Maternal neuro-psychiatric disorders in the pregnancy-puerperal cycle: early detection and intervention and its consequences in the family triad

The study investigated the prevalence and the incidence of depression during and after pregnancy, as well as the effect of an intervention based on a specific type of therapy — Cognitive Behavioral Therapy (CBT) — on the mental health of pregnant women and their children’s development.

The team 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. The recruited pregnant women were divided into groups to assess the effects of CBT sessions. Of the total sample, 342 healthy women formed part of the control group. This group did not undergo therapeutic intervention and participants were only followed up. The 150 depressed pregnant women and the 407 women at risk of depression attended up to eight therapy sessions with psychologists, or one per week. A significant portion of them attended between two to six meetings. The sessions were designed to enable women to recognize symptoms of sadness, anxiety and dysfunctional thoughts related to pregnancy. Participants were assessed 60 days after the sessions, 90 days after delivery and 18 months after childbirth. The team looked at two factors: whether the program had been effective in preventing depression among those considered to be at risk for the disease, both during pregnancy and in the postpartum period, and after 18 months and whether it had managed to treat depressive women or reduce symptoms at the three periods. The babies of the women in the intervention group were also subjected to child development tests at three and 18 months of age to assess the impact of the intervention on their children. Children born to depressed mothers at 18 months received an intervention to stimulate neurocognitive development, which is being evaluated after 90 days.

Of the total recruited to the study, 41.8% of pregnant women were at risk for depression and 15.4% were diagnosed with the problem. Both risk of depression and depression were more common in women from lower social classes. Among pregnant women in strata C, D, E — who made up 70% of the sample — the risk was 52.1% and the disease was confirmed in 16.2%. In classes A and B, it was 34%. The intervention showed a double effect of treating women and promoting improved development for their children. It not only reduced cases of depression but also prevented pregnant women at risk from developing the disease. Four out of five depressed women became asymptomatic and the benefit extended into the postpartum period and at 18 months of childbirth. The depressed pregnant women who did accept to join the sessions, were about 11 times more likely to develop postpartum depression, as compared to non-depressed women. The incidence of the problem after the baby was born was 7.2%, considerably lower than the average of 12 to 20% found in other studies. At three months of age, the children of depressed mothers who were treated performed better in motor assessment than children of untreated pregnant women.

It is the first time an intervention based on brief cognitive behavioral therapy has been tested in the gestational period on a large scale to minimize the impact of the depression during pregnancy, in the postpartum period, two years after childbirth and child development of the followed babies.

The high prevalence of depression during pregnancy, which affects more than 15% of pregnant women, in average, and during the postpartum period, which affects 12 to 20% of new mothers nationally and the harmful consequences of this disease on women and their children.

Because of its low application complexity, easy replication, and low proportional cost, the brief intervention with CBT can be tested, replicated, and extended to other country’s health services.

With appropriate cultural adaptations, it can be expanded and adopted in other countries with high rates of depression during pregnancy and postpartum.

The team now plans to complete the second study — the result of additional funding — which assesses the impact of the program on the second year of life of the children who were previously evaluated. The analyses of biomarkers of depression are also nearing completion.