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Cited by 138Maternal Mental Health During Pregnancy and PostpartumPregnancy-related medical researchPersonality Disorders and Psychopathology

Interventions to treat mental disorders during pregnancy: a systematic review and multiple treatment meta-analysis

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van Ravesteyn, Leontien M., Lambregtse - van den Berg, Mijke P., Hoogendijk, Witte J. G., Kamperman, Astrid M.·2017·PLOS ONE
DOI 10.1371/journal.pone.0173397PMC PMC5373816
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Abstract

BACKGROUND: For women suffering from an antepartum mental disorder (AMD), there is lack of evidence-based treatment algorithms due to the complicated risk-benefit analysis for both mother and unborn child. We aimed to provide a comprehensive overview of pharmacological and non-pharmacological interventions to treat AMD and performed a meta-analysis of the estimated treatment effect on the psychiatric symptoms during pregnancy. METHODS: MedLine, PsycINFO and Embase databases were searched by two independent reviewers for clinical trials with a control condition on treatment of women with AMD, i.e. major depressive (MDD), anxiety, psychotic, eating, somatoform and personality disorders. We inventoried the effect of the treatment, i.e. decrease of psychiatric symptoms at the end of the treatment or postpartum. We adhered to the PRISMA-protocol. FINDINGS: Twenty-nine trials were found involving 2779 patients. Trials studied patients with depressive disorders (k = 28), and anxiety disorders (k = 1). No pharmacological trials were detected. A form of psychotherapy, like Cognitive Behavioural Therapy (g = -0.61; 95%CI:-0.73 to -0.49, I2 = 0%; k = 7) or Interpersonal Psychotherapy (g = -0.67; 95%CI:-1.27 to -0.07; I2 = 79%; k = 4), holds robust benefit for pregnant women with MDD. Body-oriented interventions (g = -0.43; 95%CI:-0.61 to -0.25; I2 = 17%; k = 7) and acupuncture (g = -0.43; 95%CI:-0.80 to -0.06; I2 = 0%; k = 2) showed medium sized reduction of depressive symptoms. Bright light therapy (g = -0.59; 95%CI:-1.25 to 0.06; I2 = 0%; k = 2), and food supplements (g = -0.51; 95%CI:-1.02 to 0.01; I2 = 20%; k = 3) did not show significant treatment effects. One study was found on Integrative Collaborative Care. CONCLUSIONS: This meta-analysis found a robust moderate treatment effect of CBT for MDD during pregnancy, and to a lesser extent for IPT. As an alternative, positive results were found for body-oriented interventions and acupuncture. No evidence was found for bright light therapy and food supplements. Only non-pharmacological trials on women with MDD were found. Research on a wider range of AMD is needed.

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  • A systematic review on studies treating antepartum depression with a control condition showed that these trials often show a considerable reduction in symptom scores in both treatment arms.

    “A systematic review on various studies in treating antepartum depression with a control condition showed that these trials often show a considerable reduction in symptom scores in both treatment arms.39”

    From Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial (2020) · cites this paper as [39]

    The Results (Depressive disorder; page unavailable) report that both groups improved over time in a CBT trial, and the Results (Food supplements; page unavailable) report significant improvement in both groups of another trial. The review does not establish that considerable reductions in both arms occurred often across the trials. (LLM, conf=0.84)

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  • Psychotherapeutic interventions such as interpersonal psychotherapy and cognitive behavioral therapy are effective in treating perinatal depression and anxiety.

    “Psychotherapeutic interventions such as interpersonal psychotherapy and cognitive behavioral therapy (CBT), which have been shown to be effective in treating perinatal depression and anxiety (28, 29), are preferred (27, 30, 31).”

    From Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study (2022) · cites this paper as [28]

    The Abstract Findings and Results > Meta-analysis report significant benefits of CBT and interpersonal psychotherapy for depression in pregnant women. Results > Anxiety disorders reports one trial in which CBT reduced anxiety and avoidance scores, but it does not establish that interpersonal psychotherapy treats anxiety. The review also focuses on treatment during pregnancy rather than the full perinatal period. (LLM, conf=0.88)

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  • To overcome high attrition rates and improve effectiveness, interventions should be aimed primarily at at-risk women and should fit the unique preferences and needs of pregnant women.

    “From previous trials, we also know that to overcome high attrition rates and improve effectiveness, interventions should be aimed primarily at at-risk women (e.g., women with subclinical depression) and should fit the unique preferences and needs of pregnant women [22–24].”

    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 [22]

    The Discussion (Summary of evidence; page not provided) notes high attrition and recommends giving patients’ preferences substantial weight when choosing treatment. But the review studied pregnant women with diagnosed disorders and excluded those with risk factors but no diagnosis (Eligibility criteria; page not provided); it does not recommend aiming interventions primarily at at-risk women with subclinical depression. (LLM, conf=0.87)

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Research works printed but not linked: 1

  1. LC Lamprou, 2013, Randomized controlled trial assessing the efficacy of transcranial magnetic stimulation for the treatment of major depressive disorder in pregnancy, J ECT, 29, 150

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Authors
van Ravesteyn, L. M., Lambregtse - van den Berg, M. P., Hoogendijk, W. J. G., & Kamperman, A. M.
Affiliations
Erasmus MC (NL)
Corresponding author
Kamperman, Astrid M.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2017-03-30
Volume
12
Issue
3
Pages
e0173397
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0173397
PMC
PMC5373816
OpenAlex
W2599194757
Semantic Scholar
9d01af578d6ed04023e9ec64e63c387bd4d95122
Cited by
138
References
73
Citations by year
2026: 7 · 2025: 10 · 2024: 12 · 2023: 16 · 2022: 17 · 2021: 27 · 2020: 20 · 2019: 14 · 2018: 13 · 2017: 2
FWCI
2.17
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
Funders
  • Erasmus University Medical Center (MRACE) (2008-8111)
  • Coolsingel Foundation (2009)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
antenatal depression, anxiety disorders in pregnancy, psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, body-oriented interventions, acupuncture, bright light therapy, dietary supplements, maternal mental health, postpartum outcomes, treatment algorithm, risk-benefit assessment, psychosis, eating disorders, somatoform disorders, personality disorders
MeSH terms
Adult, Anxiety Disorders, Depression, Female, Humans, Phototherapy, Pregnancy, Pregnancy Complications, Psychotherapy, Acupuncture Therapy, Cognitive Behavioral Therapy

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