The Effectiveness of Mindfulness-Based Interventions in the Perinatal Period: A Systematic Review and Meta-Analysis

“The EPDS is the most frequently used self-report measure of perinatal depressive symptom severity with strong psychometric properties amongst both pregnant and postpartum samples [39, 40].”

“Mindfulness has been defined as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgementally to the unfolding of experience moment by moment” [21], p.”

“By contrast, Hofmann et al [26] found significant between-group effect sizes for controlled studies of MBIs for depression (g = 0.”

“Period prevalence estimates suggest that nearly a fifth of women experience depression during pregnancy and a similar proportion do so in the first three months after giving birth [2]].”

“However, while a number of quality assessment tools exist, and have been used for evaluating uncontrolled studies, most omit key quality domains and all have weaknesses [43].”

“There is also evidence that perinatal mental health difficulties are associated with poorer pregnancy outcomes [10] and longstanding emotional, social and cognitive difficulties in children, which appear to be mediated by problematic early parent-infant interactions [11].”

“After exploring a range of options, it was considered most appropriate for the purposes of this review to use a quality index developed for a recent large-scale comprehensive meta-analysis of mindfulness-based therapy which included both randomised and non-randomised studies [44].”

“There is also evidence that perinatal mental health difficulties are associated with poorer pregnancy outcomes [10] and longstanding emotional, social and cognitive difficulties in children, which appear to be mediated by problematic early parent-infant interactions [11].”

“Frequent mindfulness practice is purported to be fundamental to the therapeutic benefits of MBCT and MBSR [71], and it has been shown that increases in mindfulness may mediate the relationship between mindfulness practice and symptom severity and well-being outcomes [72].”

“Similarly, Khoury et al [69] found significant between-group effects of MBIs for depression (g = 0.80, p .01), anxiety (g = 0.64, p .01), and stress (g = 0.74, p .01) in samples of healthy adults.”

“In addition, it is not only mothers who are at risk of mental health problems: around 10% of fathers also experience depression in the perinatal period [7], compared to a 12-month prevalence rate of 4.”

“The EPDS is the most frequently used self-report measure of perinatal depressive symptom severity with strong psychometric properties amongst both pregnant and postpartum samples [39, 40].”

“A meta-analysis of six randomised controlled trials found that MBCT was effective in comparison to control conditions at reducing the relative risk of depressive relapse by 43% in people who were currently well but had a history of three or more episodes of depression [22], and MBCT is recommended for this population…”

“It may partly be for these reasons that MBSR and MBCT have larger effects than meditation interventions based purely on meditation [73].”

“While some studies have suggested that the incidence of mental health difficulties in the perinatal period is not significantly elevated compared with other times in a woman’s life [4, 5], others have found an increased risk once unequal distribution of risk factors between perinatal and non-perinatal populations is c…”

“[74]) and this is an important focus for future research in general as well as specifically for MBIs in the perinatal period.”

“A recent meta-analysis of CBT for perinatal depression found significantly greater reductions in symptoms of depression for women receiving CBT than for controls [17].”

“8 8.01 0.22 [-0.36, 0.79] Perez-Blasco et al (2013) [34] 13 9.54 6.44 8 18.0 8.14 -1.14 [-2.10, -0.18] Vieten & Astin (2008) [35] 13 15.90 5.70 18 16.”

“63] Duncan & Bardacke (2010) [67] 27 1.”

“While some studies have suggested that the incidence of mental health difficulties in the perinatal period is not significantly elevated compared with other times in a woman’s life [4, 5], others have found an increased risk once unequal distribution of risk factors between perinatal and non-perinatal populations is c…”

“For example, in meta-analyses of the effectiveness of psychological interventions—typically Interpersonal Psychotherapy (IPT) or cognitive-behavioural therapy (CBT)—for depression during the antenatal or postnatal period, Sockol et al [17, 70] found large between-group effects of g = 0.96 for controlled studies of IPT…”

“Engagement Of the seventeen included studies, nine reported on the number of participants meeting a study defined criterion for engagement or completion (completing all fifteen steps [64]; completing the programme [36,63]; completing at least 50% of sessions [37, 56, 58, 59], attending at least three out of four sessi…”

“However, the small number of controlled studies which did include samples of women with elevated symptoms of anxiety, stress or depression or a history of difficulties did not show significant benefits of MBIs either [35, 37, 60], suggesting factors beyond this floor effect may better explain these outcomes (although…”

“4) and research shows that many women express a preference for psychological interventions during the perinatal period, expressing fears about medication harming their developing baby, guilt about taking medication, and concerns about becoming dependent [15].”

“Meanwhile, very few studies have investigated the effectiveness of CBT for anxiety disorders in perinatal women, and those that have done so have not always found significant benefits of CBT compared with control conditions [19].”

“stress symptoms [59; 60], while the uncontrolled arm of Woolhouse et al’s, [61] study recruited women deemed to be at risk of stress, anxiety or depression by their midwives or obstetricians.”

“Similarly, Cuijpers et al [18] found moderate significant between-group effects (g = 0.61) in a meta-analysis of the effectiveness of psychological interventions for postnatal depression.”

“Engagement Of the seventeen included studies, nine reported on the number of participants meeting a study defined criterion for engagement or completion (completing all fifteen steps [64]; completing the programme [36,63]; completing at least 50% of sessions [37, 56, 58, 59], attending at least three out of four sessi…”

“While some studies have suggested that the incidence of mental health difficulties in the perinatal period is not significantly elevated compared with other times in a woman’s life [4, 5], others have found an increased risk once unequal distribution of risk factors between perinatal and non-perinatal populations is c…”

“For example, severe postpartum psychiatric disorders are associated with high rates of maternal suicide, with a seventy-fold increase in suicide risk in the first postnatal year compared to age-specific rates for the general female population [9].”

“Byrne et al (2013) [63]; Fisher et al (2012) [66] Qualitative data gathered at follow-up through two focus groups carried out around four months after the intervention—one with women who took part in the intervention and the other with their birth partners.”

“Authors Experimental Control Hedge’s g, 95% CI n M SD n M SD Dunn et al (2012) [62] 4 16.0 8.49 4 10.5 8.23 0.57 [-0.87, 2.01] Gambrel & Piercy (2013) [33] 1517 5.339.65 3.444.20 1717 9.4111.41 7.85.91 -0.65 [-1.36, 0.07]-0.34 [-1.01, 0.34] Guardino et al (2013) [60] 24 37.3 5.38 23 35.”

“8 8.01 0.22 [-0.36, 0.79] Perez-Blasco et al (2013) [34] 13 9.54 6.44 8 18.0 8.14 -1.14 [-2.10, -0.18] Vieten & Astin (2008) [35] 13 15.90 5.70 18 16.”

“Likewise, findings of previous meta-analyses of psychological interventions designed for the perinatal period have found that interventions initiated during the postpartum period are associated with larger improvements than interventions initiated during pregnancy [17, 75].”

“Muzik et al (2012) [57] Brief qualitative post-intervention feedback Self-completed feedback survey 18/22 Participants enjoyed the social support offered by the group, and found the intervention beneficial both during their pregnancy and labour.”

“01] Gambrel & Piercy (2013) [33] 1517 5.”

“Future research UK clinical guidelines recommend MBCT for the prevention of depressive relapse in people with a history of depression [23], but only two studies explored this in a perinatal population [37, 56].”

“One study was excluded because it did not evaluate an intervention [51], one did not include baseline data [52], two were excluded because they did not include eligible samples of women [53, 54], and one did not include a relevant outcome measure [55].”

“To date, there has only been one published review of mindfulness training in the perinatal period [31].”

“23] (uncontrolled arm) Zhang & Emory (2015) [36] 16 30.”

“Research suggests there are significant cost implications too: in the United States women with postpartum depression have been shown to incur 90% higher health services expenditure than non-depressed postpartum women [12], while in the UK it has been estimated that perinatal depression, anxiety and psychosis together…”

“Recent evidence suggests that MBIs work in part by reducing levels of rumination and, given that factors such as ‘brooding rumination’ have been found to predict the maintenance of depression in the perinatal period [30], mindfulness may be a particularly apt intervention at this time.”

“Byrne et al (2013) [63]; Fisher et al (2012) [66] Qualitative data gathered at follow-up through two focus groups carried out around four months after the intervention—one with women who took part in the intervention and the other with their birth partners.”

“In the only study to include the views of men as well as women, Gambrel and Piercy, 2013 [33, 68] found that while women in the sample typically initiated participation in the intervention, they commented that they already had adequate social support and did not find that the intervention provided additional benefit.”

“However, despite speculation that mindfulness-based approaches may be beneficial for early parenting [20] no studies were identified that focused on this.”

“Engagement Of the seventeen included studies, nine reported on the number of participants meeting a study defined criterion for engagement or completion (completing all fifteen steps [64]; completing the programme [36,63]; completing at least 50% of sessions [37, 56, 58, 59], attending at least three out of four sessi…”

“One study was excluded because it did not evaluate an intervention [51], one did not include baseline data [52], two were excluded because they did not include eligible samples of women [53, 54], and one did not include a relevant outcome measure [55].”

“Authors Experimental Control Hedge’s g, 95% CI n M SD n M SD Chan (2015) [32] 64 6.”

“One study was excluded because it did not evaluate an intervention [51], one did not include baseline data [52], two were excluded because they did not include eligible samples of women [53, 54], and one did not include a relevant outcome measure [55].”

“A total of 74 pregnant women were randomized to either the intervention group or treatment-asusual (control), and psychological state was assessed though the Perceived Stress Scale, Edinburgh Postnatal Depression Scale, and Five Facet Mindfulness Questionnaire at midpregnancy (baseline) and 3 months postpartum.(49) Th…”

“preventing mental health problems is far from consistent, but some reviews of trials suggest that it can be an effective alternative to conventional approaches to addressing (perinatal) depression and anxiety, as well as stress in higher-risk groups, including some groups of workers and informal carers (40, 55, 89).”

“There have been meta-analyses of mindfulness interventions in pregnancy (Hall et al. 2016; Taylor et al. 2016), focused on outcomes in common mental health symptoms, with both reviews highlighting issues with the quality of the data.”