Feasibility of an Online Intervention to Prevent Perinatal Depression and Promote Human Milk Feeding: Randomized Pilot Trial (Preprint)

BACKGROUND Mothers who identify as Black or African American are more likely to report depressed mood in late pregnancy and early postpartum and have the lowest rates of human milk feeding compared to all other racial groups in the United States. Internet interventions offer potential in extending preventative and supportive services because they address key barriers, especially for those navigating the complex and vulnerable early postpartum period. However, there is limited evidence on the feasibility of such interventions for preventing perinatal mental health disorders and improving human milk feeding outcomes in Black mothers. OBJECTIVE This pilot study aimed to assess the feasibility and preliminary findings of an online cognitive behavioral therapy-based internet intervention, with and without human milk feeding education and support, to prevent perinatal depression and promote human milk feeding in Black mothers. METHODS Participants were Black individuals between 20-28 weeks pregnant, with human milk feeding intention and mild to moderate depressive symptoms (Patient Health Questionnaire scores 5-14). Participants were randomized to Sunnyside, a six-week cognitive behavioral therapy-based online intervention, or Sunnyside Plus, which included additional education and support to promote human milk feeding. Assessments occurred at baseline, 3rd trimester (end of antenatal treatment), six weeks postpartum (end of postpartum treatment) and 12 weeks postpartum. RESULTS A total of 22 participants were randomized. Mean number of logins was 7.3 (SD 5.3) for Sunnyside and 13.8 (10.5) for Sunnyside Plus. Scores of depression and anxiety measures remained below the clinical threshold for referral for treatment in both groups. All participants initiated human milk feeding (18/18, 100%). Most participants reported at least some HMF at both six and 12 weeks postpartum (6/7, 86%; 11/11 or 10/10, 100% for Sunnyside and Sunnyside Plus respectively). Prenatal human milk feeding self-efficacy improved significantly after completion of the antenatal portion of the intervention in the Sunnyside Plus group (P=.02). CONCLUSIONS Results suggest that Black mothers at-risk for perinatal depression were receptive to and satisfied with an online cognitive behavioral therapy-based internet intervention, with and without human milk feeding education and support. Preliminary findings indicate that both Sunnyside and Sunnyside Plus interventions have a positive impact on symptoms of depression and anxiety and on human milk feeding outcomes. CLINICALTRIAL ClinicalTrials.gov NCT04128202; https://www.clinicaltrials.gov/ct2/show/NCT04128202