Postpartum Depression Study Suggests Obstacles to Prenatal Exercise

Due to low compliance rates, researchers examine whether new approaches are needed to identify, address barriers to physical activity during pregnancy.

Nosignificant improvements were associated with a prenatal exercise program thataimed to reduce postpartum depression, according to study findings published inJAMA Network Open.

The prevention of postpartum depression is of particular interest in low- and middle-income countries, where women may have limited access to mental health services. Previous studies have demonstrated the usefulness of regular exercise for preventing prenatal depression, so researchers investigated whether those benefits might extend to postpartum depression.

From 2014 to 2016, investigators recruited pregnant women at between 16 and 20 weeks gestation as part of the Physical Activity for Mothers Enrolled in Longitudinal Analysis Cohort Study. Women younger than 18 with other aggravating health issues or pregnancy complications or who were already active at least 150 minutes per week were not eligible for inclusion in the study.

Related Articles

Participants (n=639; mean age, 27.1) were randomly assigned 1:2 to a 16-week supervised exercise program or the control group. Aerobic and resistance training classes met 3 times a week for 60-minutes sessions; participants trained in groups of up to 3 per exercise instructor. The exercise protocol was designed according to American College of Obstetricians and Gynecologists recommendations.

Participants reported depressive symptoms on the Edinburgh Postnatal Depression Scale 3 months after delivery. Analyses revealed no significant difference in mean scores for postpartum depression between the scores of women in the intervention (4.8, SD 3.7) and control (5.4, SD 4.1) groups or in the rates of postpartum depression.

The investigators encountered low compliance rates (40.4%), especially in young and less-educated women, although they attempted to bolster participation by providing transportation, exercise clothes, and flexible scheduling options. Adherence to an exercise program, defined in this study as attending at least 70% of sessions, was expected to be a challenge, as decreased activity is common in the third trimester of pregnancy even in previously active women.

“Future studies on how to promote regular exercise during pregnancy… are warranted before further trials are undertaken,” researchers concluded.


CollCVN, Domingues MR, Stein A, et al. Efficacy ofregular exercise during pregnancy on the prevention of postpartum depression:The PAMELA randomized clinical trial. JAMA Network Open 2019;2(1):e186861.