Effect of the Healthy MOMS Lifestyle Intervention On Reducing Depressive Symptoms Among Pregnant Latinas

Background and Purpose: Healthy Mothers on the Move (Healthy MOMS) is an NIH-funded, community-based participatory research project aimed at reducing diabetes risk factors among pregnant, predominantly Mexican and immigrant, women in Detroit. During formative research, pregnant Latinas commonly reported social isolation and depressed feelings. They recommended a group activity program that included pregnancy and infant development education, physical activity and healthy eating guidance. The resulting healthy lifestyle intervention was conducted by trained, bilingual community health workers (CHWs), in Spanish, in trusted community organizations. Content focused on healthy eating, moderate exercise, pregnancy and infant development. While the intervention did not specifically target mood disorders, the curriculum also included content on stress management and recognition of symptoms of depression. This study will assess the impact of the Healthy MOMS healthy lifestyle intervention on depressive symptoms during pregnancy among pregnant Latinas in Detroit.

Methods: This study was a randomized, controlled clinical trial. Pregnant Latinas were recruited from a federally qualified health center that provided prenatal care and WIC services. An 11-week social support group-based healthy lifestyle intervention (HLI) was provided during pregnancy to 138 Latina women. Pregnant Latina control group participants (n=137) received 2 group healthy pregnancy/infant development education sessions conducted by staff from a community mental health agency. All sessions were conducted in Spanish. All material related to depression and stress management was provided to both groups. Depressive symptoms were assessed at baseline (mean 17.2 weeks gestation) and follow-up (mean 27.5 weeks gestation) using the 11-item version of the Center for Epidemiologic Studies-Depression Scale (CES-D). Scores were transformed to the scale of the standard 20-item CES-D, with ≥16 points indicating presence of depressive symptoms. Mixed model analysis was used to estimate levels of depressive symptoms pre- and post-intervention within, and between, the HLI and control groups. Models were adjusted for age, acculturation, parity, marital status, healthcare site, and English-speaking ability.

Results: At baseline, depressive symptoms were evident among 39.4% of HLI and 33.3% of control participants. Unadjusted and adjusted post-intervention depression scores decreased significantly in HLI but not control participants. Adjusted mean HLI scores were 12.8 at baseline and 10.7 at follow-up (p=0.001). Mean control scores were 12.8 at baseline and 12.7 at follow-up (p=0.99). The intervention effect for mean scores was a 2.10 point decrease (p=0.024).

Conclusions and Implications: Depressive symptoms were prevalent in this cohort of pregnant Latinas. A culturally tailored, Spanish language, community-based healthy lifestyle intervention that provided CHW and peer social support, significantly reduced depressive symptoms. Similar interventions, based on community-based participatory research during the formative phase, hold promise for reducing levels of depression during, and potentially after, pregnancy in other Latino communities. Such interventions can be integrated in a variety of social work practice settings, including federally qualified health centers, practices that integrate physical and mental health services and community-based organizations.