Effects of psychological treatment of mental health problems in pregnant women to protect their offspring: randomised controlled trial
Open accessAbstract
Background: Perinatal depression and anxiety are associated with unfavourable child outcomes. Aims: To assess among women with antenatal depression or anxiety the effectiveness of prenatally initiated cognitive–behavioural therapy (CBT) on mother and child compared with care as usual (CAU). Trial registration: Netherlands Trial Register number NTR2242. Method: Pregnant women (n= 282) who screened positive for symptoms of depression and/or anxiety were randomised to either CBT (n= 140) or CAU (n= 142). The primary outcome was child behavioural and emotional problems at age 18 months, assessed using the Child Behavior Checklist (CBCL). Secondary outcomes were maternal symptoms during and up to 18 months after pregnancy, neonatal outcomes, mother–infant bonding and child cognitive and motor development at age 18 months. Results: In total, 94 (67%) women in the CBT group and 98 (69%) in the CAU group completed the study. The mean CBCL Total Problems score was non-significantly higher in the CBT group than in the CAU group (mean difference: 1.38 (95% CI −1.82 to 4.57);t= 0.85,P= 0.399). No effects on secondary outcomes were observed except for depression and anxiety, which were higher in the CBT group than in the CAU group at mid-pregnancy. A post hoc analysis of the 98 women with anxiety disorders showed lower infant gestational age at delivery in the CBT than in the CAU group. Conclusions: Prenatally initiated CBT did not improve maternal symptoms or child outcomes among non-help-seeking women with antenatal depression or anxiety. Our findings are not in line with present recommendations for universal screening and treatment for antenatal depression or anxiety, and future work may include the relevance of baseline help-seeking.
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High-intensity psychological interventions such as cognitive-behavioral therapy and interpersonal therapy are less effective in women with subclinical antepartum or postpartum depression or show no effect at all in non-help-seeking women.
“Despite the advice for high-intensity psychological interventions such as cognitive-behavioral therapy (CBT) and interpersonal therapy [18], these interventions are less effective in women with subclinical antepartum or postpartum depression or show no effect at all in non-help-seeking women [20, 21].”
From Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort. (2020) · cites this paper as [21]
The Abstract (page unavailable) reports that prenatally initiated CBT did not improve symptoms among non-help-seeking women with antenatal depression or anxiety. The Comparison with findings from other studies section (page unavailable) discusses weaker effects in screening-recruited patients and stronger effects in higher-risk groups. The paper does not establish the claim for interpersonal therapy or for women whose depression began postpartum. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOnly two randomized controlled trials have tested exposure therapy efficacy for pregnant women, while over 90 randomized controlled trials have tested exposure therapy in non-pregnant adults.
“Exposure therapy has only two Randomized Controlled Trials (RCTs; Burger et al., 2020; Loughnan et al., 2019) that have tested its efficacy for pregnant women, while over 90 RCTs have tested exposure therapy in non-pregnant adults (Bandelow et al., 2015).”
From Exposure Therapy Acceptability Among Pregnant Latinas With Anxiety: A Qualitative Content Analysis (2025) · cites this paper as Burger et al., 2020
The Interventions and Results sections describe a randomized trial in pregnant women of CBT that could include exposure, so Burger et al. is relevant as a trial of an exposure-containing treatment. The trial tested CBT as a whole, not exposure therapy separately, and the paper does not establish that only two such trials existed. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredExposure therapy is underutilized during pregnancy.
“Exposure therapy is the frontline treatment for anxiety among adults but is underutilized during pregnancy.”
From Exposure Therapy Acceptability Among Pregnant Latinas With Anxiety: A Qualitative Content Analysis (2025) · cites this paper as Burger et al., 2020
The Interventions section lists exposure as an optional component of antenatal CBT, and the Comparison with findings from other studies and interpretation section discusses its possible risks. Neither reports how often exposure therapy is used during pregnancy or says it is underutilized. Searches for underuse, treatment uptake, and utilization found no supporting passage; page numbers were not available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measured
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- Authors
- Burger, H., Verbeek, T., Aris-Meijer, J. L., Beijers, C., Mol, B. W., Hollon, S. D., Ormel, J., van Pampus, M. G., & Bockting, C. L. H.
- Affiliations
- University Medical Center Groningen (NL)
- Monash University (AU)
- Vanderbilt University (US)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Burger, Huibert
- ORCID
- Venue
- The British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2019-12-06
- Volume
- 216
- Issue
- 4
- Pages
- 182-188
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2994304709
- Cited by
- 41
- References
- 30
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 5 · 2023: 7 · 2022: 12 · 2021: 6 · 2020: 1
- FWCI
- 4.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- KNAW Research Portal (The Royal Netherlands Academy of Arts and Sciences) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Medical Research Council
- National Health and Medical Research Council (1082548)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- antenatal depression, prenatal anxiety, perinatal mental health, mother-infant bonding, neonatal outcomes, help-seeking, universal screening
- MeSH terms
- Adult, Anxiety Disorders, Child Development, Depressive Disorder, Female, Humans, Infant, Netherlands, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, Cognitive Behavioral Therapy, Treatment Failure
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