Preventive Effects on Birth Outcomes: Buffering Impact of Maternal Stress, Depression, and Anxiety



Although maternal stress, anxiety, and depression have been linked to negative birth outcomes, few studies have investigated preventive interventions targeting maternal mental health as a means of reducing such problems. This randomized controlled study examines whether Family Foundations (FF)—a transition to parenthood program for couples focused on promoting coparenting quality, with previously documented impact on maternal stress, depression, and anxiety—can buffer the negative effects of maternal mental health problems.


To assess the effects of FF, we used a randomized block design with a sample of 259 expectant mothers assigned to FF or a control condition and analyzed using propensity score models. We examine two-way interactions of condition (intervention vs. control) with maternal mental health problems (financial stress, depression, and anxiety) on birth outcomes (birth weight, days in hospital for mothers and infants). For birth weight, we assess whether intervention effects depend on length of gestation by including a third interaction term.


FF buffered (p < 0.05) the negative impact of maternal mental health problems on birth weight and both mother and infant length of post-partum hospital stay. For birth weight, assignment to FF was associated with higher birth weight for infants born before term.


These results demonstrate that a psycho-educational program for couples focused on enhancing mutual coparental support, with preventive effects on maternal mental health, can reduce incidence of birth problems among women at elevated risk. Such improvements in birth outcomes could translate into substantial reductions in public and personal healthcare costs. Future work should assess mediating mechanisms of intervention impact and cost-benefit ratio of the intervention.

Clinical trials registration

The Family Foundations follow-up intervention study is currently registered with The study identifier is NCT01907412.

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Family Foundations


Adverse birth outcomes


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This study was funded by a grant from the National Institute of Child Health and Development (RO1 HD058529-02), Mark E. Feinberg, principal investigator. Dr. Feinberg created the Family Foundations program and is the owner of a private company, Family Gold, which disseminates the Family Foundations program. Dr. Feinberg’s financial interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University.

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Corresponding author

Correspondence to Michael E. Roettger.

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Funding source

All phases of this study were supported by National Institute of Child and Human Development Grant RO1 HD058529-02

Financial disclosure

Dr. Mark Feinberg created the Family Foundations program and is the owner of a private company, Family Gold, which disseminates the Family Foundations program. Dr. Feinberg’s financial interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University. The remaining authors have no financial relationships relevant to this article to disclose.

Conflict of interest

Dr. Mark Feinberg developed the Family Foundations program and is the owner of a private company, Family Gold, which disseminates the program. Dr. Feinberg’s conflict of interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University. All other authors, Dr. Deborah Ehrenthal, Dr. Michelle Hostetler, Dr. Damon Jones, Dr. Kari-Lyn Sakuma, Dr. Ian Paul, and Dr. Michael Roettger, declare no potential conflicts of interest from publication of this study.

Integrity of research and reporting

All aspects of this study, including design, implementation and analysis, have been approved by the Penn State Institutional Review Board, and have followed the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Feinberg, M.E., Jones, D.E., Roettger, M.E. et al. Preventive Effects on Birth Outcomes: Buffering Impact of Maternal Stress, Depression, and Anxiety. Matern Child Health J 20, 56–65 (2016).

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  • Prenatal stress
  • Depression
  • Anxiety
  • Birth weight
  • Length of hospital stay
  • Coparenting
  • Family Foundations