The therapy program that reduced depression during pregnancy and postpartum, as well as improved development of children of depressed mothers

Ricardo Pinheiro

Full Teacher of Psychiatry at the Catholic University of Pelotas (UCPel)
Project: Maternal neuro-psychiatric disorders in the pregnancy-puerperal cycle: early detection and intervention and its consequences in the family triad

We already know that various aspects of the mother’s health, such as the vaginal microbiome, pre-existing infections and other diseases, can directly affect a baby’s development inside and outside the womb, and even affect instances of premature birth. Studies show that levels of anxiety, stress and depression can also negatively impact child development. This is one of the conclusions of a project financed by Grand Challenges Brazil, which tested the effectiveness of a program targeted at pregnant teenagers.

Psychiatrist Ricardo Pinheiro, Full Professor of Psychiatry at the Catholic University of Pelotas (UCPel) and specialist in Psychiatric Epidemiology and Medical Psychology, has thoroughly investigated this topic. Together with his team, he evaluated the prevalence of depression during and after pregnancy, as well as the results of an intervention based on a specific type of therapy — Cognitive Behavioral Therapy (CBT) — on the mental health of pregnant women and the development of their children.

For this, he recruited 980 women at the end of the first trimester of pregnancy – up to 24 weeks pregnant — and monitored them throughout labor and delivery and until their babies were 18 months old.

Following diagnosis, the research team divided pregnant women into groups to assess the effects of CBT sessions. They were divided into groups based on whether they were healthy, at risk for the disease or had a confirmed depression diagnosis. The first group formed the control group and were only monitored. Depressed and at-risk women attended up to eight therapy sessions with psychologists and psychiatric residents once a week. The goal was to help women recognize symptoms of anxiety and dysfunctional thoughts, such as “I cannot perform this task or take good care of myself” or “I am very sad and cannot get better because I am pregnant,” and later offer techniques to overcome them. In addition, half of the pregnant women also attended two motivational interview sessions.

At the end of the sessions, in the third trimester of gestation, 3 months after delivery and 18 months after the birth, the team assessed two factors. First, whether the program had effectively prevented depression among those at risk for the disease, both during pregnancy and postpartum and 18 months after birth. Second, whether it had successfully treated the depressive women or reduced depression symptoms at these three moments.

The results found out that the intervention was effective not only in reducing cases of depression but also in preventing pregnant women who were at risk from developing it. Four out of five depressed women began having no more symptoms, and these benefits extended to the postpartum period. Six months after the first sessions, 70% of participants maintained the same results. Even twenty months after the sessions’ conclusion, 80% of the group of depressed women maintained the same good results. There was efficacy in the risk group, being verified, in higher rates, in women with less than eight years of schooling.

The depressed pregnant women who did not accept to join the sessions, were approximately 11 times more likely to keep depressed after childbirth, as compared to the non-depressed women. In general, the incidence of depression after childbirth was 7.2%, considerably lower than the average of 12 to 20% found in other studies. “This suggests that the intervention was a protective factor to prevent the disease in pregnant women who were considered at risk for it. The interventions reduced the prevalence and incidence of postpartum depression,” says Ricardo.

The study was not limited to verifying the impact of therapy on mothers. It went further, and assessed babies at three and 18 months of life to see if the intervention – and the consequent improvement in the mother’s mental and psychological health – had influenced the child’s development.

And here, too, the results are encouraging. At three months old, the children of depressed mothers who had undergone therapy performed better on motor assessment tasks than children of untreated pregnant women. These babies performed as well on the tests as children of healthy women and those who were at risk for the disease but had participated in meetings with the psychologist.

In other words, treating depression with CBT resulted in a double effect: healthier pregnant women and babies. “And this intervention can be replicated at a low cost for the health system,” says Ricardo.

In addition to running the program, the researchers also collected blood samples from these same women to try to identify biological markers of depression that would provide, at least partially, insights into the functioning of the disease in the body and facilitate diagnosis and prognosis.  The hormones cortisol, oxytocin, and the Corticotropin-releasing hormone (CRH) were measured in the mother’s blood and the cortisol was dosed in the children’s saliva. They were associated with the children’s neurocognitive performance in the postpartum and 18 months of life. The researchers also found that some genetic factors were related to the manifestation of the disease during pregnancy. Still, they found that the intervention could reduce depression even in women with genetics more prone to the disease.

The preliminary results were promising and led the team to receive additional funding from the Ministry of Health and the National Council for Scientific and Technological Development (CNPq) to expand the assessment of CBT’s effects in the second year of life for the same children monitored until now. At this moment, the group evaluates the result of an intervention to stimulate the neurocognitive development of the children of depressed mothers at 18 months after delivery, an intervention carried out by health agents and psychology interns.

The study shows that less depressed, treated and healthier women produce positive reflexes in their babies’ development. “Cared Pregnancy means Healthy Baby,” says Ricardo.