Efficacy of Yoga-Based Intervention in Improving Mother-Child Bonding in Maternal Depression

Efficacy of Yoga-Based Intervention in Improving Mother-Child Bonding in Maternal Depression - A Randomised Controlled Trial

Perinatal depression (PND), defined as a depressive episode occurring from the antenatal period through 12 months following childbirth, has a reported prevalence of 12-22%, with higher rates in low- and middle-income countries (LMICs) including India. PND has a multifaceted and detrimental impact on both the mother and the child during a critical window of the child's emotional, cognitive, and physical development. Mother-infant bonding - the affective relationship that develops between a mother and her infant - is significantly impaired by maternal depression. Impaired bonding leads to poor antenatal attachment, earlier cessation of breastfeeding, risk of child maltreatment and neglect, and diminished reciprocal emotional and cognitive growth in the infant. The maternal brain undergoes significant neurobiological adaptations during the perinatal period to facilitate recognition of infant emotional cues, reward-driven bonding experiences, and reciprocal emotional responses. These include changes in oxytocin signalling, cortisol regulation, and functional connectivity of brain regions involved in maternal behaviour. Perinatal depression disrupts these neurobiological processes. Yoga-based interventions offer a safe, cost-effective, culturally acceptable, non-pharmacological approach. Yoga has demonstrated efficacy in improving depression and anxiety in perinatal populations. Its mechanisms include modulation of the HPA axis, reduction of cortisol, enhancement of oxytocin release, and promotion of mindful interoceptive awareness - directly relevant to the neurobiological disruptions in PND. This randomised controlled trial evaluates the efficacy of a structured 3-week bedside yoga intervention as an add-on to treatment as usual in improving mother-infant bonding scores, depression scores, and peripheral oxytocin and cortisol levels in mothers with perinatal depression. The study additionally explores the baseline neural correlates of mother-infant bonding using Event Related Potentials (ERP) and functional MRI (fMRI) of the brain.

Study Overview

• Status: Not yet recruiting
• Conditions: Postpartum Depression; Perinatal Depression; Mother-Infant Bonding Disorder
• Intervention / Treatment: Behavioral: Add-on Yoga Intervention; Drug: Treatment as Usual(Medication Based)

Detailed Description

BACKGROUND: Perinatal depression affects approximately 12-22% of women globally and up to 22% in India. Despite its prevalence and serious impact on both mother and infant, evidence-based interventions specifically targeting mother-infant bonding impairment - a central and harmful consequence of PND - are limited in low-resource settings. Yoga, an Indian system of mind-body medicine, is safe, low-cost, and widely acceptable. Neurobiological studies suggest yoga modulates HPA axis dysregulation (reducing cortisol, enhancing oxytocin), increases parasympathetic tone, and promotes mindful attunement - mechanisms directly relevant to impaired maternal bonding in PND. INTERVENTION DESCRIPTION: The yoga protocol consists of a 40-minute structured bedside session delivered daily for 3 consecutive weeks by a trained yoga instructor. Sessions comprise: (1) Rotation movements with mindful awareness of imaginary circular movement - promoting embodied awareness and physical grounding (2) Beej Mantra or humming sound vibration - promoting mental grounding and parasympathetic activation Sessions are delivered at bedside to accommodate postpartum mothers, in addition to ongoing Treatment As Usual (TAU). NEUROBIOLOGICAL SUB-STUDY: Baseline ERP and fMRI will be acquired for all cases to characterise neural correlates of mother-infant bonding. Post-intervention fMRI will be acquired within 2 months of baseline to assess neurobiological changes following yoga intervention. CONTROL ARM: Treatment As Usual (TAU) - standard pharmacological management with antidepressants with or without low-dose antipsychotics and/or benzodiazepines, as clinically indicated. ASSESSMENTS: - Mother-Infant Bonding Scale (MIBS) / Postpartum Bonding Questionnaire (PBQ) - Edinburgh Postnatal Depression Scale (EPDS) - Serum oxytocin and cortisol (ELISA) - Event Related Potential (ERP) - standardised infant facial cues paradigm - Functional MRI (fMRI) - maternal brain functional connectivity - Infant development assessment.

• Study Type: Interventional
• Enrollment (Estimated): 52
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Shree Mishra, MD; Phone Number: 8249255952; Email: psych_shree@aiimsbhubaneswar.edu.in

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• • Mothers aged 19 to 45 years presenting with an index depressive episode with onset either antenatally or within 12 months following childbirth and having a living child aged 0 to 28 months at time of enrolment

  • Edinburgh Postnatal Depression Scale (EPDS) score of 13 or above3
  • Willing to participate and provide written informed consent

Exclusion Criteria:

• • Severe mental health conditions including psychotic features

  • Active suicidal ideation or infanticidal ideas
  • Active substance dependence (excluding nicotine)
  • Unstable medical condition
  • Extreme physical limitation precluding yoga participation
  • Visual or auditory impairment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Add-on Yoga Intervention; Structured bedside yoga session of 40 minutes duration, delivered daily for 3 consecutive weeks by a trained yoga instructor, in addition to Treatment as Usual (TAU). Sessions include: (1) Rotation movements with mindful awareness of imaginary circular movement; (2) Grounding with Beej Mantras or humming sound vibration.	Behavioral: Add-on Yoga Intervention; 40-minute structured bedside yoga protocol delivered daily for 3 weeks. Comprises rotation movements with mindful awareness and Beej Mantra / humming sound grounding. Delivered by trained yoga instructor at bedside to accommodate postpartum mothers.; Drug: Treatment as Usual(Medication Based); Medication as per Depression Protocall
Active Comparator: Treatment as Usual (TAU); Standard pharmacological treatment consisting of antidepressant medication with or without low-dose antipsychotics and/or benzodiazepines, as clinically indicated. No structured yoga intervention.	Drug: Treatment as Usual(Medication Based); Medication as per Depression Protocall

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To meaasure in Mother-Infant Bonding	The Mother-to-Infant Bonding Scale (MIBS) is a short self-report questionnaire (typically 10 items on a 0-3 Likert scale) used to screen for difficulties in the mother-infant bond, with total scores ranging from 0 to 30 (higher scores indicate poorer bonding). A score of 0-3 is generally considered low and reflects relatively normal bonding, while 4 or above is treated as high and suggests clinically meaningful bonding difficulties, with higher values indicating more severe problems.	Baseline (Day 0), End of Week 3 (Day 21), End of Week 6 (Day 42)
To measure the Postnatal Depression	The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report questionnaire used to screen for postnatal depression, with each item scored 0-3, giving a total range of 0-30 (higher scores indicate more severe depressive symptoms). A score of 0-9 is generally considered low and suggests minimal or no depression, while 10 or above is treated as high and indicates possible depression warranting further clinical assessment; cut-offs of 13 or more are often used to signal more severe or likely depressive illness.	Baseline (Day 0), End of Week 3 (Day 21), End of Week 6 (Day 42)
To measure the Postpartum Bonding through the Postpartum Bonding Questionnaire (PBQ)	The Postpartum Bonding Questionnaire (PBQ) is a 25-item self-report measure used to screen for difficulties in the mother-infant bond, with total scores ranging from 0 (minimum) to 75 (maximum). A score of 0-25 is considered low and within the normal/non-impaired range, 26-39 indicates impaired bonding, and 40 or above suggests severe bonding impairment.	Baseline (Day 0), End of Week 3 (Day 21), End of Week 6 (Day 42)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To measure peripheral serum oxytocin level	Serum oxytocin measured by ELISA (enzyme-linked immunosorbent assay) from 5 ml venous blood sample collected at each timepoint.	Baseline (Day 0), End of Week 3 (Day 21), End of Week 6 (Day 42)
To measure peripheral serum cortisol level	Serum cortisol measured by ELISA from 5 ml venous blood sample at each timepoint. Cortisol as a biomarker of HPA axis regulation and maternal stress.	Baseline (Day 0), End of Week 3 (Day 21), End of Week 6 (Day 42)
To assess Event Related Potential (ERP) neural responses to standardised infant facial cues	ERP recorded during presentation of standardised infant facial cue paradigm. Components of interest: N170 and P300 amplitudes and latencies reflecting neural processing of infant emotional facial expressions - biomarkers of maternal brain attunement to infant cues.	Baseline (Day 0)
To assess Functional MRI (fMRI) - maternal brain functional connectivity	Resting state and task-based fMRI to assess maternal brain functional connectivity in regions associated with bonding and maternal behaviour (medial prefrontal cortex, amygdala, striatum). Pre-post comparison in intervention arm.	Baseline (Day 0) and within 2 months of baseline (post-intervention, intervention arm only)

Collaborators and Investigators

• Sponsor: All India Institute of Medical Sciences

Publications and helpful links

General Publications

• Richards MC, Ferrario CA, Yan Y, McDonald NM. The Impact of Postpartum Depression on the Early Mother-Infant Relationship during the COVID-19 Pandemic: Perception versus Reality. Int J Environ Res Public Health. 2024 Jan 31;21(2):164. doi: 10.3390/ijerph21020164.
• Reck C, Noe D, Gerstenlauer J, Stehle E. Effects of postpartum anxiety disorders and depression on maternal self-confidence. Infant Behav Dev. 2012 Apr;35(2):264-72. doi: 10.1016/j.infbeh.2011.12.005. Epub 2012 Jan 17.
• Field T. Yoga research review. Complement Ther Clin Pract. 2016 Aug;24:145-61. doi: 10.1016/j.ctcp.2016.06.005. Epub 2016 Jun 16.
• Corrigan L, Moran P, McGrath N, Eustace-Cook J, Daly D. The characteristics and effectiveness of pregnancy yoga interventions: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2022 Mar 25;22(1):250. doi: 10.1186/s12884-022-04474-9.
• Wen DJ, Poh JS, Ni SN, Chong YS, Chen H, Kwek K, Shek LP, Gluckman PD, Fortier MV, Meaney MJ, Qiu A. Influences of prenatal and postnatal maternal depression on amygdala volume and microstructure in young children. Transl Psychiatry. 2017 Apr 25;7(4):e1103. doi: 10.1038/tp.2017.74.

Study record dates

Study Major Dates

• Study Start (Estimated): April 15, 2026
• Primary Completion (Estimated): April 14, 2027
• Study Completion (Estimated): May 15, 2027

Study Registration Dates

• First Submitted: March 26, 2026
• First Submitted That Met QC Criteria: March 31, 2026
• First Posted (Actual): April 7, 2026

Study Record Updates

• Last Update Posted (Actual): April 7, 2026
• Last Update Submitted That Met QC Criteria: March 31, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Yoga; Postpartum depression; Perinatal depression; Mother-infant bonding
• Additional Relevant MeSH Terms: Urogenital Diseases; Mental Disorders; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Mood Disorders; Puerperal Disorders; Depressive Disorder; Depression, Postpartum; Therapeutics
• Other Study ID Numbers: T/IM-F/24-25/11

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No