title: Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: a randomized controlled trial in Spain and France.
abstract: BACKGROUND
  Postpartum depression (PPD) and poor childbirth outcomes are associated with poverty; these variables should be addressed by an adapted approach. The aim of this research was to evaluate the impact of an antenatal programme based on a novel psychosomatic approach to pregnancy and delivery, regarding the risk of PPD and childbirth outcomes in disadvantaged women.
  
  
  METHODS
  A multi-centre, randomized, controlled trial comparing a novel to standard antenatal programme. Primary outcome was depressive symptoms (using EPDS) and secondary outcome was preterm childbirth (fewer 37 weeks). The sample comprised 184 couples in which the women were identified to be at PPD risk by validated interview. The study was conducted in three public hospitals with comparable standards of perinatal care. Women were randomly distributed in to an experimental group (EG) or a control group (CG), and evaluated twice: during pregnancy (T1) and four weeks post-partum (T2). At T2, the variables were compared using the chi square test. Data analysis was based on intention to treat. The novel programme used the Tourné psychosomatic approach focusing on body awareness sensations, construction of an individualized childbirth model, and attachment. The 10 group antenatal sessions each lasted two hours, with one telephone conversation between sessions. In the control group, the participants choose the standard model of antenatal education, i.e., 8 to 10 two-hour sessions focused on childbirth by obstetrical prophylaxis.
  
  
  RESULTS
  A difference of 11.2% was noted in postpartum percentages of PPD risk (EPDS ≥ 12): 34.3% (24) in EG and 45.5% (27) in CG (p = 0.26). The number of depressive symptoms among EG women decreased at T2 (intragroup p = 0.01). Premature childbirth was four times less in EG women: three (4.4%) compared to 13 (22.4%) among CG women (p = 0.003). Birth weight was higher in EG women (p = 0.01).
  
  
  CONCLUSIONS
  The decrease of depressive symptoms in women was not conclusive. However, because birth weight was higher and the rate of preterm childbirth was lower in the EG, our results suggest that the psychosomatic approach may be more helpful to the target population than the standard antenatal programs.
authors.affiliation: La Source, School of Nursing Sciences, University of Applied Sciences of Western Switzerland, 30 Avenue Vinet, CH-1004 Lausanne, Switzerland. m.ortizcollado@ecolelasource.ch.
authors.forename: Maria Assumpta
authors.initials: MA
authors.lastname: Ortiz Collado
authors.forename: Marc
authors.initials: M
authors.lastname: Saez
authors.forename: Jérôme
authors.initials: J
authors.lastname: Favrod
authors.forename: Marie
authors.initials: M
authors.lastname: Hatem
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D019052:Depression, Postpartum / Q000517:prevention & control* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D005602:France; D006801:Humans; D007398:Interpersonal Relations; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control* / Q000523:psychology; D011295:Prenatal Care / Q000379:methods* / Q000523:psychology; D011611:Psychosomatic Medicine; D012944:Social Support; D012959:Socioeconomic Factors; D013030:Spain; D013315:Stress, Psychological / Q000523:psychology; D016896:Treatment Outcome; D035862:Vulnerable Populations / Q000523:psychology*; D055815:Young Adult