Short-term oestrogen as a strategy to prevent postpartum depression in high-risk women: protocol for the double-blind, randomised, placebo-controlled MAMA clinical trial

Stinne Høgh, Hanne Kristine Hegaard, Kristina Martha Renault, Eleonora Cvetanovska, Anette Kjærbye-Thygesen, Anders Juul, Camilla Borgsted, Anne Juul Bjertrup, Kamilla Woznica Miskowiak, Mette Skovgaard Væver, Dea Siggaard Stenbæk, Vibeke Høyrup Dam, Elisabeth Binder, Brice Ozenne, Divya Mehta, Vibe G Frokjaer, Stinne Høgh, Hanne Kristine Hegaard, Kristina Martha Renault, Eleonora Cvetanovska, Anette Kjærbye-Thygesen, Anders Juul, Camilla Borgsted, Anne Juul Bjertrup, Kamilla Woznica Miskowiak, Mette Skovgaard Væver, Dea Siggaard Stenbæk, Vibeke Høyrup Dam, Elisabeth Binder, Brice Ozenne, Divya Mehta, Vibe G Frokjaer

Abstract

Introduction: Postpartum depression affects 10%-15% of women and has a recurrence rate of 40% in subsequent pregnancies. Women who develop postpartum depression are suspected to be more sensitive to the rapid and large fluctuations in sex steroid hormones, particularly estradiol, during pregnancy and postpartum. This trial aims to evaluate the preventive effect of 3 weeks transdermal estradiol treatment immediately postpartum on depressive episodes in women at high risk for developing postpartum depression.

Methods and analysis: The Maternal Mental Health Trial is a double-blind, randomised and placebo-controlled clinical trial. The trial involves three departments of obstetrics organised under Copenhagen University Hospital in Denmark. Women who are singleton pregnant with a history of perinatal depression are eligible to participate. Participants will be randomised to receive either transdermal estradiol patches (200 µg/day) or placebo patches for 3 weeks immediately postpartum. The primary outcome is clinical depression, according to the Diagnostic and Statistical Manual of Mental Disorders-V criteria of Major Depressive Disorder with onset at any time between 0 and 6 months postpartum. Secondary outcomes include, but are not limited to, symptoms of depression postpartum, exclusive breastfeeding, cortisol dynamics, maternal distress sensitivity and cognitive function. The primary statistical analysis will be performed based on the intention-to-treat principle. With the inclusion of 220 participants and a 20% expected dropout rate, we anticipate 80% power to detect a 50% reduction in postpartum depressive episodes while controlling the type 1 error at 5%.

Ethics and dissemination: The study protocol is approved by the Regional Committees on Health Research Ethics in the Capital Region of Denmark, the Danish Medicines Agency and the Centre for Data Protection Compliance in the Capital Region of Denmark. We will present results at scientific meetings and in peer-reviewed journals and in other formats to engage policymakers and the public.

Trial registration number: NCT04685148.

Keywords: depression & mood disorders; maternal medicine; mental health; preventive medicine.

Conflict of interest statement

Competing interests: VGF declares that she has received honorarium as a consultant for SAGE therapeutics and Lundbeck Pharma A/S.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
CONSORT flow diagram of MAMA trial. CONSORT, Consolidated Standards of Reporting Trials; MAMA, Maternal Mental Health.
Figure 2
Figure 2
Recruitment pathways for the MAMA trial. MAMA, Maternal Mental Health.

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