Behavioral Change in the Mother-Infant Dyad: Preventing Postpartum Depression

Of the over 4 million live births each year in the United States, nearly 800,000 — or 20% —
of the mothers will develop major or minor depression within the first 3 months postpartum.
This number dwarfs prevalence rates for gestational diabetes (2-5%) and preterm birth
(12.7%). Existing clinical approaches to postpartum depression (PPD) use standard
pharmacologic and psychological interventions to reduce women's symptoms. Nevertheless, PPD
is undertreated, in part because women are reluctant to seek treatment due to stigma
associated with mental health care and disinclination to take psychotropic medications when
breastfeeding. The consequences of this are substantial. Untreated PPD is associated with
diminished quality of life and significant emotional suffering for women, and, through
compromised caregiving, poor outcomes in children's cognitive and social-emotional
development. Although maternal risk factors for PPD are well known, protocols for prevention
based on commonly used depression interventions are only beginning to be evaluated. Building
on developmental data showing the profound bi-directionality of emotional and behavioral
influences between mother and infant, the investigators are testing a novel PPD intervention
protocol that challenges the standard, individually-focused treatment paradigm. Our
intervention is based on the conceptualization of PPD as a potential disorder of the dyad,
and one that can be approached through behavioral change in and affective engagement with
mother and child. Studies show that infant cry/fuss and sleep behavior are associated with
PPD, and that parenting interventions can change infant behavior, yet these findings have
never been applied to PPD. The investigators aim to collect data on a novel PPD
risk-reducing protocol based on a dyadic behavioral approach to PPD in which the
investigators treat at-risk women by promoting maternally-mediated behavioral changes in
their infants. The investigators will select a sample of pregnant women at risk for PPD,
teach parenting skills to increase infant nocturnal sleep and reduce fuss/cry behavior to
half of the sample during 3 perinatal visits, then evaluate infant behavior at 6 and 14
weeks, and maternal mood at 6, 10, and 14 weeks postpartum. The investigators will fully
exploit the investigative opportunities of this intervention study by using state-of-the-art
EEG and fetal monitoring to characterize early biomarkers associated with infant behavior
and behavior change. This study has the potential to have a major impact on clinical
research, and to transform the standard care of PPD in that (1) the intervention will have
high rates of treatment compliance because (a) the protocol sessions can be incorporated
into usual perinatal medical visits, (b) parenting skills will appeal to women as a
non-psychiatric intervention, (c) the clinical approach will have face validity given the
dyadic focus of the perinatal period; (2) its aim is prevention; (3) it fosters both
maternal and child well being; (4) it will expand the risk factors for PPD to include
neurobehavioral markers in the perinate.

Inclusion Criteria:

- Healthy, non-smoking pregnant women

- Ages 18-35

- Score of 28 or higher on the Predictive Index of Postnatal Depression

- Low to normal obstetric risk

- Before 34 weeks gestation

Exclusion Criteria:

- High Risk pregnancy

- Taking medications that affect the cardiovascular system (α blockers, β blockers,
corticosteroids

- Chronic-use asthma medications (e.g. beta2-adrenoceptor agonists)

- Smoking during pregnancy

- Illicit drug/alcohol use during pregnancy

- Taking any psychotropic medications