Title: Adapting and testing a brief intervention to reduce maternal anxiety during pregnancy.
Funder: Department of Health (England)

Abstract: There is now a substantial body of evidence from observational cohort studies demonstrating that anxiety in mothers during pregnancy is associated with an increased risk of a range of short and long term adverse outcomes in their children (Talge et al, 2007). These include higher rates of preterm delivery (Diego et al, 2009), impaired cognitive functioning (Bergman et al, 2007; Burns et al, in press), difficult temperament (Davis et al, 2007; Field et al, 2004) and behavioural and emotional problems (O’Connor et al, 2002). Despite robust evidence for an association between antenatal maternal anxiety and adverse child outcomes, there is no systematic evidence from clinical trials to show whether treating antenatal anxiety in mothers will improve the outcomes of their children. The effects of intervening early in development could be large, because of the enormous cognitive and socio-emotional developments that occur in the foetal period and the first years of life, and the apparent long-lasting effects of exposure to maternal anxiety during pregnancy (Talge et al, 2007). In light of this evidence, it is crucial that the NHS develops and delivers effective and accessible interventions for anxiety during pregnancy. Evidence indicates that the association between antenatal anxiety and subsequent child difficulties is linear (Bergman et al, 2007), suggesting that efforts to reduce anxiety across the population of pregnant women will yield benefits for the greatest number of children. Brief, cost-effective interventions are required to meet this broader population need. In addition, previous studies have highlighted the critical importance of tailoring interventions to meet the specific needs of pregnant women, in terms of both the therapeutic focus and the mode of delivery. One such intervention that has been developed and had positive preliminary evaluation in Australia is the guided self-help intervention Towards Parenthood (Milgrom et al, 2011). In a randomised controlled trial of 143 women significant reductions in maternal anxiety were reported (Cohen’s d = 0.58). The key question that will be addressed in the current research is. 1. What is the acceptability and feasibility of delivering a workbook-based parenting intervention integrated within group-based midwife-led care to treat anxiety in women in the antenatal period? Phase one of the research will involve testing the existing “Towards Parenthood” intervention with a small group of pregnant women, which will allow us to test how well the intervention can be integrated into routine antenatal care. As we intend for the intervention to be delivered alongside existing routine NHS antenatal care, we plan to modify the support element for use in a brief group-based format of 3 sessions, rather than offering weekly individual telephone support as was offered in the trial by Milgrom et al (2011). This has strong potential to make the intervention more cost-effective and more robust for delivery within the shifting NHS environment. It will also make the intervention much more widely available for pregnant women affected by anxiety. We will gather feedback from the women and midwives in the test group on the relevance and acceptability of the intervention to pregnant women experiencing anxiety. This will inform the final adaptation of the Towards Parenthood intervention to an NHS context. Phase two will incorporate the further development and testing of the Towards Parenthood intervention. The intervention will be modified in the light of the work undertaken in phase one, and then tested for feasibility and acceptability in a randomised controlled trial. In sum, the proposed research will lead to the development of an effective, cost-effective and acceptable treatment for women with anxiety symptoms which could be made widely available, thereby meeting critical patient and NHS needs.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH;REPRODUCTIVE HEALTH AND CHILDBIRTH