Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3–7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future Aims

Purpose of ArticleIn a previous pilot randomized controlled trial including 54 pregnant women with depression, maternal mood improved after Cognitive Behavioural Therapy (CBT) compared to treatment as usual (TAU), showing medium to large effect sizes. The effect persisted up to 9 months postpartum,...

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Main Authors: Laura S. Bleker, Jeannette Milgrom, Alexandra Sexton-Oates, Donna Parker, Tessa J. Roseboom, Alan W. Gemmill, Christopher J. Holt, Richard Saffery, Alan Connelly, Huibert Burger, Susanne R. de Rooij
Format: Article
Language:English
Published: Frontiers Media S.A. 2020-02-01
Series:Frontiers in Psychiatry
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Online Access:https://www.frontiersin.org/article/10.3389/fpsyt.2020.00034/full
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language English
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author Laura S. Bleker
Laura S. Bleker
Jeannette Milgrom
Jeannette Milgrom
Alexandra Sexton-Oates
Donna Parker
Tessa J. Roseboom
Tessa J. Roseboom
Alan W. Gemmill
Christopher J. Holt
Richard Saffery
Alan Connelly
Huibert Burger
Huibert Burger
Susanne R. de Rooij
spellingShingle Laura S. Bleker
Laura S. Bleker
Jeannette Milgrom
Jeannette Milgrom
Alexandra Sexton-Oates
Donna Parker
Tessa J. Roseboom
Tessa J. Roseboom
Alan W. Gemmill
Christopher J. Holt
Richard Saffery
Alan Connelly
Huibert Burger
Huibert Burger
Susanne R. de Rooij
Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3–7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future Aims
Frontiers in Psychiatry
depression
anxiety
pregnancy
Cognitive Behavioural Therapy
neurodevelopment
programming
author_facet Laura S. Bleker
Laura S. Bleker
Jeannette Milgrom
Jeannette Milgrom
Alexandra Sexton-Oates
Donna Parker
Tessa J. Roseboom
Tessa J. Roseboom
Alan W. Gemmill
Christopher J. Holt
Richard Saffery
Alan Connelly
Huibert Burger
Huibert Burger
Susanne R. de Rooij
author_sort Laura S. Bleker
title Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3–7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future Aims
title_short Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3–7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future Aims
title_full Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3–7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future Aims
title_fullStr Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3–7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future Aims
title_full_unstemmed Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3–7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future Aims
title_sort cognitive behavioral therapy for antenatal depression in a pilot randomized controlled trial and effects on neurobiological, behavioral and cognitive outcomes in offspring 3–7 years postpartum: a perspective article on study findings, limitations and future aims
publisher Frontiers Media S.A.
series Frontiers in Psychiatry
issn 1664-0640
publishDate 2020-02-01
description Purpose of ArticleIn a previous pilot randomized controlled trial including 54 pregnant women with depression, maternal mood improved after Cognitive Behavioural Therapy (CBT) compared to treatment as usual (TAU), showing medium to large effect sizes. The effect persisted up to 9 months postpartum, with infant outcomes also showing medium to large effects favoring CBT in various child domains. This perspective article summarizes the results of a follow-up that was performed approximately 5 years later in the same cohort, assessing the effects of antenatal Cognitive Behavioural Therapy for depression and anxiety on child buccal cell DNA-methylation, brain morphology, behavior and cognition.FindingsChildren from the CBT group had overall lower DNA-methylation compared to children from the TAU group. Mean DNA-methylation of all NR3C1 promoter-associated probes did not differ significantly between the CBT and TAU groups. Children from the CBT group had a thicker right lateral occipital cortex and lingual gyrus. In the CBT group, Voxel-Based-Morphometry analysis identified one cluster showing increased gray matter concentration in the right medial temporal lobe, and fixel-based analysis revealed reduced fiber-bundle-cross-section in the Fornix, the Optical Tract, and the Stria Terminalis. No differences were observed in full-scale IQ or Total Problems Score. When the total of hypotheses tests in this study was considered, differences in DNA-methylation and brain measurements were no longer significant.SummaryOur explorative findings suggest that antenatal depression treatment decreases overall child DNA-methylation, increases cortical thickness, and decreases white matter fiber-bundle cross-section in regions involved in cognitive function and the stress response. Nevertheless, larger studies are warranted to confirm our preliminary conclusion that CBT in pregnancy alters neurobiological outcomes in children. Clinical relevance remains unclear as we found no effects of antenatal CBT on child behavior or cognition (yet).
topic depression
anxiety
pregnancy
Cognitive Behavioural Therapy
neurodevelopment
programming
url https://www.frontiersin.org/article/10.3389/fpsyt.2020.00034/full
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spelling doaj-8d66e9ffb7544443999431f369ee01532020-11-25T02:36:51ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402020-02-011110.3389/fpsyt.2020.00034496635Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3–7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future AimsLaura S. Bleker0Laura S. Bleker1Jeannette Milgrom2Jeannette Milgrom3Alexandra Sexton-Oates4Donna Parker5Tessa J. Roseboom6Tessa J. Roseboom7Alan W. Gemmill8Christopher J. Holt9Richard Saffery10Alan Connelly11Huibert Burger12Huibert Burger13Susanne R. de Rooij14Academic Medical Centre, Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, NetherlandsAcademic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, NetherlandsParent-Infant Research Institute, Austin Health, Melbourne, VIC, AustraliaMelbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, AustraliaMurdoch Children’s Research Institute—Cancer and Disease Epigenetics, Royal Children’s Hospital, Melbourne, VIC, AustraliaFlorey Institute of Neuroscience and Mental Health, Melbourne, VIC, AustraliaAcademic Medical Centre, Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, NetherlandsAcademic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, NetherlandsParent-Infant Research Institute, Austin Health, Melbourne, VIC, AustraliaParent-Infant Research Institute, Austin Health, Melbourne, VIC, AustraliaMurdoch Children’s Research Institute—Cancer and Disease Epigenetics, Royal Children’s Hospital, Melbourne, VIC, AustraliaFlorey Institute of Neuroscience and Mental Health, Melbourne, VIC, AustraliaUniversity Medical Center Groningen, Department of General Practice, University of Groningen, Groningen, NetherlandsAcademic Medical Centre, Department of Psychiatry, Amsterdam UMC, Amsterdam, NetherlandsAcademic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, NetherlandsPurpose of ArticleIn a previous pilot randomized controlled trial including 54 pregnant women with depression, maternal mood improved after Cognitive Behavioural Therapy (CBT) compared to treatment as usual (TAU), showing medium to large effect sizes. The effect persisted up to 9 months postpartum, with infant outcomes also showing medium to large effects favoring CBT in various child domains. This perspective article summarizes the results of a follow-up that was performed approximately 5 years later in the same cohort, assessing the effects of antenatal Cognitive Behavioural Therapy for depression and anxiety on child buccal cell DNA-methylation, brain morphology, behavior and cognition.FindingsChildren from the CBT group had overall lower DNA-methylation compared to children from the TAU group. Mean DNA-methylation of all NR3C1 promoter-associated probes did not differ significantly between the CBT and TAU groups. Children from the CBT group had a thicker right lateral occipital cortex and lingual gyrus. In the CBT group, Voxel-Based-Morphometry analysis identified one cluster showing increased gray matter concentration in the right medial temporal lobe, and fixel-based analysis revealed reduced fiber-bundle-cross-section in the Fornix, the Optical Tract, and the Stria Terminalis. No differences were observed in full-scale IQ or Total Problems Score. When the total of hypotheses tests in this study was considered, differences in DNA-methylation and brain measurements were no longer significant.SummaryOur explorative findings suggest that antenatal depression treatment decreases overall child DNA-methylation, increases cortical thickness, and decreases white matter fiber-bundle cross-section in regions involved in cognitive function and the stress response. Nevertheless, larger studies are warranted to confirm our preliminary conclusion that CBT in pregnancy alters neurobiological outcomes in children. Clinical relevance remains unclear as we found no effects of antenatal CBT on child behavior or cognition (yet).https://www.frontiersin.org/article/10.3389/fpsyt.2020.00034/fulldepressionanxietypregnancyCognitive Behavioural Therapyneurodevelopmentprogramming