PROJECT ABSTRACT
Postpartum depression (PPD) affects 13% of women and is associated with maternal, fetal/infant, and
childhood morbidity. Though risk factors are multifactorial, a history of depression strongly predicts risk of PPD,
and women of racial/ethnic minority status are especially vulnerable. Although psychological interventions exist
for the prevention of PPD, a yoga-based intervention to prevent PPD among at-risk women utilizes a similar
theoretical foundation (i.e., mindfulness), may be more acceptable to women of minority status, and may
confer additional physical activity benefits. Yoga interventions in pregnancy have been shown to be efficacious
for depression, although pragmatic research is needed to evaluate these types of interventions in a way that
facilitates external validity. The purpose of this R34 Pilot Effectiveness Trial is to determine the effectiveness of
using a virtually delivered prenatal yoga intervention for the prevention of PPD among at-risk women in a
diverse health care system and explore preliminary factors which influence implementation of the intervention.
To this end, we have gathered a research team with content, intervention, statistical, and methodological
expertise who will collaboratively execute the proposed project. In the proposed study, Phase 1 will evaluate
facilitators and barriers to intervention implementation among patient, clinician, and health system
stakeholders, followed by an open trial, and Phase 2 will include conducting an 8-session pilot randomized
controlled trial to assess the feasibility and acceptability of the proposed prenatal yoga intervention among
women with a history of depression, as well as the onset and course of PPD and mediating factors. The
specific aims are to: 1) Optimize delivery of a yoga intervention within a healthcare system to prevent PPD
through examining facilitators and barriers of implementation, 2) Examine feasibility, acceptability and
satisfaction of the intervention within a health care system, and 3) Evaluate preliminary effectiveness of the
intervention on PPD and proposed mechanisms. For Phase 1, separate focus groups with patient stakeholders
and clinician and administrative stakeholders from Henry Ford Health will inform intervention implementation,
and an open trial to refine and optimize the intervention. For Phase 2, women with a history of depression who
are 8-28 weeks pregnant will be randomized to the intervention group (n=24) or treatment-as-usual (n=24) and
will complete survey measures at baseline, post-intervention, and 1 and 3 months postpartum. It is
hypothesized that the intervention will be feasible and acceptable, engage women of racial/ethnic minority
status, and contribute to lower rates of PPD onset. Embodiment and mindfulness are the proposed mediators.
Findings from this study will provide preliminary data to inform a fully powered hybrid type 2 effectiveness-
implementation trial. The potential knowledge gained from this study can facilitate prevention efforts for PPD
and ameliorate the adverse public health impact of this disorder.