Background and rationale {6a}
PTB, anxiety, Antenatal depression, depression, AD
PRETERM BIRTH, PRETERM BIRTH
Antenatal depression (AD) is common, affecting approximately 15% of pregnant individuals, and is a major risk factor for conditions linked to neonatal intensive care unit (NICU) admission, including preterm birth (PTB), small for gestational age (SGA), and low birth weight (LBW) [While pharmacologic treatment represents one effective and relatively fast avenue for treating AD, the evidence remains unclear about exposure to the most common form of pharmacological depression treatment (selective serotonin reuptake inhibitors, SSRIs) and some studies have identified an association with increased risk of preterm birth above and beyond the increased risk associated with depression [Several effective, evidence-based therapy treatments exist for AD [Remotely administered (i.e., online, phone) and paraprofessional counselling interventions offer a potential avenue to increase the accessibility and sustainability of effective AD treatment in Canada, through reduced costs to the patient, and to the system [Recent studies have also highlighted that social and peer support during pregnancy has an important role in reducing the risk of postpartum depression and anxiety, and clinical trials have demonstrated the effectiveness of peer support for preventing postpartum depression [The current study will test the effectiveness of a remote behavioural activation plus informal ongoing peer-support intervention, administered by trained peer paraprofessional counsellors, for increasing gestational age at delivery and decreasing symptoms of AD, in a randomized controlled trial (RCT). This RCT is nested in the larger Prediction, Prevention and Interventions for Preterm Birth (P3) cohort study in Alberta Canada. The remote- and peer-delivered format of our intervention provides a cost-effective mechanism to increase access to evidence-based treatment for AD, while reducing stigma and responding to patient-articulated needs for more continuous and social-oriented support than can be obtained through traditional psychological therapy. Further, the prevalence of AD and anxiety symptoms increased dramatically during the global COVID-19 pandemic [The P3 study will recruit 4000 Albertans during pregnancy and follow them to 12 months postpartum, and aims to identify predictors of preterm birth, identify effective interventions for preterm birth, and improve the care and outcomes for preterm infants and their families. Questionnaire data will be collected before 36 weeks’ gestation (T1), and at 5–6 months (T3) and 11–12 months (T4) postpartum, and be linked with electronic health records. The current study will also involve a questionnaire at intervention completion (T2) to assess immediate post-intervention depression scores.