Targeting affective cognition during pregnancy to prevent postpartum depression: a randomized controlled trial with parity-specific effects

IF 8.1 2区医学 Q1 CLINICAL NEUROLOGY

European Neuropsychopharmacology Pub Date : 2027-01-01 Epub Date: 2026-10-18 DOI:10.1016/j.euroneuro.2026.113885

Anne Bjertrup, Karoline HE Rasmussen, Sille Tørring, Kamilla W Miskowiak

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引用次数: 0

Abstract

Postpartum depression (PPD) affects approximately 17% of women globally and is predicted by prior mental illness and socioeconomic disadvantage. Emerging evidence suggests that negative bias in the cognitive processing of infant cues and heightened reactivity to infant distress during pregnancy contribute to PPD risk and may thus represent a treatment target. This randomized controlled trial examined whether prenatal affective cognitive training (PACT) reduces PPD risk by modulating negative biases in pregnant women at heightened risk. Of 280 women assessed, 147 at heightened risk were randomized to PACT or care as usual (CAU). PACT comprised five individualized 90-minute sessions over five weeks, combining computerized and virtual-reality tasks targeting negative cognitive bias, attentional bias, emotion regulation, and working memory in response to infant stimuli. Affective cognition was assessed at baseline and post-intervention; mood was rated at baseline, post-intervention, and weekly for six weeks after birth. Diagnostic interviews (Present State Examination) were conducted six months postpartum. The primary outcome was PPD incidence within six months postpartum; secondary outcomes included depressive symptoms over the first six weeks and changes in affective cognition. Follow-up data were available for 121 (83%) participants (PACT n = 54; CAU n = 67). PACT did not significantly reduce PPD overall (p = 0.18) or depressive symptoms (p = 0.31) but increased positive interpretation of infant emotions (p = 0.003). Exploratory analyses indicated lower PPD incidence among multiparous participants receiving PACT than CAU (5% vs. 35%; OR=0.10, 95% CI [0.01–0.92], p = 0.04) and additional parity-specific changes in affective cognition. These exploratory findings require replication in larger trials.

Trial registration

The trial was registered at ClinicalTrials.gov with Trial number NCT06046456 on 21 September 2023 https://clinicaltrials.gov/study/NCT06046456.

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针对孕期情感认知预防产后抑郁症：一项胎次特异性随机对照试验

产后抑郁症（PPD）影响全球约17%的女性，可由先前的精神疾病和社会经济劣势来预测。新出现的证据表明，对婴儿线索的认知加工中的负偏倚和怀孕期间对婴儿痛苦的高反应性会增加产后抑郁症的风险，因此可能是一个治疗目标。这项随机对照试验研究了产前情感认知训练（PACT）是否通过调节高风险孕妇的负面偏见来降低PPD风险。在接受评估的280名妇女中，147名高危妇女随机分为PACT组或照护组（CAU）。PACT包括五个个性化的90分钟课程，为期五周，结合计算机和虚拟现实任务，针对婴儿刺激的负面认知偏见、注意偏见、情绪调节和工作记忆。在基线和干预后评估情感认知；在基线、干预后和出生后六周内每周对情绪进行评估。诊断性访谈（现状检查）于产后6个月进行。主要观察指标为产后6个月内PPD的发生率；次要结果包括前六周的抑郁症状和情感认知的变化。121名（83%）参与者可获得随访数据（PACT n = 54;CAU n = 67）。PACT总体上没有显著降低PPD （p = 0.18）或抑郁症状（p = 0.31），但增加了婴儿情绪的积极解释（p = 0.003）。探索性分析表明，接受PACT治疗的多产参与者的PPD发生率低于接受CAU治疗的多产参与者（5% vs. 35%； OR=0.10, 95% CI [0.01-0.92], p = 0.04），并且在情感认知方面存在额外的胎次特异性变化。这些探索性的发现需要在更大规模的试验中得到重复。试验注册：该试验于2023年9月21日在ClinicalTrials.gov注册，试验号为NCT06046456 https://clinicaltrials.gov/study/NCT06046456。

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来源期刊

European Neuropsychopharmacology 医学-精神病学

CiteScore

10.30

自引率

5.40%

发文量

730

审稿时长

41 days

期刊介绍： European Neuropsychopharmacology is the official publication of the European College of Neuropsychopharmacology (ECNP). In accordance with the mission of the College, the journal focuses on clinical and basic science contributions that advance our understanding of brain function and human behaviour and enable translation into improved treatments and enhanced public health impact in psychiatry. Recent years have been characterized by exciting advances in basic knowledge and available experimental techniques in neuroscience and genomics. However, clinical translation of these findings has not been as rapid. The journal aims to narrow this gap by promoting findings that are expected to have a major impact on both our understanding of the biological bases of mental disorders and the development and improvement of treatments, ideally paving the way for prevention and recovery.