Impact of maternal baseline depressive symptoms in modulating the Mindfulness-Based Childbirth and Parenting program’s efficacy: An Individual Participant Data Review
Enoch Chu, Wing-Tung Chou, R. Tang, M. Y. Lo, Guan-Ho Hui, Matthew Yeung
Journal of Asian Medical Students Association June 25, 2026 DOI: 10.52629/jamsa.vi.1001 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Post-hoc subgroup analysis of a two-arm randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 164 |
| Population | Pregnant women in Hong Kong, stratified by baseline depressive symptoms (CES-D ≥16, n=28; CES-D <16, n=136) |
| Interventions | Mindfulness-Based Childbirth and Parenting (MBCP) Antenatal Childbirth Education and Support (ACES) |
| Duration | Assessments at baseline, last antenatal session, 6–8 weeks postpartum, and 6 months postpartum |
| Measures | Center for Epidemiologic Studies Depression Scale (CES-D), Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) |
| Topics | Meditation |
| Key findings | MBCP was associated with greater reductions in postpartum depressive symptoms than ACES among mothers with higher baseline depressive symptoms, with the largest effects at 6 months postpartum on the EPDS (β = −6.11) and CES-D (β = −10.55), plus improvements in stress, trait anxiety, and state anxiety (β = −14.07). Among mothers with lower baseline symptoms, only EPDS at the last antenatal session showed a significant benefit (β = −1.64). |
Abstract
Introduction: Postpartum depression is a common psychiatric morbidity with family-wide consequences. Mindfulness-Based Childbirth and Parenting (MBCP) program is a low-risk and cost-effective intervention suitable for Hong Kong’s work-oriented mothers. However, its unclear efficacy across mothers with varying levels of depressive symptoms limits its adoption.
Objectives: This post-hoc analysis examines whether baseline depressive symptoms moderated MBCP efficacy.
Method: Data were analyzed from a published two-arm randomized controlled trial involving 164 pregnant women randomized to MBCP or an attention-matched control, Antenatal Childbirth Education and Support (ACES) program. Participants were stratified by baseline depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D) (score ≥16, n=28; score<16, n=136). CES-D, Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), and Perceived Stress Scale (PSS) were assessed at baseline (T1), last antenatal session (T2), 6–8 weeks postpartum (T3), and 6 months postpartum (T4). A linear mixed model assessed outcome differences between groups, reporting standardized β coefficients for the interaction term, with T1 and ACES as referents.
Results: Compared to ACES, MBCP implicated greater reductions in postpartum depressive symptoms among participants with higher baseline depressive symptoms, with pronounced effects at T4 for EPDS (β = −6.11, p = 0.007) and CES-D (β = −10.55, p = 0.007). MBCP improved stress, trait anxiety, and most effectively state anxiety (β = −14.07, p < 0.001) at T4, suggesting sustained benefits on postpartum mental health. In contrast, only EPDS at T2 showed a significant benefit (β = −1.64, p = 0.039) for MBCP participants with lower levels of baseline depressive symptoms.
Conclusion: MBCP significantly improved postpartum mental health among mothers with higher baseline depressive symptoms, with effects most pronounced at later follow-ups. The subgroup-specific effects suggest MBCP’s long-term benefits, underscoring its potential as a sustainable and accessible intervention for postpartum mental health. Keywords Mindfulness-Based Childbirth and Parenting, postpartum mental health, accessibility
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |