A new UC San Francisco study says that a low-cost prenatal intervention improves mothers' mental health up to eight years later. According to the study, which was one of the first to look at outcomes so far into the future, pregnant women who participated in a group wellness class that met weekly for eight weeks were half as likely to be depressed eight years later as women who received standard care, according to the Journal of Consulting and Clinical Psychology.
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Previous research on the same group of women discovered that the intervention also reduced their risk of depression and diabetes in the short term and supported healthier stress responses in their children.
"Given the economic and social burden of maternal depression and its potential impact on offspring, our findings suggest a meaningful benefit of a modest investment during pregnancy that supports well-being across two generations," said Danielle Roubinov, PhD, UCSF assistant professor of psychiatry and first author of the study.
The eight-week class intervention, conducted by Elissa Epel, PhD, UCSF professor of psychiatry, and her team, included groups of eight to ten pregnant women who met twice a week for two hours to practise mindfulness-based stress reduction exercises, with an emphasis on mindful eating, breathing, and movement. A master's degree-level health specialist led them through group courses and activities. In addition, the mothers received two phone sessions and a postpartum "booster" group session with their babies.
Historically, most studies on prenatal depression have comprised primarily white women - but not this one, noted Nicki Bush, PhD, professor of paediatrics and psychiatry at the UCSF Weill Institute for Neurosciences and senior author on the study.
"Our participants were lower-income, racially and ethnically diverse women who are systemically exposed to factors that put them at risk for depression, such as racism and economic hardship," Bush said. "Also, the final years of the study were during the COVID-19 pandemic, when depression rates were higher for everyone, and the burden placed on communities of colour was even greater. Even so, the treatment effects held up."
In the trial, 162 women were randomly allocated to one of two groups: intervention or standard care. The women's depression symptoms were examined using the Patient Health Questionnaire (PHQ-9) before, during, and after the wellness intervention classes, as well as 1, 2, 3, 4, 5, 6, and 8 years later.
Despite the fact that both groups of women had comparable levels of depression prior to the class, 12 per cent of the women in the wellness class reported moderate or severe depressive symptoms at the eight-year mark, compared to 25 per cent of the women in standard care, which was a consistent pattern throughout the years.
"Mindfulness practice is known to help alleviate stress in many situations and can meaningfully affect coping and health, and it seems here that it was particularly powerful during pregnancy, with enduring effects," Bush said. "Our sense is that the community connections and social support involved with the (wellness class) group were therapeutic as well."
The researchers are currently collecting additional data to better understand how the intervention had such a long-term effect. Potential mechanisms include long-term changes in coping and stress reactivity, nutrition, and exercise.
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Up to 27 per cent of pregnant women suffer prenatal depression, which is predictive of postnatal depression. Maternal depression is also associated with social, emotional and cognitive deficits in offspring.
"This dramatic demonstration of both short-term reduction of depressive symptoms and long-term prevention of more severe maternal depression, even during the pandemic, is remarkable, even to us researchers," Epel said.
"It's likely that the effects of increased stress resilience in these women are having pervasive effects on their own health and their children. We would never have known about the durability of these changes if Dr Bush and her team had not followed them for eight years. We already know pregnancy is a critical period, and the lesson here is that we need to invest heavily in pregnancy wellness interventions."
The researchers hope the low cost and relatively short time commitment of the intervention class will make it easy to scale up to larger groups of pregnant women -- especially women of colour and those with lower incomes.
"It's critical to have interventions that meet the needs of lower-income, Black, Indigenous, and people of colour, who are especially likely to experience the stress of social inequities," said Roubinov. "We're excited to see how these results can be scaled to reach more women and a more diverse pool of women."