An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS)

The parental brain, perinatal mental illness, and treatment: A review of key structural and functional changes

The transition to parenthood is perhaps the only time in adult life when the brain changes to such a significant degree in such a short period, particularly in birthing parents. It is also a time when there is an increased risk of developing a mental illness, which may be due, in part, to the increased neuroplasticity. Thus, we must develop interventions and treatments that support parents and promote parental brain health. This review will highlight key findings from current research on how human brain structure and function are modified with 1) the transition to parenthood, 2) parenting stress and perinatal mental illness, and 3) treatments aimed at promoting perinatal mental health. The focus will be on birthing parents and mothers, but brain changes in non-birthing parents will also be discussed. Improvements in our understanding of the parental brain, in health and with illness, will promote the well-being of generations to come.

Mindfullness based intervention reduce anxiety in labor

OBJECTIVE

To determine the effectiveness of mindfulness interventions on anxiety through a systematic review.

METHOD

Systematic review by searching articles through the PubMed, ProQuest, Science Direct, Wiley Library, Sage Journal, and Cochrane Library databases with publication years January 2012 to January 2022 RESULTS: Eleven articles met the inclusion criteria covering several countries, including Canada 1 article, Egypt 1 article, Taiwan 1 article, Amsterdam 2 articles, Iran 1 article, Austria 1 article, San Francisco 1 article, Germany 1 article, Sweden 1 article, China 1 article, and Spain 1 article.

CONCLUSIONS

Management of anxiety about childbirth is important for pregnant women. Mindfulness interventions are effective for reducing anxiety about labor and increasing comfort during labor. Mindfulness intervention mechanisms have the potential to reduce anxiety by increasing skills to regulate emotions.

The Effect of Mandala Activity and Technology-Based Breastfeeding Program on Breastfeeding Self-Efficacy and Mother-Infant Attachment of Primiparous Women: A Randomized Controlled Study

The use of art therapy methods such as mandala is becoming increasingly popular in mother-infant health education and counseling. The aim of the study was to evaluate the effect of a mandala and technology-based breastfeeding program on women's breastfeeding self-efficacy and attachment between mother and infant. This randomized controlled, single-blind, and parallel-group trial design was conducted in foundation university hospital. The study was completed by 66 women and their infants (intervention group: n = 33; control group: n = 33). The women who are at the 32-37th gestational week in the intervention group participated in the mandala and technology-based breastfeeding (including Zoom and WhatsApp platforms) program. They received three education module via WhatsApp. Women in control group received routine care. The Maternal Attachment scale and Breastfeeding Self-efficacy Scale were applied in the first week and second month postpartum. Growth follow-ups of the infants were evaluated in the first week, first month and second month postpartum. The registration number of this study on ClinicalTrials.gov is NCT05199298. In the second month postpartum, it was determined that the women in the intervention group had higher Breastfeeding Self-efficacy and Maternal Attachment scale scores compared to the control group (p < 0.05). Also, the rates of breastfeeding in the intervention group were higher than in the control group. Mandala and technology-based breastfeeding program increased women's breastfeeding self-efficacy and maternal attachment. Health care professionals should make use of technology-based educations to give holistic care in maternal and infant health.

A Pilot Study of Maternal Songwriting to Support Bonding During Pregnancy: "I Could Feel Her Rise and Fall With My Breath While Singing"

INTRODUCTION

Attachment is a lasting psychological and emotional bond that impacts a child's social, emotional, and cognitive development. Maternal-fetal attachment is a precursor to this bond that is regarded as a predictor for mother-infant relating postbirth. Although previous studies have investigated use of music interventions to support maternal-fetal attachment, no study to date has investigated the use of maternal songwriting to support this bond during pregnancy.

METHODS

Four pregnant women were recruited to this pilot study. Each woman participated in 2 songwriting workshops with the aim of writing an original song to their fetus. Following the workshops, experiences of using songwriting for the purposes of supporting bonding were investigated through individual semistructured interviews and analyzed using thematic content analysis.

RESULTS

Analysis of semistructured interviews with pregnant women revealed 3 main themes: song singing promotes physical connection with the fetus; songwriting encourages open communication with the fetus; and songwriting can create a musical legacy within families.

DISCUSSION

To the best of our knowledge, this study is the first of its kind that investigated maternal songwriting to support bonding during pregnancy. Findings indicated that songwriting has the potential to support such attachment due to its capacity to enhance physical connection and open communication with the fetus, while also creating a musical legacy that can be used and passed on among other family members. Overall, songwriting may support pregnant women to draw on their inner resources to create such a bespoke musical gift to their unborn child. Further research around this topic is warranted.

Effectiveness of mindfulness training on pregnancy stress and the hypothalamic-pituitary-adrenal axis in women in China: A multicenter randomized controlled trial

Introduction

In the past two decades, mindfulness-based intervention programs have gradually become popular.Many studies have confirmed that these programs can effectively alleviate prenatal stress and negative emotion.The mindfulness-based stress-buffering hypothesis suggests that mindfulness training can induce changes in the levels of the cortisol secreted by the HPA axis, thereby reducing stress susceptibility. However, to date, only a few high-quality evidence-based medical studies have analyzed the effect of the mindfulness-based intervention in a maternal population.Thus, this study investigated the effects of a mindfulness-based psychosomatic intervention on pregnancy stress and the HYPERLINK "javascript:;" hypothalamic-pituitary-adrenal (HPA) axis of pregnant Chinese women.

Methods

Women experiencing first-time pregnancy (n = 117) were randomly allocated to the intervention group or parallel active control group, and data were collected at baseline and post-intervention periods. The participants completed questionnaires regarding mindfulness and pregnancy stress. Saliva samples was collected at the time of waking up, and 30, 45, and 60 min after waking up for analyzing the salivary cortisol levels. We analyzed differences between the two groups and changes within the same group before and after the intervention.

Results and discussion

A total of 95 participants completed the trial. Compared with the parallel active control group, the intervention group exhibited lower levels of stress after the intervention (P = 0.047). For HPA-axis-related indicators after the intervention, Delta value (P = 0.01) and AUCM value (P = 0.031) of the intervention group were significantly higher than that of the control group. Mindfulness-based interventions effectively reduced the level of pregnancy stress and adjusted the HPA axis function in pregnant women in China.

Clinical Trial Registration

https://www.chictr.org.cn, identifier ChiCTR 2000033149.

Instruments to Identify Symptoms of Paternal Depression During Pregnancy and the First Postpartum Year: A Systematic Scoping Review

Men often experience depressive symptoms during the transition to parenthood, but there is a lack of synthesized knowledge of instruments used to identify such symptoms. The aim of this scoping review was to identify instruments used to measure symptoms of depressive symptoms among fathers in pregnancy and the postpartum period, and to describe the instruments' characteristics and measurement properties. We identified studies published since 1990 through searches in databases such as MEDLINE, EMBASE, and PsycINFO and in gray literature. Pairs of reviewers selected relevant studies based on predetermined inclusion criteria. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). We included 13 instruments, described in 59 studies with about 29,000 participants across 25 countries. There were 12 validation studies. None of the instruments were uniquely developed for assessing paternal depressive symptoms related to fatherhood. The three most extensively examined instruments were the Edinburgh Postnatal Depression Scale (EPDS), Center for Epidemiologic Studies Depression Scale, and Beck Depression Inventory. For seven of the 13 instruments, there was no information reported about the instruments' properties beyond internal consistency, but for the other six instruments the 12 validation studies reported on both reliability and validity. No studies reported on measurement error or responsiveness. EPDS was both the most extensively assessed instrument and reported to be the most reliable and valid. Further research on instruments for identifying men with depression in pregnancy and the postpartum period is warranted.

Emotion Management for College Students: Effectiveness of a Mindfulness-Based Emotion Management Intervention on Emotional Regulation and Resilience of College Students

ABSTRACT

The discovery of psychological healing methods that are easy to master and can be developed by the individual as a means of improving students' self-psychological adjustment ability is of great practical value. This study is a randomized control trial intended to investigate the effectiveness of mindfulness-based emotion management interventions and to test their effects on the mood state and resilience of college students. A total of 72 students were recruited and randomly divided into an intervention group and a control group. Thirty-six students in the intervention group received a modified mindfulness-based emotion management intervention once per week for 4 weeks, with each intervention having a duration of 80 minutes. Participants were assessed by questionnaires to measure mindfulness level, emotion, and resilience before and after intervention. There were significant interaction effects on mindfulness level (F = 97.76, p < 0.00), mood state (F = 353.52, p < 0.00), and resilience (F = 178.99, p < 0.00) scores. A modified 4-week mindfulness-based emotion management intervention can improve the mindfulness level and resilience of college students and is an innovative and feasible strategy for enhancing mental health in college students.

Repetitive negative thinking in the perinatal period and its relationship with anxiety and depression

BACKGROUND

Rumination and worry represent two types of repetitive negative thinking (RNT), and their predictive and maintaining roles are well-established in depression and anxiety, respectively. Furthermore, there is an emerging literature on the link between RNT and psychological wellbeing in the perinatal period.

METHODS

We conducted a scoping review of studies that have investigated the relationship between RNT and perinatal depression and anxiety. We identified 87 papers eligible for inclusion in the review; they included cross-sectional and longitudinal studies, as well as treatment evaluations (pilot trials and randomised controlled trials).

RESULTS

Cross-sectional studies provided evidence of an association between RNT (i.e., rumination and worry) and depression and anxiety, in both pregnancy and postpartum. Longitudinal findings were mixed. Whilst antenatal worry consistently predicted subsequent depression and anxiety (both later in pregnancy and postpartum), rumination did not consistently predict depression. However, there was some evidence that rumination interacted with other processes to predict later psychopathology. Three randomised controlled trials evaluated whether psychological treatments reduce RNT in the perinatal period, only one of which included a clinical sample.

LIMITATIONS

No experimental investigations were eligible for inclusion in the review.

CONCLUSIONS

Further studies are needed to further our understanding of the nature and role of RNT in pregnancy and postpartum, and its consequences for maternal mental health. These include (but are not limited to) experimental investigations, studies with large clinical samples, and RCTs evaluating the effectiveness of psychological interventions targeting RNT to prevent and treat perinatal depression and anxiety.

The effectiveness of psychological interventions for pregnant women with anxiety in the antenatal period: A systematic review

OBJECTIVE

Anxiety is a significant public health concern, that if untreated may lead to adverse outcomes for mother, baby and the family unit. The aim of this review was to determine the efficacy of psychological interventions for pregnant women with anxiety in the antenatal period. Although guidelines recommend psychological interventions for managing anxiety in the perinatal period, there is a lack of strong evidence on the most effective psychological intervention for use in the antenatal period. Effective non-pharmacological interventions are an important area that requires significant clinical attention.

DESIGN

A systematic review of quantitative and qualitative studies was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Applied Social Sciences Index and Abstracts (ASSIA), Web of Science and PsychInfo. Quality appraisal was performed using The Joanna Briggs Institute (JBI) critical appraisal tool to assess methodological quality on all six included papers. All four RCT's were assessed separately using the Cochrane Risk of Bias Tool.

FINDINGS

Of the 7278 articles, six quantitative studies were included. The overall results of this review found that mindfulness based interventions are by far the most effective intervention for the treatment of anxiety in the antenatal period. These findings are not in line with current guidance on treatment of women with anxiety in the antenatal period and warrants immediate attention.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Healthcare professionals need to be aware of the potential benefits of mindfulness based interventions in practice. There is some evidence to support their use in the antenatal period, however, there remains insufficient evidence to confidently advocate for their use in practice. Follow-up research needs to be conducted on the efficacy of mindfulness based interventions on women with anxiety in the antenatal period using rigorous RCT's. Education and training of Midwives to help promote and use this intervention is recommended.

Worries among pregnant Danish women with chronic medical conditions - A cross sectional study with data from the Copenhagen pregnancy cohort

OBJECTIVE

Pregnancy is a time of uncertainty and worries are common. Pregnant women with somatic chronic medical conditions (SCMC) are at higher risk of adverse pregnancy outcomes and perinatal mental illness than women without SCMC. We aimed to describe the degree and content of worries in early pregnancy among Danish women with SCMC compared with women without SCMC.

STUDY DESIGN

We conducted a cross-sectional study with self-reported questionnaires answered by 28,794 women from 2012─2019 during 1st trimester at a large university hospital in Denmark.

MAIN OUTCOME MEASURES

We used the Cambridge Worry Scale (CWS). The outcomes of interest were the prevalence of major worry at item level (n/%) and the total CWS score (mean/SEM) as expression of the degree and content of worries. Univariate and multivariable regression analysis were performed.

RESULTS

Women with SCMC reported a significantly higher total CWS score (aMD 1.50, 95% CI: 1.20-1.80). Women with SCMC were significantly more likely to report major worry in relation to own health (aOR 2.72, 95% CI: 2.43-3.08), the baby's health (aOR 1.40 95% CI 1.31-1.52), the process of giving birth (aOR 1.12, 95% CI: 1.04-1.21), the possibility of preterm labor (aOR 1.44, 95% CI: 1.28-1.63), and miscarriage (aOR 1.34, 95% CI: 1.24-1.43).

CONCLUSION

Women with SCMC reported higher overall degree of worry during early pregnancy and an increased risk of major worry in relation to own health, pregnancy complications and giving birth. In antenatal care, these worries should be addressed by clinicians.

Trait mindfulness during pregnancy and perception of childbirth

Women's subjective childbirth experience is a risk factor for postpartum depression and childbirth-related posttraumatic stress symptoms. Subjective childbirth experience is influenced not only by characteristics of the childbirth itself but also by maternal characteristics. A maternal characteristic that may be associated with a more positive childbirth experience is trait mindfulness. The current study aimed to assess this association and to assess whether trait mindfulness during pregnancy had a moderating role in the possible association between non-spontaneous delivery and perception of childbirth. A subsample of 486 women, participating in a longitudinal prospective cohort study (Holistic Approach to Pregnancy and the first Postpartum Year study), completed the Three Facet Mindfulness Questionnaire-Short Form at 22 weeks of pregnancy. Women completed the Childbirth Perception Scale and the Edinburgh Postnatal Depression Scale between 7 and 21 days postpartum. The mindfulness facets acting with awareness and non-reacting were significantly associated with a more positive perception of childbirth, after adjusting for covariates. Moderation analyses showed a significant interaction between acting with awareness and non-spontaneous delivery and non-judging and non-spontaneous delivery. Non-spontaneous delivery was associated with a more negative perception of childbirth for low/medium scores of acting with awareness and non-judging, but not for high scores on these mindfulness facets. Trait mindfulness during pregnancy may enhance a positive perception of childbirth. Because this is among the first studies examining the association between maternal dispositional mindfulness and perception of childbirth, future research is needed to confirm the results of the current study.

Effects of prenatal mindfulness-based childbirth education on child-bearers' trajectories of distress: a randomized control trial

BACKGROUND

The perinatal period is a time of immense change, which can be a period of stress and vulnerability for mental health difficulties. Mindfulness-based interventions have shown promise for reducing distress, but further research is needed to identify long-term effects and moderators of mindfulness training in the perinatal period.

METHODS

The current study used data from a pilot randomized control trial (RCT) comparing a condensed mindfulness-based childbirth preparation program-the Mind in Labor (MIL)-to treatment as usual (TAU) to examine whether prenatal mindfulness training results in lower distress across the perinatal period, and whether the degree of benefit depends on child-bearers' initial levels of risk (i.e., depression and anxiety symptoms) and protective (i.e., mindfulness) characteristics. Child-bearers (N = 30) in their third trimester were randomized to MIL or TAU and completed assessments of distress-perceived stress, anxiety, and depressive symptoms-at pre-intervention, post-intervention, six-weeks post-birth, and one-year postpartum.

RESULTS

Multilevel modeling of distress trajectories revealed greater decreases from pre-intervention to 12-months postpartum for those in MIL compared to TAU, especially among child-bearers who were higher in anxiety and/or lower in dispositional mindfulness at baseline.

CONCLUSIONS

The current study offers preliminary evidence for durable perinatal mental health benefits following a brief mindfulness-based program and suggests further investigation of these effects in larger samples is warranted.

TRIAL REGISTRATION

The ClinicalTrials.gov identifier for the study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

Effects of an Online Mindfulness Intervention Focusing on Attention Monitoring and Acceptance in Pregnant Women: A Randomized Controlled Trial

INTRODUCTION

Attention monitoring and acceptance underlie the effects of mindfulness meditation. This study tested the feasibility and acceptability of an online mindfulness intervention for pregnant women as an approach to reduce depressive and anxious symptoms.

METHOD

We developed an 8-week mindfulness intervention program that trained participants to monitor their internal and external experiences in an accepting way. The mindfulness course was based on the Wechat platform. This study was conducted in a women's hospital in China. A total of 123 women with scores on the Generalized Anxiety Disorder Scale and Patient Health Questionnaire suggesting mild or moderate symptoms of depression and anxiety were recruited from the outpatient department between April and June 2018. The participants were randomized to receive the mindfulness intervention or routine prenatal care. The Generalized Anxiety Disorder Scale, the Patient Health Questionnaire, and the Five Facets of Mindfulness Questionnaire were used to evaluate the levels of anxiety, depression, and mindfulness, respectively, before and after the intervention.

RESULTS

Of the 123 women enrolled in this study, 10 in the intervention group and 11 in the control group did not complete the intervention. The retention rate and feedback suggested that the mindfulness intervention was feasible and acceptable among pregnant women. Participants in the intervention group showed greater declines in depressive and anxious symptoms compared with those in the control group, as well a significant improvement in mindfulness skills (eg, attention monitoring and acceptance).

DISCUSSION

These results suggest that an online mindfulness intervention may be a promising technique to help women use mindfulness skills to reduce depressive and anxious symptoms. The mindfulness intervention could constitute part of the psychological care provided to pregnant women.

A mindfulness and compassion-based program applied to pregnant women and their partners to decrease depression symptoms during pregnancy and postpartum: study protocol for a randomized controlled trial

BACKGROUND

Pregnancy and the postpartum period are times of great change for women and their partners, often bringing substantial challenges and stress. Approximately 10%-20% of women suffer from mood disorders such as depression in the perinatal period. There are risks involved in using psychopharmacological interventions to treat perinatal depression. Mindfulness and compassion-based educational programs could be efficacious and cost-effective options for the prevention and treatment of perinatal mood disorders. The aim of this study is to assess the efficacy of an adapted Mindfulness-Based Childbirth and Parenting (MBCP) program that includes compassion training for pregnant women in primary care (PC) settings in the Spanish National Health System to decrease perinatal depression.

METHODS

A multicenter randomized controlled trial (RCT) will be conducted. Participants will be pregnant women (n = 122) and their partners who wish to participate. They will be enrolled and assessed in PC settings and randomly assigned to either: (1) an adapted MBCP educational program tailored to the Spanish National Health System + treatment as usual (TAU); or (2) TAU only. The main outcome to be assessed will be depression, evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Secondary outcomes will include self-reported measures of perceived stress, affects, mindfulness, self-compassion, maternal self-efficacy, and use of health and social services. Patients will be assessed at four timepoints: baseline; post-treatment; and at three and six months after childbirth. Intention-to-treat and per-protocol analyses will be carried out using linear regression mixed models. Effect sizes will be estimated using Cohen's d.

DISCUSSION

Perinatal depression is a significant health problem. An effective and low-cost childbirth education program that incorporates mindfulness and compassion practices may be a beneficial preventive complementary healthcare modality for expectant women and their partners. This study will be the first multicenter RCT in Spanish PC settings using adapted MBCP and compassion practices to reduce symptoms of depression during pregnancy and the postpartum period.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03247491. Registered on 31 July 2017.

Fetal and Infant Outcomes in the Offspring of Parents With Perinatal Mental Disorders: Earliest Influences

Mental illness is highly prevalent and runs in families. Mental disorders are considered to enhance the risk for the development of psychopathology in the offspring. This heightened risk is related to the separate and joint effects of inherited genetic vulnerabilities for psychopathology and environmental influences. The early years of life are suggested to be a key developmental phase in the intergenerational psychopathology transmission. Available evidence supports the idea that early exposure to parental psychopathology, during the pregnancy and first postpartum year, may be related to child psychological functioning beyond the postpartum period, up to adulthood years. This not only highlights the importance of intervening early to break the chain of intergenerational transmission of psychopathology but also raises the question of whether early interventions targeting parental mental disorders in this period may alleviate these prolonged adverse effects in the infant offspring. The current article focuses on the specific risk of psychopathology conveyed from mentally ill parents to the offspring during the pregnancy and first postpartum year. We first present a summary of the available evidence on the associations of parental perinatal mental illness with infant psychological outcomes at the behavioral, biological, and neurophysiological levels. Next, we address the effects of early interventions and discuss whether these may mitigate the early intergenerational transmission of risk for psychopathology. The summarized evidence supports the idea that psychopathology-related changes in parents' behavior and physiology in the perinatal period are related to behavioral, biological, and neurophysiological correlates of infant psychological functioning in this period. These alterations may constitute risk for later development of child and/or adult forms of psychopathology and thus for intergenerational transmission. Targeting psychopathology or mother-infant interactions in isolation in the postnatal period may not be sufficient to improve outcomes, whereas interventions targeting both maternal psychopathology and mother-infant interactions seem promising in alleviating the risk of early transmission.