1. Mitigating Pregnancy-Related Stress and Depression in a CenteringPregnancy TM Model for Prenatal Care Montiel Rosenthal, MD Hillary Mount, MD Barbara Hoffrogge, RN Suzanne Van Niman, M.Ed. Judy Piron, RN, BSN Elizabeth Beckman, MD Tony Leonard, Ph.D Beth-Erin Smith, MD

2. Objectives Background on stress in pregnancy Description of research project Preliminary data Future considerations

3. Background 15-20% women experience depression at some point in their pregnancy Lower SES status, lower level eduation = higher rate of depression in pregnancy Maternal stress and depression decreases child cognitive and social functioning. Maternal antenatal depression linked to higher rates of health problems in childhood, higher rates of depression in offspring at age 18, and poorer social functioning. Depression linked to PTB and SGA

4. Background Yoga reduces anxiety, depression and pregnancy related uncomfortable experiences.

5. CenteringPregnancy TM Model Group prenatal care Empowering self- management Increased education Improved patient and provider satisfaction

6. Research questions 1. Do Sheldon Cohen Perceived Stress Scale (PSS) scores in prenatal patients correlate with higher self-reported tobacco or alcohol use during or after pregnancy? Urine drug screens? Number of ER visits? Low birth weight infants (LBW)? Preterm delivery rate? 2. Does the CenteringPregnancy TM model of prenatal care improve PSS scores in patients throughout the progression of the pregnancy? 3. Does the CenteringPregnancy TM model of care improve PSS scores with the implementation of a yoga training session (started March 2014)?

7. Project Design Population PSS, PHQ9 and Edinburgh given in each trimester and postpartum visit Tracking of regular outcomes data

8. Perceived Stress Scale In the last month, how often have you felt that you were unable to control the important things in your life? In the last month, how often have you felt nervous and “stressed”? In the last month, how often have you found that you could not cope with all the things that you had to do? AlmostFairlyVery NeverNeverSometimesOftenOften 0 1 2 3 4

9. Interventions Yoga training session (started Mar 2014) Breastfeeding discussion Relaxation techniques (guided meditation and breathing exercises) Newborn massage (inconsistent) Happiest Baby on the Block video Infant CPR Hand massage Labor comfort measures

10. Preliminary Results 63 patients (thru April) 16 depressed, 47 non-depressed Depressed group had higher scores at all testing times

11. Results Scores increase as pregnancy progresses

12. Future considerations Link PSS with outcomes through chart review Collect data on whether Centeringpregnancy TM or specific components helped them self- manage their stress Comparison group with TCHMA prenatal patients Guest speakers: Mindfulness, Couples session, Clinical counselor to discuss self-help strategies (limited by funding) Specific targets at high PSS scores (separate session vs hiring mental health professional or care coordinator)

13. Suggestions or Questions