Physical Activity as an Intervention for Antenatal Depression: Rationale for Developing Tailored Exercise Programs for Pregnant Women with Depression

Exercise for perinatal depressive symptoms: A systematic review and meta-analysis of randomized controlled trials in perinatal health services

BACKGROUND

Exercise improves perinatal depressive (PD) symptoms, but reports call for more robust evidence. This systematic review and meta-analysis aimed at synthesizing evidence exclusively from randomized controlled trials (RCTs) examining the effects of exercise on PD symptoms in women recruited through perinatal health services.

METHODS

Nine e-databases and fifteen systematic reviews were searched for relevant RCTs. Exercise-specific tools extracted/coded data. A meta-analysis using a random effects model (Standardized Mean Difference [SMD]) investigated the effects of exercise on PD scores post-intervention.

RESULTS

From 285 records, 14 RCTs (2.025 participants) were considered eligible including two RCTs with clinically diagnosed PD women. Exercise showed a statistically significant, small, overall antidepressant effect (SMD = -0.21, 95% CI = -0.31, -0.11, p = 0.0001) with low/non-significant heterogeneity (Q = 17.82, I ² = 16%, p = 0.27). Only the fail-safe criterion recorded marginally significant publication bias, but trim-fill analysis added no study. Sensitivity analyses increased the overall effect in RCTs showing lower risk of bias or delivering ≥150 min/week moderate intensity aerobic exercise. Subgroup analyses revealed significant antidepressant effects for exercise across various settings, delivery formats, depressive symptoms severities and outcome measures used. Heterogeneity was low/non-significant in all analyses (I ² ≤ 50%). Hedges' g corrections did not influence the results.

LIMITATIONS

Study limitations include the small number of available trials and clinically diagnosed PD samples and the variety of exercise modalities.

CONCLUSIONS

Exercise improved PD symptoms, especially in RCTs with lower risk of bias or with ≥150 min/day moderate intensity aerobic exercise interventions. Findings are clinically useful but more RCTs for clinically diagnosed PD women are needed for firmer conclusions.

Mindful Moms: Motivation to Self-Manage Depression Symptoms

BACKGROUND

Nearly 20% of women in the United States experience depressive symptoms during the perinatal period, with known detrimental effects for the mother, child, and family. Depressive symptoms affect motivation to engage in healthy behaviors and self-management of symptoms.

PURPOSE

The purpose of this study was to explore the experiences of women with depressive symptoms who participated in a 12-week mindful physical activity intervention (Mindful Moms) throughout their pregnancy.

STUDY DESIGN

In this qualitative study, we explore the lived experience of women with depressive symptoms who participated in Mindful Moms, a self-management intervention involving nurse-led motivational sessions and group-based mindful physical activity (yoga).

METHODS

Semistructured interviews conducted at approximately 6 weeks postpartum provided rich qualitative data that was analyzed using a phenomenological approach.

RESULTS

Twenty-five women participated. Findings suggest that participants in Mindful Moms felt empowered to manage their depressive symptoms through the combination of four key factors: a newly recognized need for help, a felt sense of physical and emotional benefit from participation, the power of shared safe space with other pregnant women, support from study staff, and an overall sense of empowerment.

CLINICAL IMPLICATIONS

Mindful Moms appears to be a feasible and acceptable approach to enhancing motivation to self-manage depressive symptoms in pregnant women. Nurses working with childbearing women should be aware of the potential benefits of self-management strategies, such as mindful physical activity and motivational interviewing, for women facing perinatal depressive symptoms.

The prevalence and risk factors of depression in prenatal and postnatal women in China with the outbreak of Corona Virus Disease 2019

BACKGROUND

The prevalence of depression increase with the outbreaks of epidemic disease. The prevalence of depression during the outbreak of Corona Virus Disease 2019 (COVID-19) in prenatal and postnatal women was examined in China.

METHODS

2201 prenatal and postnatal women in mainland China were recruited in this cross-sectional study from February 28^th to April 26^th, 2020. The Patient Health Questionnaire (PHQ-9) was used to assess depression in prenatal and postnatal women.

RESULTS

The prevalence rate of depression was 35.4%. The risk factors for depression included drinking (p = 0.04; adjusted OR = 2.81, 95%CI: 1.26~6.24), nausea and vomiting during pregnancy (p < 0.001; adjusted OR = 3.54, 95%CI: 1.10~11.44), pregnancy's influence on mobility (p = 0.02; adjusted OR = 1.42, 95%CI: 1.11~1.83), anxiety (p < 0.001; adjusted OR = 1.66, 95%CI: 1.57~1.75), insomnia (p < 0.001; adjusted OR = 1.17, 95%CI: 1.14~1.21) and daily attention to fetal movement (p < 0.001; adjusted OR = 0.41, 95%CI: 0.31~0.56).

LIMITATIONS

This study used a cross-sectional design, and cannot compare changes in the incidence of depression before and after the COVID-19 outbreak.

CONCLUSIONS

During the COVID-19 outbreak, the prevalence rate of depression among Chinese prenatal and postnatal women was 35.4%. Moreover, anxiety, insomnia, drinking, nausea and vomiting during pregnancy, as well as the impaired movement and less daily monitoring of fetal movement were risk factors for depression.

Innovations in the Treatment of Perinatal Depression: the Role of Yoga and Physical Activity Interventions During Pregnancy and Postpartum

PURPOSE OF REVIEW

We review evidence for physical activity and yoga as interventions for depressed pregnant and postpartum women.

RECENT FINDINGS

Results from existing trials have generally indicated that physical activity and yoga interventions are acceptable to women during the perinatal period, and that these interventions can be effective in reducing depression. However, some studies have not found significant differences between intervention and control conditions. In addition, symptom improvements were not always maintained. The available research on physical activity and yoga as interventions for perinatal depression is encouraging with regard to feasibility, acceptability, patient safety, and preliminary efficacy. These interventions have the ability to reach a large number of women who may not engage in traditional treatment. Additional high quality, rigorous, randomized controlled trials are needed. Future research is also needed to examine the optimal dose of these interventions and how to best increase sustained engagement.

Associations between quality of life, physical activity, worry, depression and insomnia: A cross-sectional designed study in healthy pregnant women

Health-related quality of life (QOL) is reported to be reduced during pregnancy. Associations between QOL, physical activity (PA), insomnia, depression and worry are insufficiently investigated among pregnant women. The aim of this study was to evaluate QOL and PA patterns among healthy pregnant women, and to examine how QOL might correlate to PA, sleep, worry and depression. This is an observational cross-sectional study, conducted among a convenient sample of 141 healthy pregnant women using five questionnaires: WHOQOL-brief (WHO quality of life questionnaire, brief version, ISI (Insomnia Severity Index), PSWQ (Penn State Worry Questionnaire), ZSRDS (Zung Self-Rating Depression Scale), and Pregnancy Physical Activity Questionnaire (PPAQ). Pre-gestational BMI was inversely correlated to overall health while education was positively correlated to psychological health, social relationships and environment domains. Smoking before and during pregnancy significantly impacted the general health and psychological health. Total and light PA were positively correlated to psychological health and social relationships. Sports/exercise showed positive correlations with several QOL domains. Insomnia and depression were significantly associated with a decrease in all domains of QOL, while worries were associated with a decrease in physical, psychological and environmental domains. There were significant negative correlations between ZSRDS scores and total activity. PA, worries, depression and insomnia affected QOL during pregnancy. Furthermore, pregnant women presenting depression had a reduced total PA. Sleep and mental health as well as encouraging PA during pregnancy are necessary to improve the quality of life of pregnant women.