placental neurotrophic factors in preterm and term deliveries. Int J Dev Neurosci 31(8):719–723CrossRefPubMedGoogle Scholar
  12. Feinberg ME, Roettger ME, Jones DE, Paul IM, Kan ML (2015) Effects of a psychosocial couple-based prevention program on adverse birth outcomes. Matern Child Health J 19(1):102–111CrossRefPubMedPubMedCentralGoogle Scholar
  13. Field T, Diego M, Hernandez-Reif M, Figueiredo B, Deeds O, Ascencio A, Schanberg S, Kuhn C (2010) Comorbid depression and anxiety effects on pregnancy and neonatal outcome. Infant Behav Dev 33(1):23–29CrossRefPubMedGoogle Scholar
  14. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R (2009) A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand 119:350–364CrossRefPubMedGoogle Scholar
  15. Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A, Radford K, Martinovic J, Ross LE (2013) The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry 74(4):e321–e341CrossRefPubMedGoogle Scholar
  16. Hamdan A, Tamim H (2011) Psychosocial risk and protective factors for postpartum depression in the United Arab Emirates. Arch Womens Ment Health. 14(2):125–133CrossRefPubMedGoogle Scholar
  17. Han XS (2013) Study of antenatal care requirement and nursing among high-risk pregnant women. Contemporary Medicine 19(19):115–117Google Scholar
  18. Hübner-Liebermann B, Hausner H, Wittmann M (2012) Recognizing and treating peripartum depression. Dtsch Arztebl Int 109(24):419–424PubMedPubMedCentralGoogle Scholar
  19. Kaihola H, Olivier J, Poromaa IS, Åkerud H (2015) The effect of antenatal depression and selective serotonin reuptake inhibitor treatment on nerve growth factor signaling in human placenta. PLoS One 10(1):e0116459CrossRefPubMedPubMedCentralGoogle Scholar
  20. Katon WJ, Russo JE, Melville JL, Katon JG, Gavin AR (2012) Depression in pregnancy is associated with preexisting but not pregnancy-induced hypertension. Gen Hosp Psychiatry 34:9–16CrossRefPubMedGoogle Scholar
  21. Kingston D, Janes-Kelley S, Tyrrell J, Clark L, Hamza D, Holmes P, Parkes C, Moyo N, McDonald S, Austin MP (2015) An integrated web-based mental health intervention of assessment-referral-care to reduce stress, anxiety, anddepression in hospitalized pregnant women with medically high-risk pregnancies: a feasibility study protocol of hospital-based implementation. JMIR Res Protoc 4(1):e9CrossRefPubMedPubMedCentralGoogle Scholar
  22. Kozinszky Z, Dudas RB, Devosa I, Csatordai S, Tóth E, Szabó D, Sikovanyecz J, Barabás K, Pál A (2012) Can a brief antepartum preventive group intervention help reduce postpartum depressive symptomatology. Psychother Psychosom 81(2):98–107CrossRefPubMedGoogle Scholar
  23. Lau Y, Yin L, Wang Y (2011) Antenatal depressive symptomatology, family conflict and social support among Chengdu Chinese women. Matern Child Health J 15(8):1416–1426CrossRefPubMedGoogle Scholar
  24. Lee DT, Yip SK, Chiu HF, Leung TY, Chan KP, Chau IO, Leung HC, Chung TK (1998) Postnatal depression in Chinese women. Br J Psychiatry 172(5):433–437CrossRefPubMedGoogle Scholar
  25. Leung SS, Lam TH (2012) Group antenatal intervention to reduce perinatal stress and depressive symptoms related to intergenerational conflicts: a randomized controlled trial. Int J Nurs Stud 49(11):1391–1402CrossRefPubMedGoogle Scholar
  26. Li D, Liu L, Odouli R (2009) Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod 24:146–153CrossRefPubMedGoogle Scholar
  27. Li LZ, Liu F, Zhang HL, Wang L, Chen X (2011) Chinese version of the Postpartum Depression Screening Scale translation and validation. Nurs Res 60(4):231–239CrossRefPubMedGoogle Scholar
  28. Liou SR, Wang P, Cheng CY (2016) Effects of prenatal maternal mental distress on birth outcomes. Women Birth 29(4):376–380CrossRefPubMedGoogle Scholar
  29. Lukkari S, Hakko H, Herva A, Pouta A, Riala K, Räsänen P (2012) Exposure to obstetric complications in relation to subsequent psychiatric disorders of adolescent inpatients: specific focus on gender differences. Psychopathology 45(5):317–326CrossRefPubMedGoogle Scholar
  30. Ma H, Zhang Y, Wang XD, Bai YL (2012) Effect of psychological and behavioral intervention on pregnancy outcome and negative mood for high-risk pregnant women. Chinese Journal of Behavior Medicine & Brain Science 21(9):813–816Google Scholar
  31. Maxson PJ, Edwards SE, Valentiner EM, Miranda ML (2016) A multidimensional approach to characterizing psychosocial health during pregnancy. Matern Child Health J 20(6):1103–1113CrossRefPubMedGoogle Scholar
  32. Mendelson T, Leis JA, Perry DF, Stuart EA, Tandon SD (2013) Impact of a preventive intervention for perinatal depression on mood regulation, social support, and coping. Arch Womens Ment Health 16(3):211–218CrossRefPubMedGoogle Scholar
  33. Myors KA, Schmied V, Johnson M, Cleary M (2014) Therapeutic interventions in perinatal and infant mental health services: a mixed methods inquiry. Issues Ment Health Nurs 35(3):372–385CrossRefPubMedGoogle Scholar
  34. Neggers Y, Goldenberg R, Cliver S, Hauth J (2006) The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta Obstet Gynecol Scand 85(3):277–285CrossRefPubMedGoogle Scholar
  35. Nishioka E, Haruna M, Ota E, Matsuzaki M, Murayama R, Yoshimura K, Murashima S (2011) A prospective study of the relationship between breastfeeding and postpartum depressive symptoms appearing at 1-5 months after delivery. J Affect Disord 133(3):553–559CrossRefPubMedGoogle Scholar
  36. Pesonen AK, Lahti M, Kuusinen T, Tuovinen S, Villa P, Hämäläinen E, Laivuori H, Kajantie E, Räikkönen K (2016) Maternal prenatal positive affect, depressive and anxiety symptoms and birth outcomes: the PREDO study. PLoS One 11(2):1–13CrossRefGoogle Scholar
  37. Saeed A, Raana T, Saeed AM, Humayun A (2016) Effect of antenatal depression on maternal dietary intake and neonatal outcome: a prospective cohort. Nutr J 15(1):64CrossRefPubMedPubMedCentralGoogle Scholar
  38. Shanghai High-risk Pregnancy Grading (nd) Maternal health care work specification compilation. http://wenku.baidu.com/view/4fb1d0d380eb6294dd886ca6.html
  39. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. 59:22–57Google Scholar
  40. Signal TL, Paine SJ, Sweeney B, Muller D, Priston M, Lee K, Gander P, Huthwaite M (2016) The prevalence of symptoms of depression and anxiety, and the level of life stress and worry in New Zealand Māori and non-Māori women in late pregnancy. Aust N Z J Psychiatry. doi: 10.1177/0004867415622406 PubMedGoogle Scholar
  41. Siu BW, Leung SS, Ip P, Hung SF, O’Hara MW (2012) Antenatal risk factors for postnatal depression: a prospective study of chinese women at maternal and child health centres. BMC Psychiatry 12:22CrossRefPubMedPubMedCentralGoogle Scholar
  42. Sun XJ (2012) Investigation and analysis on antenatal psychological status of high-risk pregnant women. Journal of QiLu Nursing 18(23):42–43Google Scholar
  43. Tachibana Y, Koizumi T, Takehara K, Kakee N, Tsujii H, Mori R, Inoue E, Ota E, Yoshida K, Kasai K, Okuyama M, Kubo T (2015) Antenatal risk factors of postpartum depression at 20 weeks gestation in a Japanese sample: psychosocial perspectives from a cohort study in Tokyo. PLoS One 10(12):e0142410CrossRefPubMedPubMedCentralGoogle Scholar
  44. Tan XY, Guo WH, Wang AM (2011) Analysis of psychological state and influencing factors of high risk pregnancies before cesarean section. Journal of Nursing 18:74–76Google Scholar
  45. Toohill J, Fenwick J, Gamble J, Creedy DK, Buist A, Turkstra E, Ryding EL (2014) A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women. Birth 41(4):384–394CrossRefPubMedGoogle Scholar
  46. Zeng SQ (2010) Risk assessment and holistic nursing on high-risk pregnant women during prenatal period. Nursing Practice and Study 7(10):52–54Google Scholar
  47. Zhao Y, Kane I, Wang J, Shen B, Luo J, Shi S (2015) Combined use of the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS) to identify antenatal depression among Chinese pregnant women with obstetric complications. Psychiatry Res 226:113–119CrossRefPubMedGoogle Scholar
  48. Zhao Y, Kane I, Mao L, Shi S, Wang J, Lin Q, Luo J (2016) The prevalence of antenatal depression and its related factors in Chinese pregnant women who present with obstetrical complications. Arch Psychiatr Nurs 30(3):316–321CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  1. 1.School of NursingFudan UniversityShanghaiPeople’s Republic of China
  2. 2.Psychiatry DepartmentFudan University Affiliated Huashan HospitalShanghaiPeople’s Republic of China
  3. 3.School of NursingUniversity of MichiganAnn ArborUSA
  4. 4.Fudan University Affiliated Obstetrics and Gynecology HospitalShanghaiPeople’s Republic of China
  5. 5.Department of Biostatistics, School of Public HealthFudan UniversityShanghaiPeople’s Republic of China

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