Therapy for Prenatal Depression:Maternal &Fetal Effects

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DESCRIPTION (provided by applicant): Historically, an unsubstantiated view held that pregnancy was a protective factor against depression. Data now dramatically contradict this view. Approximately 10-15% of pregnant women are depressed, which puts them -- and their children ---at risk for the deleterious affects of postpartum depression. Moreover, new data indicate that prenatal depression also may adversely affect the child even before birth. Despite the high prevalence rates of prenatal depression and its negative consequences, few controlled studies have tested the efficacy of psychotherapy during pregnancy. None has examined the effects of successfully treated depression on the fetus and newborn. The goal of this application -- submitted under the NIMH R34 mechanism for exploratory intervention research -- is to determine if an intervention for prenatal depression can enhance women's pre- and postpartum moods and improve fetal and newborn functioning. Specifically, in a study of 80 depressed women randomly assigned to either of two treatment options and 40 psychiatrically-healthy pregnant women, we hypothesize that depressed pregnant women treated with a group version of Interpersonal Psychotherapy versus standard psychiatric care will result in: (a) improved prenatal mood, (b) less postpartum depression and (c) fetal and newborn neurobehavioral profiles similar to healthy women's offspring. In past work we have shown that fetuses of depressed women have altered heart rate responses suggestive of risk for future stress-based psychopathology. Women's mood will be assessed using standard rating scales. Fetal heart rate and movement will be assessed while women undergo a laboratory stressor. Newborn heart rate will be assessed during an orthostatic challenge. This study has the potential to alter the clinical approach to perinatal mood disorders by demonstrating that we can (1) prevent postpartum depression before it occurs and (2) positively influence the child's development by limiting their exposure to women's pre- and postpartum depression.