Offspring outcomes after prenatal interventions for common mental disorders: a meta-analysis

Brouwer, Marlies E.; Williams, Alishia D.; van Grinsven, Sam E.; Cuijpers, Pim; Lambregtse-van den Berg, Mijke P.; Burger, Huibert; Bockting, Claudi L. H.

doi:10.1186/s12916-018-1192-6

Table 1 Overview of included studies

From: Offspring outcomes after prenatal interventions for common mental disorders: a meta-analysis

Author, year	Study focus	Selection criteria	Conditions and timing of intervention	No. of participants	Authors conclude sign. Effect of intervention on mother?	Offspring measures	Country	Risk of bias
Author, year	Study focus	Selection criteria	Conditions and timing of intervention	No. of participants	Authors conclude sign. Effect of intervention on mother?	Offspring measures	Country	S	C	B	A	I	R	O	T
Bastani, 2006 [53]	Anxiety	STAI > 30	IG: Applied relaxation training, 7 wk. group sessions CG: TAU Prenatal	IG, 52; CG, 52; Total, 104	Yes, on anxiety symptoms	Medical records: BW & GA	Iran	?	?	?	?	+	–	?	H
Cappon, 2015 [54] ^x	Anxiety	BAI ≥ 21	IG: Listening to music, 20 to 296 times individually CG: TAU Prenatal	IG, 36; CG, 37; Total, 73	Yes, on anxiety symptoms	Questionnaire: BW & GA. IBQ-r at age 2 to 3 months	USA	?	?	+	+	–	+	+	L
Chambers, 2009 [55] ^x	Anxiety	STAI; State or trait subscale ≥ 40	IG: 6 wk. individual relaxation training CG: List of tips for reducing stress Prenatal	IG, 10; CG, 12; Total, 22	No	Medical records: BW & GA & Apgar scores	USA	+	?	–	+	–	+	–	H
Fenwick, 2015 [56]	Fear of childbirth	W-DEQ ≥ 66	IG: Telephone psycho-education, 2 sessions CG: TAU Prenatal	IG, 91; CG, 93; Total, 184	Yes, on flashbacks	Medical records: GA. Hospitalization up to 6 weeks	Australia	+	–	–	+	+	+	+	L
Field, 2009 [45]	Depression	SCID diagnosis MDD	IG: Massage therapy, 12 wk. sessions CG: TAU Prenatal	IG, 88; CG, 61; Total, 149	Yes, on depressive symptoms	Medical records: BW & GA. Saliva (cortisol) & BNBAS at age 2 days	USA	+	?	–	+	–	–	–	H
Karamoozian, 2015 [51]	Depression & Anxiety	EPDS > 9 & PRAQ high score	IG: 12 wk. group CBSM CG: TAU Prenatal	IG, 14; CG, 15; Total, 29	Yes, on anxiety and depressive symptoms	Apgar scale: Apgar scores	Iran	?	?	?	?	+	+	–	H
Madigan, 2015 [58]	PTSD in adolescents	CPTSDI PTSD diagnosis or AAI unresolved state of mind	IG: 12 wk. trauma focused CBT plus 12 sessions parenting course CG: Parenting course (TAU) Prenatal	IG, 12; CG, 14; Total, 26	No	ASSP at age 12 months	Canada	?	?	?	+	+	+	–	L
Maselko, 2015 [46] ^a*	Depression	SCID diagnosis MDD	IG: Thinking healthy programme (CBT based), 7 wk. visits and 9 monthly visits CG: Enhanced routine care Prenatal and postpartum	IG, 289; CG, 295; Total, 584	Yes, less MDD diagnoses in IG	SDQ, SCAS, weight, height, and BMI at age 7 years	Pakistan	+	+	+	+	+	–	–	L
Milgrom, 2015 [50]	Depression	SCID diagnosis MDD and EPDS ≥ 13	IG: Beating blues before birth (CBT based), 8 sessions CG: TAU Prenatal	IG, 16; CG, 13; Total, 29	Yes, on depressive and anxiety symptoms	Medical records: BW & GA. IBQ-R, ASQ-3, and ASQ-SE at age 9 months	Australia	+	+	?	+	+	–	–	M
Netsi, 2015 [47]	Depression	CIS diagnosis MDD	IG: 12 sessions individual CBT CG: TAU Prenatal	IG, 14; CG, 11; Total, 25	Yes, on depressive symptoms	Medical records: BW. ICQ and BISQ at age 2 months	UK	+	+	–	+	–	+	–	H
Rahman, 2008 [44]*	Depression	SCID diagnosis MDD	IG: Thinking healthy programme (CBT based), 7 wk. visits and 9 monthly visits CG: Enhanced routine care Prenatal and postpartum	IG, 440; CG, 463; Total, 903	Yes, on MDD diagnoses	Records: Weight, height, health at ages 6 and 12 months	Pakistan	+	+	+	+	+	+	+	L
Rothberg, 1991 [59]	Stress	SRRS ≥ 39	IG: Psychosocial support during each antenatal clinic visit CG: TAU Prenatal	IG, 43; CG, 43; Total, 86	No	Medical records & Ballard score: BW & GA. Height, hospitalization at birth	South Africa	+	?	?	+	–	+	–	H
Rouhe, 2013 [57]	Fear of childbirth	W-DEQ ≥ 100	IG: 6 sessions psycho-educative group therapy CG: TAU Prenatal and postpartum	IG, 131; CG, 240; Total: 371	Yes, on fear symptoms	Medical records: BW & GA & Apgar scores. Arterial Ph. at birth	Finland	+	+	–	–	–	+	–	H
Urizar, 2011 [48]	Depression	CES-D ≥ 16 or past history of MDD	IG: 12 wk. group CBSM CG: TAU Prenatal	IG, 24; CG, 29; Total, 53	No	Saliva (cortisol) at ages 6 and 18 months	USA	?	?	?	?	+	+	–	H
Verbeek, 2016[52]^x	Depression & Anxiety	EPDS ≥ 12 or STAI ≥ 42	IG: 10 to 12 sessions individual CBT CG: TAU Prenatal and postpartum	IG, 121; CG, 120; Total, 241	No	Medical records: BW & GA & Apgar scores	NL	+	+	–	+	+	+	+	L
Verbeek, 2016b [52] ^{b x}	Depression & Anxiety	EPDS ≥ 12 or STAI ≥ 42	IG: 10 to 12 sessions individual CBT CG: TAU Prenatal and postpartum	IG, 97; CG, 99; Total, 196	No	CBCL and BSID at age 18 months	NL	+	+	–	+	+	+	+	L
Vilhena, 2017 [60]	Common mental disorder in obese women	SRQ-20 ≥ 8	IG: Homeopathy, 2 times a day, 4 days a week CG: Placebo Prenatal	IG, 62; CG, 72; Total, 134	No	Records: GA, BW, Apgar of 10 at 5 min after birth	Brazil	+	+	+	?	?	+	–	L
Zhao, 2017 [49]	Depression	EPDS ≥ 9 or PDSS ≥ 20	IG: 6 sessions couple-separated psycho-educational program for first time parents CG: TAU Prenatal	IG, 175; CG, 174; Total, 349	Yes, on depressive status	Medical records: GA, BW	China	+	?	?	?	+	+	?	L

All presented studies were randomized controlled trials (RCT), except for *cluster RCT. ^xDoctoral dissertation. ^aFollow-up for Rahman 2008. ^bFollow-up for Verbeek 2016. IG intervention group, CG control group, TAU treatment as usual, wk weekly, MDD major depressive disorder, CBSM cognitive-behavioral stress management, CBT cognitive behavioral therapy, BW birth weight, GA gestational age, USA United States of America, UK United Kingdom, NL the Netherlands, BAI Beck anxiety inventory, STAI state trait anxiety inventory, W-DEQ Wijma delivery expectancy/experience questionnaire, SCID structured clinical interview for DSM disorders, EPDS Edinburgh postnatal depression scale, PRAQ pregnancy-related anxiety questionnaire, CPTSDI children’s PTSD inventory, PTSD posttraumatic stress disorder, AAI adult attachment interview, MDD major depressive disorder, CIS clinical interview schedule, SRRS social readjustment rating scale, CES-D Centre for Epidemiological Studies depression Scale, SRQ-20 self-report questionnaire, IBQ-R infant behaviour questionnaire revised, ASQ-3 ages and stages questionnaire, ASQ-SE ages and stages questionnaire social emotional, SDQ strengths and difficulties questionnaire, SCAS Spence children’s anxiety scale, ASSP Ainsworth strange situation procedure, BNBAS Brazelton neonatal behaviour assessment scale, ICQ infant characteristic questionnaire, BISQ brief infant sleep questionnaire, BSID Bayley scales of infant development, CBCL child behaviour checklist. Risk of bias criteria are represented as S = sequence generation, C = allocation concealment, B = blinding of participants and personnel, A = blinding of outcome assessors, I = incomplete outcome data, R = selective reporting, O = other sources of bias, and are coded as + = low risk of bias (0 points), − = high risk of bias (2 points),? = unclear risk of bias (1 point). T = total risk of bias, in which H = high risk of bias, L = low risk of bias. Total risk of bias is scored as < 6 = low risk, > 6 high risk

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