Pamela J. Surkan ScD, PhD , Soim Park PhD , Ziyue Sheng MB , Ahmed Zaidi MSc , Najia Atif PhD , Lauren M. Osborne MD , Atif Rahman PhD, MBBS, FRCPsych, MRes , Abid Malik PhD, FRCPsych
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Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators.</div></div><div><h3>Results</h3><div>Socio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI: −0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (B<sub>indirect</sub> <!-->=<!--> <!-->1.94 (95% CI: 0.86, 3.25) depression; B<sub>indirect</sub> <!-->= 0.57 (95% CI: 0.09, 1.16) bonding; B<sub>indirect</sub> <!-->= 0.53 (95% CI: 0.01, 1.21) and responsiveness (B<sub>indirect</sub> <!-->= 1.94 (95% CI: 0.86, 3.25)). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively.</div></div><div><h3>Conclusions</h3><div>HMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT03880032; <span><span>https://clinicaltrials.gov/ct2/show/NCT03880032</span><svg><path></path></svg></span></div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 1","pages":"Article 102551"},"PeriodicalIF":3.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of a Prenatal Anxiety Randomized Controlled Trial Intervention on Infant Development in Pakistan\",\"authors\":\"Pamela J. Surkan ScD, PhD , Soim Park PhD , Ziyue Sheng MB , Ahmed Zaidi MSc , Najia Atif PhD , Lauren M. Osborne MD , Atif Rahman PhD, MBBS, FRCPsych, MRes , Abid Malik PhD, FRCPsych\",\"doi\":\"10.1016/j.acap.2024.07.018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Given that infant development is influenced by caregiver mental health, we tested whether an intervention to reduce antenatal anxiety could affect infant development. A secondary aim was to test depressive symptoms, maternal responsiveness, and maternal infant bonding as mediators of this relationship.</div></div><div><h3>Methods</h3><div>Between 2020 and 2022, pregnant women participated in a randomized controlled trial of the <em>Happy Mother-Healthy Baby (HMHB)</em> program based on cognitive behavioral therapy. We collected data on child development from 202 intervention and 198 control participants in a public hospital in Pakistan. Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators.</div></div><div><h3>Results</h3><div>Socio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI: −0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (B<sub>indirect</sub> <!-->=<!--> <!-->1.94 (95% CI: 0.86, 3.25) depression; B<sub>indirect</sub> <!-->= 0.57 (95% CI: 0.09, 1.16) bonding; B<sub>indirect</sub> <!-->= 0.53 (95% CI: 0.01, 1.21) and responsiveness (B<sub>indirect</sub> <!-->= 1.94 (95% CI: 0.86, 3.25)). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively.</div></div><div><h3>Conclusions</h3><div>HMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT03880032; <span><span>https://clinicaltrials.gov/ct2/show/NCT03880032</span><svg><path></path></svg></span></div></div>\",\"PeriodicalId\":50930,\"journal\":{\"name\":\"Academic Pediatrics\",\"volume\":\"25 1\",\"pages\":\"Article 102551\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Academic Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1876285924002869\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1876285924002869","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Effects of a Prenatal Anxiety Randomized Controlled Trial Intervention on Infant Development in Pakistan
Objective
Given that infant development is influenced by caregiver mental health, we tested whether an intervention to reduce antenatal anxiety could affect infant development. A secondary aim was to test depressive symptoms, maternal responsiveness, and maternal infant bonding as mediators of this relationship.
Methods
Between 2020 and 2022, pregnant women participated in a randomized controlled trial of the Happy Mother-Healthy Baby (HMHB) program based on cognitive behavioral therapy. We collected data on child development from 202 intervention and 198 control participants in a public hospital in Pakistan. Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators.
Results
Socio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI: −0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (Bindirect = 1.94 (95% CI: 0.86, 3.25) depression; Bindirect = 0.57 (95% CI: 0.09, 1.16) bonding; Bindirect = 0.53 (95% CI: 0.01, 1.21) and responsiveness (Bindirect = 1.94 (95% CI: 0.86, 3.25)). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively.
Conclusions
HMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings.
期刊介绍：
Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.
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