Scottish Government Health Directorates Chief Scientist Office
ANTENATAL PARENTING SUPPORT: AN EXPLORATORY RANDOMISED CONTROLLED TRIAL OF PSYCHOSOCIAL ANTENATAL PROGRAMMES Researchers Prof. P. Wilson, Dr. C. Puckering, Dr. L. Thompson, Ms. A. Clarke, Dr. A. MacBeth, Ms S. McAlees, Dr. M. Henderson, Dr Jane White.
Aim We aimed to compare the impact of participation in two psychosocial interventions: Mellow Bumps and a similar intervention with no infant mental health component, with care-as-usual, on the mental health and parenting behaviour of pregnant women with substantial health and social care needs.
Project Outline/Methodology This was an exploratory study with a three-arm parallel randomised open-label blinded end-point clinical trial design. Consecutive women meeting high risk criteria were invited to participate. Consented participants (n=35) were randomly allocated in clusters of six, to either a Mellow Bumps (MB) group, an active comparison group (Chill-out in Pregnancy ChIP) or care as usual. MB is a six-week group based antenatal parenting programme which aims to decrease maternal antenatal stress levels, increase expectant mothers’ understanding of neonates’ capacity for social interaction and which emphasises the importance of early interaction in enhancing brain development and attachment. ChIP is a six-week group based stress reduction programme which includes all the mother-centred components of MB but with no focus on the baby. Participants were visited at home on at least three occasions. To compensate them for their time they were offered a £20 shopping voucher at the last data collection point. The Edinburgh Postnatal Depression Scale (EPDS) and Adult Wellbeing Scale (AWS) questionnaires were administered at baseline (preintervention), post-intervention and eight to twelve week post-birth. At the post-birth data collection point, interviews were conducted and permission from participants was sought to video record interactions with the infant. Salivary cortisol samples were collected before and after the intervention as well as from infants before and after the newborn blood spot screening (around 5 days old).
data were available for seven, five and nine women respectively. Because of small numbers, women were allocated to the final group without randomisation. Few women gave consent for salivary cortisol collection and saliva collection from infants proved difficult. Participants who were allocated to an intervention group showed modest but promising improvements in mental health and wellbeing postintervention and eight to twelve weeks post-birth compared to those allocated to the care-as-usual group.
Conclusions A randomised trial is feasible and psychoeducational interventions in pregnancy may benefit women with major psychosocial needs.
What does this study add to the field? There is very little relevant work in this field. We aimed to carry out a randomised controlled trial of a social intervention with a very ‘hard-to-reach’ population and met with considerable success.
Implications for Practice or Policy Providing group-based parenting support in a format acceptable to pregant women with additional health and social care needs may impact on their mental wellbeing in the short and longer term, but a definitive trial is required.
Where to next? Further research is needed with a larger sample size to confirm or refute the findings of this exploratory study. Following up participants beyond 8-12 postnatal weeks would mean that potential longer term benefits could be examined. This project served as a feasibility study for the large Trial of Healthy Relationships in the Very-Early years (THRIVE) which has been funded by the National Institute for Health Research and is hosted by the MRC/CSO Social Public Health Sciences Unit, University of Glasgow.
Further details from: Professor Phil Wilson, Centre for Rural Health University of Aberdeen, Email p.wilson@abdn.ac.uk
Key Results Twelve women were allocated to MB, nine to ChIP and fourteen to Care as Usual. Complete follow up
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