BACKGROUND Perinatal depression and anxiety are associated with unfavourable child outcomes. AIMS To assess among women with antenatal depression or anxiety the effectiveness of prenatally initiated cognitive-behavioural therapy (CBT) on mother and child compared with care as usual (CAU). Trial registration: Netherlands Trial Register number NTR2242. METHOD Pregnant women (n = 282) who screened positive for symptoms of depression and/or anxiety were randomised to either CBT (n = 140) or CAU (n = 142). The primary outcome was child behavioural and emotional problems at age 18 months, assessed using the Child Behavior Checklist (CBCL). Secondary outcomes were maternal symptoms during and up to 18 months after pregnancy, neonatal outcomes, mother-infant bonding and child cognitive and motor development at age 18 months. RESULTS In total, 94 (67%) women in the CBT group and 98 (69%) in the CAU group completed the study. The mean CBCL Total Problems score was non-significantly higher in the CBT group than in the CAU group (mean difference: 1.38 (95% CI -1.82 to 4.57); t = 0.85, P = 0.399). No effects on secondary outcomes were observed except for depression and anxiety, which were higher in the CBT group than in the CAU group at mid-pregnancy. A post hoc analysis of the 98 women with anxiety disorders showed lower infant gestational age at delivery in the CBT than in the CAU group. CONCLUSIONS Prenatally initiated CBT did not improve maternal symptoms or child outcomes among non-help-seeking women with antenatal depression or anxiety. Our findings are not in line with present recommendations for universal screening and treatment for antenatal depression or anxiety, and future work may include the relevance of baseline help-seeking.

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孕妇心理健康问题心理治疗对保护后代的影响：随机对照试验

背景 围产期抑郁和焦虑与不利的儿童结局相关。目的 评估产前启动的认知行为疗法 (CBT) 与常规护理 (CAU) 相比，产前抑郁或焦虑的女性对母婴的有效性。试验注册：荷兰试验注册号 NTR2242。方法 筛选出抑郁和/或焦虑症状呈阳性的孕妇 (n = 282) 随机接受 CBT (n = 140) 或 CAU (n = 142)。主要结果是 18 个月大的儿童行为和情绪问题，使用儿童行为检查表 (CBCL) 进行评估。次要结局是孕期和孕后 18 个月内的母亲症状、新生儿结局、母婴关系以及 18 个月时儿童的认知和运动发育。结果 总共，CBT 组 94 名 (67%) 女性和 CAU 组 98 名 (69%) 女性完成了研究。CBT 组的平均 CBCL 总问题得分不显着高于 CAU 组（平均差异：1.38（95% CI -1.82 至 4.57）；t = 0.85，P = 0.399）。除了抑郁和焦虑之外，没有观察到对次要结局的影响，在妊娠中期，CBT 组的抑郁和焦虑高于 CAU 组。对 98 名患有焦虑症的女性进行的事后分析显示，CBT 组的婴儿出生胎龄低于 CAU 组。结论 产前开始的 CBT 并没有改善产前抑郁或焦虑的非寻求帮助妇女的母亲症状或儿童结局。我们的研究结果不符合目前对产前抑郁症或焦虑症进行普遍筛查和治疗的建议，