Early pregnancy therapy can cut postpartum depression and anxiety by tackling prenatal anxiety, new research has revealed.
A trial of 1,200 pregnant women in Pakistan found those receiving cognitive behavioural therapy (CBT), a talking therapy that changes patterns of thought and behaviour, had 81 per cent lower odds of postpartum depression or moderate-to-severe anxiety than those receiving usual care.
Only 12 per cent of women in the intervention group developed postpartum depression, compared with 41 per cent in the control group.
The research was led by Pamela Surkan at Johns Hopkins University, in partnership with the University of Liverpool and the Human Development Research Foundation Pakistan.
Surkan said: “We hope this research doesn’t end with evidence, but with implementation.
“Every pregnant woman deserves the chance to thrive, and mental health must be recognised as a core part of maternal health everywhere.”
Among women who attended five or more sessions, the risk of low birthweight (under 2.5kg) and small-for-gestational-age births (smaller than expected for weeks of pregnancy) decreased by 39 per cent and 32 per cent respectively.
The approach was designed to be scalable: therapy was delivered by trained non-specialist counsellors in a public hospital in Rawalpindi, making it accessible and low-cost for health systems without specialist clinicians.
In Pakistan, up to 49 per cent of pregnant women experience anxiety, yet access to mental health care remains limited.
Prenatal anxiety is rarely addressed in public health systems despite long-term consequences for mothers and children.
What began at a global mental health meeting in Washington DC in 2012 evolved into a research partnership spanning 2017 to 2024. Findings from the main trial were published in March 2024.
Beyond clinical outcomes, the research linked better social support, reduced stress and fewer pregnancy-related difficulties to improved mental health outcomes.
To date, 29 peer-reviewed articles have been published from the project, which has established one of the world’s largest datasets on prenatal anxiety in low and middle-income countries and developed an intervention manual ready for wider use.
The team is now focused on scaling, with proposals submitted to test the intervention in new contexts and plans to make the manual publicly available.
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