Prenatal Yoga to Prevent Postpartum Depression (PRY-D)

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PROJECT ABSTRACT Postpartum depression (PPD) affects 13% of women and is associated with maternal, fetal/infant, and childhood morbidity. Though risk factors are multifactorial, a history of depression strongly predicts risk of PPD, and women of racial/ethnic minority status are especially vulnerable. Although psychological interventions exist for the prevention of PPD, a yoga-based intervention to prevent PPD among at-risk women utilizes a similar theoretical foundation (i.e., mindfulness), may be more acceptable to women of minority status, and may confer additional physical activity benefits. Yoga interventions in pregnancy have been shown to be efficacious for depression, although pragmatic research is needed to evaluate these types of interventions in a way that facilitates external validity. The purpose of this R34 Pilot Effectiveness Trial is to determine the effectiveness of using a virtually delivered prenatal yoga intervention for the prevention of PPD among at-risk women in a diverse health care system and explore preliminary factors which influence implementation of the intervention. To this end, we have gathered a research team with content, intervention, statistical, and methodological expertise who will collaboratively execute the proposed project. In the proposed study, Phase 1 will evaluate facilitators and barriers to intervention implementation among patient, clinician, and health system stakeholders, followed by an open trial, and Phase 2 will include conducting an 8-session pilot randomized controlled trial to assess the feasibility and acceptability of the proposed prenatal yoga intervention among women with a history of depression, as well as the onset and course of PPD and mediating factors. The specific aims are to: 1) Optimize delivery of a yoga intervention within a healthcare system to prevent PPD through examining facilitators and barriers of implementation, 2) Examine feasibility, acceptability and satisfaction of the intervention within a health care system, and 3) Evaluate preliminary effectiveness of the intervention on PPD and proposed mechanisms. For Phase 1, separate focus groups with patient stakeholders and clinician and administrative stakeholders from Henry Ford Health will inform intervention implementation, and an open trial to refine and optimize the intervention. For Phase 2, women with a history of depression who are 8-28 weeks pregnant will be randomized to the intervention group (n=24) or treatment-as-usual (n=24) and will complete survey measures at baseline, post-intervention, and 1 and 3 months postpartum. It is hypothesized that the intervention will be feasible and acceptable, engage women of racial/ethnic minority status, and contribute to lower rates of PPD onset. Embodiment and mindfulness are the proposed mediators. Findings from this study will provide preliminary data to inform a fully powered hybrid type 2 effectiveness- implementation trial. The potential knowledge gained from this study can facilitate prevention efforts for PPD and ameliorate the adverse public health impact of this disorder.