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BMC Pregnancy and Childbirth

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Open Access 01-12-2014 | Research article

Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: a randomized controlled trial in Spain and France

Authors: Maria Assumpta Ortiz Collado, Marc Saez, Jérôme Favrod, Marie Hatem

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

Abstract

Background

Postpartum depression (PPD) and poor childbirth outcomes are associated with poverty; these variables should be addressed by an adapted approach. The aim of this research was to evaluate the impact of an antenatal programme based on a novel psychosomatic approach to pregnancy and delivery, regarding the risk of PPD and childbirth outcomes in disadvantaged women.

Methods

A multi-centre, randomized, controlled trial comparing a novel to standard antenatal programme. Primary outcome was depressive symptoms (using EPDS) and secondary outcome was preterm childbirth (fewer 37 weeks). The sample comprised 184 couples in which the women were identified to be at PPD risk by validated interview. The study was conducted in three public hospitals with comparable standards of perinatal care. Women were randomly distributed in to an experimental group (EG) or a control group (CG), and evaluated twice: during pregnancy (T1) and four weeks post-partum (T2). At T2, the variables were compared using the chi square test. Data analysis was based on intention to treat. The novel programme used the Tourné psychosomatic approach focusing on body awareness sensations, construction of an individualized childbirth model, and attachment. The 10 group antenatal sessions each lasted two hours, with one telephone conversation between sessions. In the control group, the participants choose the standard model of antenatal education, i.e., 8 to 10 two-hour sessions focused on childbirth by obstetrical prophylaxis.

Results

A difference of 11.2% was noted in postpartum percentages of PPD risk (EPDS ≥ 12): 34.3% (24) in EG and 45.5% (27) in CG (p = 0.26). The number of depressive symptoms among EG women decreased at T₂ (intragroup p = 0.01). Premature childbirth was four times less in EG women: three (4.4%) compared to 13 (22.4%) among CG women (p = 0.003). Birth weight was higher in EG women (p = 0.01).

Conclusions

The decrease of depressive symptoms in women was not conclusive. However, because birth weight was higher and the rate of preterm childbirth was lower in the EG, our results suggest that the psychosomatic approach may be more helpful to the target population than the standard antenatal programs.

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O’Hara MW, Swain A: Rates and Risk of Postpartum depression a meta-analyses. Int Rev Psychiatry. 1996, 8: 37-54. 10.3109/09540269609037816.CrossRef

Gorman LL, O’Hara MW, Figueiredo B, Hayes S, Jacquemain F, Kammerer MH: Adaptation of the Structured Clinical Interview for DSM-IV disorders for assessing depression in women during pregnancy and postpartum across countries and cultures. Br J Psychiatry. 2004, 46: 17-23.CrossRef

Affonso D, De AK, Horowitz JA, Mayberry LJ: An international study exploring levels of postpartum depressive symptomatology. J Psychosom Res. 2000, 49: 207-216. 10.1016/S0022-3999(00)00176-8.CrossRefPubMed

Ortiz Collado MA: Effets d’un programme prénatal de groupe adressé aux couples parentaux pour prévenir la dépression postnatale des femmes de classes moyenne et défavorisée habitant en Catalogne Nord et en France Sud [Doctoral thesis]. 2009, Montreal: Faculty of Medicine Montreal University, Biomedical Sciences

Chaaya M, Campbell OMR, El Kak F, Shaar D, Harb H, Kaddour A: Postpartum depression: prevalence and determinants in Lebanon. Arch Womens Ment Health. 2002, 5: 65-72. 10.1007/s00737-002-0140-8.CrossRefPubMedPubMedCentral

Harvey ST, Pun PK: Analysis of positive Edinburgh depression scale referrals to a consultation liaison psychiatry service in a two-year period. Int J Ment Health Nurs. 2007, 16: 161-167. 10.1111/j.1447-0349.2007.00463.x.CrossRefPubMed

De La Gándara J, Mico JA, Olivares JM, Szerman N: Depresión en pacientes de riesgo. 2004, Barcelona: Ars Medica

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 2000, Washington, DC, 4

Affonso D, Lovett S, Paul S, Arizmendi T, Nussbaum R, Newman L, Johnson D: Predictors of depression symptoms during pregnancy and postpartum. J Psychosom Obstet Gynecol. 1991, 12: 255-271. 10.3109/01674829109078007.CrossRef

10.

Gotlib I, Whiffen V, Wallace P, Mount J: Prospective investigation of postpartum depression: factors involved in onset and recovery. J Abnorm Psychol. 1991, 100 (2): 122-132.CrossRefPubMed

11.

Nicolson P: Loss, happiness and postpartum depression: The ultimate paradox. Can Psychol. 1999, 40 (2): 162-178.CrossRef

12.

Beck CT, Indman P: The many faces of postpartum depression. J Obstet Gynecol Neonatal Nurs. 2005, 34 (5): 569-576. 10.1177/0884217505279995.CrossRefPubMed

13.

Seyfried LS, Marcus SM: Postpartum mood disorders. Int Rev Psychiatry. 2003, 15 (3): 231-10.1080/0954026031000136857.CrossRefPubMed

14.

Righetti-Veltema M, Conne-Perréard E, Bousquet A, Manzano J: Construction et validation multicentrique d’un questionnaire prépartum de dépistage de la dépression postpartum. La Psychiatrie de l’enfant. 2006, 49 (2): 513-541. 10.3917/psye.492.0513.CrossRef

15.

Romero A, Carrillo A: Alteraciones psiquiátricas en el postparto. Jano: Medicina y Humanidades. 2002, 1449 (63): 30-36.

16.

Chee Cornelia YI, Chong YS, Ng TP, Lee Dominic TS, Tan LK, Fones , Calvin SL: The association between maternal depression and frequent non-routine visits to the infant’s doctor – A cohort study. J Affect Disord. 2008, 107 (1–3): 247-253.CrossRefPubMed

17.

Tammentie T, Paavilainen E, Astedt-Kurki P, Tarkka MT: Family dynamics of postnatal depressed mothers – discrepancy between expectations and reality. J Clin Nurs. 2004, 13: 65-74. 10.1046/j.1365-2702.2003.00824.x.CrossRefPubMed

18.

Diego MA, Field T, Hernandez-Reif M: Prepartum, postpartum and chronic depression effects on neonatal behaviour. Infant Behav Dev. 2005, 28: 155-164. 10.1016/j.infbeh.2005.02.002.CrossRef

19.

Field T, Diego M, Hernandez-Reif M: Prenatal depression effects on the foetus and new born: a review. Infant Behav Dev. 2006, 29 (3): 445-455. 10.1016/j.infbeh.2006.03.003.CrossRefPubMed

20.

Field T, Diego M, Hernandez-Reif M, Deeds O, Figueiredo B: Pregnancy massage reduces prematurity, low birth weight and postpartum depression. Infant Behav Dev. 2009, 32: 454-460. 10.1016/j.infbeh.2009.07.001.CrossRefPubMed

21.

Marcus SM: Depression during pregnancy: rates, risks and consequences-mother risk update 2008. Can J Clin Pharmacol. 2009, 16: 15-22.

22.

McGrath JM, Records K, Rice M: Maternal depression and infant temperament characteristics. Infant Behav Dev. 2008, 31 (1): 71-80. 10.1016/j.infbeh.2007.07.001.CrossRefPubMed

23.

Dearing E, Taylor BA, McCartney K: Implications of family income dynamics for women’s depressive symptoms during the first 3 years after childbirth. Am J Public Health. 2004, 94 (8): 1372-1377. 10.2105/AJPH.94.8.1372.CrossRefPubMedPubMedCentral

24.

Beck CT: Predictors of postpartum depression: an update. Nurs Res. 2001, 50: 275-285. 10.1097/00006199-200109000-00004.CrossRefPubMed

25.

Ludemir AB, Lewis G, Valongueiro SA, De Araujo TV, Araya R: Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet. 2010, 376 (9744): 903-910. 10.1016/S0140-6736(10)60887-2.CrossRef

26.

Woolhouse H, Gartland D, Hegarthy K, Donath S, Brown S: Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG. 2012, 119: 315-323. 10.1111/j.1471-0528.2011.03219.x.CrossRefPubMed

27.

Rubertsson C, Wickberg B, Gustavsson P, Râdestad I: Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Arch Womens Ment Health. 2005, 8 (2): 97-10.1007/s00737-005-0078-8.CrossRefPubMed

28.

Yelland J, Sutherland G, Brown SJ: Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health. 2010, 10: 12-771. 10.1186/1471-2458-10-12.CrossRef

29.

Urizar GG, Milazzo M, Le HN, Delucchi K, Sotelo R, Munoz RF: Impact of stress reduction instructions on stress and cortisol levels during pregnancy. Biol Psychol. 2004, 67: 275-282. 10.1016/j.biopsycho.2003.11.001.CrossRefPubMed

30.

Vieten C, Astin J: Effects of a mindfulness-based intervention duringpregnancy on prenatal stress and mood: results of a pilot study. Arch Womens Ment Health. 2008, 11: 67-74. 10.1007/s00737-008-0214-3.CrossRefPubMed

31.

Field T, Diego MA, Hernandez-Reif M, Schanberg S, Kuhn C: Massage therapy effects on depressed pregnant women. J Psychosom Obstet Gynecol. 2004, 25 (2): 115-122. 10.1080/01674820412331282231.CrossRef

32.

Zlotnick C, Miller IW, Pearlstein T, Howard M, Sweeney P: A preventive intervention for pregnant women on public assistance at risk for postpartum depression. Am J Psychiatr. 2006, 163 (8): 1443-1445. 10.1176/appi.ajp.163.8.1443.CrossRefPubMedPubMedCentral

33.

Lara MA, Navarro C, Navarrete L: Outcome results of a psycho-educational intervention in pregnancy to prevent PPD: A randomized control trial. J Affect Disord. 2010, 122: 109-117. 10.1016/j.jad.2009.06.024.CrossRefPubMed

34.

Wisner KL, Perel JM, Peindl KS, Hanusa BH, Findling RL, Rapport D: Prevention of recurrent postpartum depression. A randomized clinical trial. J Clin Psychiatry. 2001, 62 (2): 82-86. 10.4088/JCP.v62n0202.CrossRefPubMed

35.

Gentile S: The safety of newer antidepressants in pregnancy and breastfeeding. Drug Saf. 2005, 28: 137-152. 10.2165/00002018-200528020-00005.CrossRefPubMed

36.

Saisto T, Salmela-Aro K, Nurmi JE, Kononen T, Halmesmaki E: A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol. 2001, 98: 820-826. 10.1016/S0029-7844(01)01552-6.PubMed

37.

Zayas LH, McKee D, Jankowski KR: Adapting psychosocial intervention research to urban primary care environments: a case example. Ann Fam Med. 2004, 2 (5): 504-508. 10.1370/afm.108.CrossRefPubMedPubMedCentral

38.

Muñoz RF, Le HN, Ghosh IC, Diaz MA, Urizar GG, Soto J, Mendelson T, Delucchi K, Lieberman AF: Prevention of postpartum depression in Low-income women: development of the mamas y bebes/mothers and babies course. Cogn Behav Pract. 2007, 14 (1): 70-83. 10.1016/j.cbpra.2006.04.021.CrossRef

39.

Austin MP, Frilingos M, Lumley J, Hadzi-Paviovic D, Roncolato W, Acland S, et al: Brief antenatal cognitive behaviour therapy group intervention for the prevention of postnatal depression and anxiety: a randomised controlled trial. J Affect Disord. 2008, 105 (1–3): 35-44.CrossRefPubMed

40.

Le HN, Stuart EA, Perry DF: Randomized controlled trial of a preventive intervention for perinatal depression in high-risk Latinas. J Consult Clin Psychol. 2011, 79: 135-141.CrossRefPubMed

41.

Zlotnick C, Johnson SL, Miller IW, Pearlstein T, Howard M: Postpartum depression in women receiving public assistance: pilot study of an interpersonal– therapy–oriented group intervention. Am J Psychiatr. 2001, 158: 638-640. 10.1176/appi.ajp.158.4.638.CrossRefPubMed

42.

Spinelli MG, Endicott J: Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatr. 2003, 160: 555-562. 10.1176/appi.ajp.160.3.555.CrossRefPubMed

43.

Grote NK, Swartz HA, Bledsoe SE, Frank E: Treating depression in low-income pregnant patients: the role of brief interpersonal psychotherapy. Res Soc Work Pract. 2004, 14: 397-406. 10.1177/1049731504265835.CrossRef

44.

Buist A, Westley D, Hill C: Antenatal prevention of postnatal depression. Arch Womens Ment Health. 1999, 1: 167-173. 10.1007/s007370050024.CrossRef

45.

Brugha TS, Wheatley S, Taub NA, Culverwell A, Friedman T, Kirwan P, Jones DR, Shapiro DA: Pragmatic randomized trial of antenatal intervention to prevent post-natal depression by reducing psychosocial risk factors. Psychol Med. 2000, 30: 1273-1281. 10.1017/S0033291799002937.CrossRefPubMed

46.

Hayes BA, Muller R, Bradley BS: Perinatal depression: a randomised controlled trial of an antenatal education intervention for primiparas. Birth. 2001, 28 (1): 28-35. 10.1046/j.1523-536x.2001.00028.x.CrossRefPubMed

47.

Hayes BA, Muller R: Prenatal depression: a randomized controlled trial in the emotional health of primiparous women. Res Theory Nurs Pract. 2004, 18 (2/3): 165-183.CrossRefPubMed

48.

Cabero Roura L: Parto prematuro. 2004, Buenos Aires-Madrid: Panamericana

49.

Lumley J: Defining the problem: the epidemiology of preterm birth. Br J Obstet Gynecol. 2003, 110: 3-7.CrossRef

50.

Ascaso Terren C, Garcia Esteve L, Navarro P, Aguado J, Ojuel J, Jesús Tarragona M: Postpartum depression prevalence in a Spanish sample: comparison of estimations with structured clinical interview for DSM-IV against the Edinburgh postnatal depression scale (EPDS). Med Clin. 2003, 120 (9): 326-329.CrossRef

51.

Cox JL, Holden JM, Sagovsky R: Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987, 150: 782-786. 10.1192/bjp.150.6.782.CrossRefPubMed

52.

Spanier GB: Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976, 38: 15-28. 10.2307/350547.CrossRef

53.

Broadhead WE, Gehlbach SH, De Gruy FW: The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in Family Medicine patients. Med Care. 1988, 26: 709-10.1097/00005650-198807000-00006.CrossRefPubMed

54.

Holmes TH, Rahe RH: The social readjustment rating scale. J Psychosom Res. 1967, 11: 213-218. 10.1016/0022-3999(67)90010-4.CrossRefPubMed

55.

Tourné C-E: Obstétrique psychosomatique et fonctionnelle. 2002, Montpellier: Sauramps Medical

56.

Ortiz-Collado MA, Cararach V, Tourné C-E: Prevención del riesgo de depresión postnatal y prematuridad con un enfoque psicosomático: estudio aleatorizado multicentrico. Med Clin. 2012, 139 (9): 385-392. 10.1016/j.medcli.2011.12.016.CrossRef

57.

Tough SC, Siever JE, Johnston DW: Retaining women in a prenatal care randomized controlled trial in Canada: implications for program planning. BMC Public Health. 2007, 7: 148-152. 10.1186/1471-2458-7-148.CrossRefPubMedPubMedCentral

58.

Dennis CL, Janssen PA, Singer J: Identifying women at-risk for postpartum depression in the immediate postpartum period. Acta Psychiatr Scand. 2004, 110 (5): 338-340. 10.1111/j.1600-0447.2004.00337.x.CrossRefPubMed

59.

Kuo W-H, Wilson Tracey E, Holman S, Fuentes-Afflick E: Depressive symptoms in the immediate postpartum period among Hispanic women in three U.S. Cities. J Immigr Health. 2004, 6 (4): 145-148.CrossRefPubMed

60.

Boury JM, Larkin KT, Krummel DA: Factors related to postpartum depressive symptoms in low-income women. Women Health. 2004, 39 (3): 19-20. 10.1300/J013v39n03_02.CrossRefPubMed

61.

Polomeno V: Focal point on childbirth education: family health promotion from the Couple’s perspective, part 2; practical considerations. Int J Childbirth Educ. 1999, 14 (2): 31-36.

62.

Rees BL: Effect of relaxation with guided imagery on anxiety, depression, and self-esteem in primiparas. J Holist Nurs. 1995, 13: 255-267. 10.1177/089801019501300307.CrossRefPubMed

63.

Spinelli MG: Interpersonal psychotherapy for depressed antepartum women: a pilot study. Am J Psychiatr. 1997, 154 (7): 1028-1030.CrossRefPubMed

64.

Elliott SA, Leverton TJ, Sanjack M, Turner H, Cowmeadow P, Hopkins J, Bushnell D: Promoting mental health after childbirth: a controlled trial of primary prevention of postnatal depression. Br J Clin Psychol. 2000, 39 (3): 223-241. 10.1348/014466500163248.CrossRefPubMed

65.

Stamp GE, Williams AS, Crowther CA: Evaluation of antenatal and postnatal support to overcome postnatal depression: a randomized, controlled trial. Birth. 1995, 22: 138-143. 10.1111/j.1523-536X.1995.tb00689.x.CrossRefPubMed

66.

Waldenström U, Brown S, McLachlan H, Forster D, Brennecke S: Does team midwife care increase satisfaction with antenatal, intrapartum and postpartum care? A randomized controlled trial. Birth. 2000, 27: 156-167. 10.1046/j.1523-536x.2000.00156.x.CrossRefPubMed

67.

Webster J, Linnane J, Roberts J, Starrenburg S, Hinson J, Dibley L: Identify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depression. BJOG. 2003, 110: 842-846. 10.1111/j.1471-0528.2003.02377.x.CrossRefPubMed

68.

Tam VH, Lee DT, Chiu HF, Ma KC, Lee A, Chung TK: A randomised controlled trial of educational counselling on the management of women who have suffered suboptimal outcomes in pregnancy. BJOG. 2003, 110: 853-859. 10.1111/j.1471-0528.2003.02412.x.CrossRefPubMed

69.

Rauff EL, Downs DS: Mediating effects of body image satisfaction on exercise behavior, depressive symptoms, and gestational weight gain in pregnancy. Ann Behav Med. 2011, 42 (3): 381-390. 10.1007/s12160-011-9300-2.CrossRefPubMed

70.

Vigod SN, Villegas L, Dennis C-L, Ross LE: Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG. 2010, 117: 540-550. 10.1111/j.1471-0528.2009.02493.x.CrossRefPubMed

71.

Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W: Depression and anxiety during pregnancy: A risk factor for obstetric, fetal and neonatal outcome? A criasical review of the literature. J Matern Fetal Neonatal Med. 2007, 20 (3): 189-209. 10.1080/14767050701209560.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/14/22/prepub

Title: Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: a randomized controlled trial in Spain and France
Authors: Maria Assumpta Ortiz Collado
Marc Saez
Jérôme Favrod
Marie Hatem
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/1471-2393-14-22

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Springer Medicine

Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: a randomized controlled trial in Spain and France

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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