INTER-ACT-II: Pregnancy and postpartum coaching for a healthy future-II: reducing emotional distress

Emotional distress - defined as symptoms of anxiety, depression and stress – during and after pregnancy is a major risk factor for the development of peripartum depression and anxiety disorders and has a negative impact on mothers and their offspring. Unfortunately, emotional distress is increasing dramatically in this group. Recent integrated perinatal care programs invest in early detection and screening of mental health, but a program aiming at preventing escalation of emotional distress is lacking. Therefore, we want to decrease emotional distress before it escalates by developing a program that is easily accessible and timely (prevention is better than cure). 
In 2016, we started INTER-ACT-I, an eHealth supported coaching program in postpartum and pregnant women with a history of excessive gestational weight gain (N=1200 women). INTER-ACT-I revealed mental health to be a crucial mediator in lifestyle behavior (i.e. eating and sedentary behavior) and maternal physical health (postpartum weight retention, pre-pregnancy BMI).
The research question in INTER-ACT II is:
P – in pregnant women 
I – is the INTER-ACT II lifestyle intervention
C – compared to care as usual
O – effective in decreasing emotional distress? 
An evidence based mental health module was lacking in the INTER-ACT-I program. The INTER-ACT-II program will include an evidence-based mindfulness module, will update the existing modules on diet, eating behavior and physical activity, and will integrate care pathway information. The
INTERACT-II intervention will be evaluated in a multicentric randomized controlled trial including 698 women. 
We hypothesize that the intervention will reduce emotional distress (= primary outcome), and ultimately enhance women’s wellbeing by reducing the risk of developing clinical levels of depression and anxiety, as well as improve their psychosocial wellbeing, lifestyle behavior, and pregnancy and postpartum outcomes.