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Effects of Mindfulness-Based Cognitive Therapy in Pregnancy on Psychological Distress and Gestational Age: Outcomes of a Randomized Controlled Trial

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Given stress, anxiety, and depression affect 15–25% of women during pregnancy and are associated with adverse outcomes for maternal and child health if untreated, a randomized controlled trial evaluated the effectiveness of an 8-week modified Mindfulness-Based Cognitive Therapy for Perinatal Depression (MBCT-PD) intervention for psychological distress.


A community sample of pregnant women who self-identified as experiencing high levels of psychological distress was randomized into MBCT-PD (n = 28) or treatment as usual (n = 32). Participants completed online questionnaires assessing symptoms of distress, pregnancy and generalized anxiety, depression, and stress during lab visits at enrolment (before allocation), immediately following the intervention, and at follow-up (3 months postpartum). Women also reported delivery type and gestational age of their newborn.


Using an intention-to-treat approach, multilevel modeling indicated a significant effect of MBCT-PD treatment on overall psychological distress, but not on other symptoms. Path analysis revealed a moderated mediation, with an indirect effect of MBCT-PD treatment on lengthening gestational age through decreasing pregnancy anxiety among women with higher baseline symptoms.


In pregnant women seeking treatment for high levels of psychological distress, MBCT-PD was associated with improved overall distress, but not other specific symptoms such as anxiety and depression beyond treatment as usual. MBCT-PD has the potential to reduce the risk of preterm birth by targeting and reducing high levels of pregnancy anxiety during early gestation. Further research is warranted to examine other outcomes (e.g., coping skills, interpersonal functioning) and comparisons to other interventions.

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We gratefully acknowledge the women who participated in the study. We would also like to thank Elena Buliga, Ashley Dhillon, Emily Cameron, Zahra Clayborne, Ivan Sedov, Matt Shay, and John Wong for their valuable research assistance in conducting the trial.


This study was funded by the Alberta Children’s Hospital Foundation; Alberta Center for Child, Family and Community Research; and Alberta Family Wellness Initiative.

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Authors and Affiliations



All authors contributed to the conceptualization of the current study. Material preparation and data collection were performed by Lianne Tomfohr-Madsen and Joshua Madsen. Data analysis, writing the original draft, and editing were completed by Anna MacKinnon. All authors commented on previous versions of the manuscript, read and approved the final manuscript.

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Correspondence to Lianne Tomfohr-Madsen.

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Conflict of Interest

It may be noted that Dr. Dimidjian has a financial interest in other mindfulness programs/products (e.g., Mindful Noggin, Mindful Mood Balance) and has received NIH and private foundation grant support (Psychological treatments for depression). Dr. MacKinnon received a travel allowance from the Alberta Children’s Hospital Research Institute to present preliminary findings at a conference. The rest of the authors declare that they have no conflict of interest.

Ethical Approval

Ethics approval was obtained from the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary (REB13-0860), and all procedures were performed in accordance with the 1964 Helsinki declaration and its later amendments.

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All participants provided informed consent prior to enrollment in the study.

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MacKinnon, A.L., Madsen, J.W., Giesbrecht, G.F. et al. Effects of Mindfulness-Based Cognitive Therapy in Pregnancy on Psychological Distress and Gestational Age: Outcomes of a Randomized Controlled Trial. Mindfulness 12, 1173–1184 (2021).

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