Effectiveness of Digital Guided Self-help Mindfulness Training During Pregnancy on Maternal Psychological Distress and Infant Neuropsychological Development: Randomized Controlled Trial

Abstract

Background: Maternal psychological distress during pregnancy is associated with unfavorable outcomes in infants. Mindfulness-based interventions (MBIs) can effectively alleviate psychological distress, but there are often barriers to the access of face-to-face interventions.

Objective: This study aimed to investigate the effectiveness of a digital guided self-help (GSH) MBI (GSH-MBI) in reducing maternal psychological distress and improving infant neuropsychological performance.

Methods: This was a randomized controlled trial. We recruited 160 women who were 12 to 20 weeks pregnant and exhibited psychological distress. We randomized them into a digital GSH-MBI group and a control group (usual perinatal care). The digital GSH-MBI consisted of a 6-week intervention through a WeChat mini program, with a daily reminder sent to the participants by a research assistant via WeChat. The primary outcomes consisted of maternal psychological distress, including depression, anxiety, and pregnancy-related anxiety symptoms, which were assessed at 6 time points from baseline to 6 months post partum (only pregnancy-related anxiety symptoms were assessed 3 times during pregnancy). The secondary outcomes were infant neuropsychological outcomes, including temperament and developmental behaviors, which were assessed at 6 weeks and 6 months post partum.

Results: Compared with the control group, the digital GSH-MBI group showed a significant reduction in depression, anxiety, and pregnancy-related anxiety symptoms. In addition, the scores of the digital GSH-MBI group were lower than those of the control group for the 3 types of infant temperament at 6 weeks post partum, including quality of mood, distractibility, and adaptability.

Conclusions: Digital GSH-MBIs are effective in alleviating psychological distress among pregnant women and protecting infant outcomes.

Trial registration: Chinese Clinical Trial Register ChiCTR2000040717; https://www.chictr.org.cn/showproj.aspx?proj=65376.

Keywords: digital; guided self-help; infant; mHealth; mindfulness; mobile health; neuropsychological performance; pregnancy; psychological distress; psychosocial intervention.

Figure 1

Screenshot of WeChat mini program.

Figure 2

Participant flow diagram. GSH: guided self-help; MBI: mindfulness-based intervention. T1: baseline (12-20 weeks of gestation); T2: immediately after the intervention (approximately 20-28 weeks of gestation); T3: before birth (36-37 weeks of gestation); T4: 6 weeks post partum; T5: 3 months post partum; T6: 6 months post partum.

Figure 3

Changes in maternal psychological distress over time in the digital guided self-help (GSH)–mindfulness-based intervention (MBI) group and the control group. T1: baseline (12-20 weeks of gestation); T2: immediately after the intervention (approximately 20-28 weeks of gestation); T3: before birth (36-37 weeks of gestation); T4: 6 weeks post partum; T5: 3 months post partum; T6: 6 months post partum.

Figure 4

Mediation model of maternal pregnancy-related anxiety symptoms at T2 between treatment allocation and infant quality of mood. Standardized estimates are shown for relationships among treatment allocation, maternal pregnancy-related anxiety symptoms at T2, and infant quality of mood. T2: immediately after the intervention; ^aP<.05; ^bP<.001; Pregnancy-related anxiety at T1 (baseline, 12-20 weeks of gestation), infant sex, maternal age, education, and average monthly household income were adjusted for.