A trial conducted in Pakistan has tested whether treating anxiety early in pregnancy can prevent postnatal depression. Researchers led by Surkan and colleagues worked with women who were 22 weeks pregnant or less and who had at least mild anxiety but no clinical depression. Half were randomly assigned to the Happy Mother-Healthy Baby program: six one-on-one sessions of cognitive behavioural therapy, delivered by non-specialist providers trained for the role. The rest received enhanced standard care.
At six weeks after birth, 12% of women who had completed the program had developed major depression, compared with 41% in the standard care group. Across the whole sample, women who received the program had 81% lower odds of experiencing either major depression or significant anxiety after birth. Looked at separately, the odds of postnatal depression alone were reduced by 81%, and the odds of moderate-to-severe anxiety were reduced by 74%.
The findings suggest that addressing anxiety early in pregnancy, before depression develops, can meaningfully change what happens afterwards for new mothers. CBT did not need to be delivered by a specialist to have this effect: with training, non-specialist providers achieved these results themselves.
If anxiety during pregnancy is affecting you, it is worth speaking with a health professional. Support is available, and reaching out early can help.
What the researchers did
This was a phase 3 randomised controlled trial, a design in which participants are assigned by chance to different treatments so that any difference in outcomes can be attributed to the treatment itself rather than to other factors. Surkan and colleagues ran the trial in Pakistan. It was single-blind: the researchers assessing outcomes did not know which group a woman belonged to, although the women themselves did.
Women could take part if they were 22 weeks pregnant or less and had at least mild anxiety but no clinical depression at the start. Each woman was randomised to one of two groups. One received the Happy Mother-Healthy Baby program, built on cognitive behavioural therapy (CBT), a talking therapy that helps people identify and shift unhelpful thought and behaviour patterns. The other received enhanced care, a more supportive version of the usual standard of care. The program consisted of six one-on-one sessions delivered during pregnancy by non-specialist providers: people trained specifically to deliver this program, rather than psychologists or psychiatrists. That detail matters. It tests whether meaningful mental health care can be delivered without a large specialist workforce, which is particularly relevant in settings where such specialists are scarce.
The main outcome the researchers tracked was whether a woman developed a major depressive episode, generalised anxiety disorder, or both, measured six weeks after she gave birth.
What they found
Of 755 women who completed assessments after birth, 380 (50.3%) had received the program and 375 (49.7%) had received enhanced care. The results favoured the program clearly. Looking at major depression and moderate-to-severe anxiety together, women who received the program had 81% lower odds of developing either, expressed as an adjusted odds ratio of 0.19 (95% confidence interval 0.14–0.28). An odds ratio compares the likelihood of an outcome between two groups; the word "adjusted" means the researchers statistically accounted for other factors that could influence the result. The confidence interval gives the range within which the true effect most likely sits.
Looking at depression on its own, 12% of women in the program group developed a major depressive episode by six weeks postpartum, compared with 41% of women in the enhanced-care group. That corresponds to the same 81% reduction in odds (adjusted odds ratio 0.19, 95% CI 0.13–0.28). For moderate-to-severe anxiety specifically, the odds were reduced by 74% (adjusted odds ratio 0.26, 95% CI 0.17–0.40).
Why this matters
Anxiety in pregnancy is common, especially in resource-poor settings, and it is a known predictor of depression and anxiety after birth. Rather than waiting for depression to appear and then treating it, this trial tested prevention: addressing anxiety early, before depression has a chance to take hold. And because the program was delivered by non-specialists, the trial also points to a model of care that could potentially be delivered at larger scale in places where mental health specialists are in short supply.
What it doesn't tell us
The trial was conducted in one country, Pakistan, among women who already had at least mild anxiety but not depression when they enrolled. The findings apply most directly to that group, in that setting, rather than to pregnant women in general. The abstract also does not report outcomes beyond six weeks after birth, so how long these effects last is not yet known from this study alone.
If pregnancy or early motherhood ever starts to feel like more than you can manage on your own, it is worth speaking with a doctor, midwife, or mental health professional. Support at this stage of life can make a genuine difference.