2026 ECNP Congress

PS01-1175

Targeting affective cognition during pregnancy to prevent postpartum depression: a randomized controlled trial with parity-specific effects

Anne Bjertrup — K. Rasmussen, S. Tørring, K. Miskowiak · NEAD Centre, Psychiatric Centre Copenhagen, Frederiksberg, Denmark

2026 ECNP Congress

Background

Postpartum depression (PPD) affects around 17% of women globally [1]. History of mental illness and low socio-economic status increase risk substantially [2]. Emerging evidence indicates that negative cognitive bias in perceiving infant cues and heightened reactivity to infant distress play a key role in PPD risk [3]. In parallel, neuroimaging studies suggest that pregnancy induces adaptive brain plasticity in networks supporting social cognition and attention, with altered neural adaptation associated with peripartum depressive symptoms [4]. This raises the possibility that affective cognitive processing of infant cues reflects a modifiable pathway linking neurobiological adaptation to maternal mental health. In the present study, we explored whether pregnancy represents a window of opportunity to leverage this plasticity by training affective cognitive mechanisms in preparation for motherhood.

Aims

The aim of this randomized controlled trial was to investigate the prophylactic effects of prenatal affective cognitive training (PACT) in pregnant women at heightened risk of PPD and examine whether the intervention modifies affective cognition.

Methods

The study enrolled 146 pregnant women at heightened risk of PPD. Participants completed baseline assessments of affective cognitive processing, depressive symptoms, and questionnaires, and were randomized to PACT or care as usual (CAU). The PACT intervention consisted of three to five individualized computerized and virtual reality-based sessions over five weeks, targeting cognitive bias, attentional bias, emotion regulation, and working memory in response to infant stimuli. The primary outcome was PPD incidence within six months postpartum, assessed via clinical diagnostic interview. Secondary outcomes included weekly self-reported depressive symptoms during the first six weeks postpartum and changes in affective cognition from baseline to post-intervention during pregnancy.

Results

Follow-up data were available for 121 participants (PACT: n=54; CAU: n=67). There was no overall effect on PPD incidence, although odds were lower in PACT than CAU (OR=0.56, 95% CI [0.24–1.30], p=0.18). There was a trend toward parity-specific effects (OR=0.11, 95% CI [0.01–1.18], p=0.07). In multiparous participants, odds of PPD were lower in the PACT group compared to CAU (OR=0.10, 95% CI [0.01–0.92], p=0.04). PACT increased positive interpretation of infant cues (p=0.003), particularly for neutral stimuli, and enhanced attention to infant signals among multiparous participants (p=0.01). In contrast, reductions in negative affective reactivity to infant distress were specific to primiparous participants in the PACT group (p=0.002). Across participants, higher negative affective reactivity predicted more depressive symptoms (p=.018) and increased PPD risk (OR=4.63, p=0.04). In the PACT group, a significant interaction between affective reactivity and galvanic skin response predicted parental stress (p=0.02) and PPD risk (OR=36.48, p=0.02), suggesting that distinct combinations of affective and physiological responses are differentially associated with risk.

Conclusions

PACT did not prevent PPD overall but was associated with reduced risk among multiparous women. Findings suggest parity-dependent mechanisms: in primiparous women, effects relate to internal affective–physiological regulation, whereas in multiparous women, they are driven by infant-directed perceptual processing. These results support pregnancy as a window for targeted preventive interventions and suggest that PPD prevention may benefit from stratification by parity and mechanism-specific targeting.

References

  1. Wang, Z., et al., Mapping global prevalence of depression among postpartum women. Translational Psychiatry, 2021. 11(1): p. 543.
  2. Hutchens, B.F. and J. Kearney, Risk Factors for Postpartum Depression: An Umbrella Review. Journal of midwifery & women’s health, 2020. 65(1): p. 96-108.
  3. Bjertrup, A.J., et al., Processing of infant emotion in mothers with mood disorders and implications for infant development. Psychological Medicine, 2021: p. 1-11.
  4. Straathof, M., et al., The effects of a second pregnancy on women’s brain structure and function. Nature Communications, 2026. 17(1): p. 1495.