The association between prenatal depression and obstetric outcome in Taiwan: a prospective study

Heart Rate Variability Biofeedback Training Reduces Early Maternal Stress, Anxiety, and Depression in Women Undergoing Cesarean Delivery: A Randomized Controlled Trial

Women who undergo cesarean delivery have reported experiencing mood distress related to the surgery and postoperative pain. Heart rate variability biofeedback (HRVB) training is known to have positive effects on mental health, but its effects on women undergoing cesarean delivery have not yet been determined. This study evaluated the effects of an HRVB training intervention on stress, anxiety, and depression in women undergoing cesarean delivery. We hypothesized that 10 sessions of HRVB training could cumulatively improve emotion regulation in participants. This study was designed as a double-blinded randomized controlled trial involving a total of 86 enrolled women who were then divided into two groups: intervention and control. During their hospitalization, the intervention group underwent HRVB training daily, while both groups received standard perinatal care. Heart rate variability (HRV) was assessed using root mean square of successive differences (RMSSD), standard deviation of normal-to-normal intervals (SDNN), high-frequency power (HF) and low-frequency power (LF). HRV parameters, stress, anxiety, and depression were evaluated at baseline and on the fifth day after childbirth. Intention-to-treat (ITT) analyses examined change over time between groups. Although no significant effects were found for the RMSSD and HF, a significant increase was observed in SDNN (F = 13.43, p = < 0.001, ƞ2 = 0.14), and LF at post-assessment (F = 4.26, p = .04, ƞ2 = 0.05) compared to the control group. Except for the depression variable, stress (F = 6.11, p = .02, ƞ2 = 0.07) and anxiety (F = 8.78, p = .004, ƞ2 = 0.10) significantly decreased compared to the control group on the fifth postpartum day. Furthermore, post-hoc analysis showed that HRVB was more effective in decreasing mild to severe depressive symptoms (F = 7.60, p = .001, ƞ2 = 0.27). The intervention program successfully decreased self-perceived stress and anxiety in the postpartum period and relieved symptoms in more severely depressed participants. Our findings suggest that this program is suitable and beneficial for application in women during the early postpartum period following cesarean delivery.

The impact of prenatal mental health on birth outcomes before and during the COVID-19 pandemic in Anhui, China

Adverse birth outcomes remain challenging public health problems in China. Increasing evidence indicated that prenatal depression and anxiety are associated with adverse birth outcomes, highlighting the importance and severity of prenatal depression and anxiety in China. The COVID-19 pandemic is likely to further exacerbate prenatal mental health problems and increase the risk of adverse birth outcomes. The aim of this study is to assess and compare the impacts of prenatal mental health issues on birth outcomes before and during the COVID-19 pandemic in Ma'anshan, Anhui, China. Participants in this study were women who visited local maternal and child health hospitals in Ma'anshan, Anhui, China. Two independent sets of individual maternal data (npre-pamdemic = 1148; npandemic = 2249) were collected. Prenatal depression and anxiety were measured online using the Edinburgh Postnatal Depression Scale (EPDS) and the General Anxiety Disorder-7 (GAD-7). Adverse birth outcomes were determined using hospital-recorded infant birth weight and gestational age at delivery. In this study, we found that the pandemic cohort had lower mean EPDS and GAD-7 scores than the pre-pandemic cohort. The prevalence of prenatal depression (14.5%) and anxiety (26.7%) among the pandemic cohort were lower than the pre-pandemic cohort (18.6% and 36.3%). No significant difference was found in the prevalence of adverse birth outcomes comparing the two cohorts. Prenatal depression was associated with small gestational age only in the pandemic cohort (OR = 1.09, 95% CI 1.00-1.19, p = 0.042). Overall, this study highlighted an association between prenatal depression and small for gestational age in Anhui, China. Addressing prenatal depression may thus be key in improving birth outcomes. Future studies could focus on potential causal relationships.

Path analysis of influencing factors for maternal antenatal depression in the third trimester

Maternal antenatal depression (AD) is a nonpsychotic depressive episode during pregnancy that can harm both the pregnant woman and the fetus. This study aimed to investigate the intrinsic interrelationships between AD and its influencing factors by constructing a path model. This survey-based cross-sectional study included 1071 pregnant women who underwent pregnancy examinations in three hospitals in Nantong City, China, between February and June 2023. General information and information regarding maternal AD, pregnancy stress, prenatal anxiety, social support, marital satisfaction, sleep quality, and resilience were collected. Multiple linear regression analysis using SPSS 25.0 was employed to determine the factors influencing pregnancy depression, and Amos25.0 was used to construct a structural equation model. AD incidence was 19.4% (208/1071). The independent risk factors affecting AD in pregnant women have been integrated into the established path analysis model. The model demonstrated a good fit (χ2/DF = 1.238, comparative fit index = 0.999, goodness-of-fit index = 0.998, normed fit index = 0.996, adjusted goodness-of-fit index = 0.990, incremental fit index = 0.999, and root mean square error of approximation = 0.015). While prenatal anxiety (0.230) and hyperthyroidism (0.048) only had direct effects on AD, mental resilience was the biggest factor affecting AD, followed by pregnancy stress, marital satisfaction, prenatal anxiety, sleep quality, social support, and hyperthyroidism. Improved mental resilience, social support, sleep quality, and marital satisfaction; reduced pregnancy stress and prenatal anxiety; and effective hyperthyroidism treatment might reduce AD. This study underscored the significance of delivering actionable strategies and tangible assistance to pregnant women to reduce AD.

Perceived Partner's Self-Control and Social Support Effects on Relationship Satisfaction in Couples Experiencing Infertility or Miscarriage: Dyadic Analyses

The process that infertile couples and those after a miscarriage go through is unpredictable and difficult to control; therefore, it is associated with a lowered sense of control for both partners. Uncontrolled stress creates a higher level of anxiety, which is associated not only with a lower quality of life but also with worse results from infertility treatment and higher risks of miscarriage. The aim of this study was to analyze the relationship between the partner’s perceived self-control and marital satisfaction in the context of the partners’ coping strategies. The actor-partner interdependence model was applied to 90 heterosexual married couples. Our results show that men who perceive their wives as being more self-controlled and women who are perceived by their husbands as being more self-controlled feel more satisfied in their relationships. The effect of a partner’s perceived self-control on satisfaction with the relationship was weaker when controlled for the length of marriage. It also appeared to be moderated through the spouses’ use of social support. We conclude that the effects of the partner’s perceived self-control and social support are strong for marital satisfaction in the context of infertility and miscarriage.

Risk factors of perinatal depression in women: a systematic review and meta-analysis

BACKGROUND

Perinatal depression in women is associated with high morbidity and mortality, and has attracted increasing attention. The investigation of risk factors of perinatal depression in women may contribute to the early identification of depressed or depression-prone women in clinical practice.

MATERIAL AND METHODS

A computerized systematic literature search was made in Cochrane Library, PubMed, Web of Science, and EMBASE from January 2009 to October 2021. All included articles were published in English, which evaluated factors influencing perinatal depression in women. Based on the recommendations of the Cochrane Collaboration protocols, Review Manager 5.3 was used as a statistical platform.

RESULTS

Thirty-one studies with an overall sample size of 79,043 women were included in the review. Educational level (P = 0.0001, odds ratio [OR]: 1.40, 95% CI: [1.18,1.67]), economic status of families (P = 0.0001, OR: 1.69, 95%CI: [1.29,2.22]), history of mental illness (P < 0.00001, OR: 0.29, 95% CI: [0.18, 0.47]), domestic violence (P < 0.00001, OR: 0.24, 95% CI: [0.17,0.34]), perinatal smoking or drinking (P = 0.005, OR: 0.63; 95% CI [0.45, 0.87]; P = 0.008, OR: 0.43, 95% CI, [0.23 to 0.80]; respectively), and multiparity(P = 0.0003, OR: 0.74, 95% CI: [0.63, 0.87]) were correlated with perinatal depression in women. The stability of our pooled results was verified by sensitivity analysis and publication bias was not observed based on funnel plot results.

CONCLUSION

Lower educational level, poor economic status of families, history of mental illness, domestic violence, perinatal smoking or drinking, and multiparity serve as risk factors of perinatal depression in women.

Risk of adverse maternal outcomes associated with prenatal exposure to moderate-severe depression compared with mild depression: A fellow-up study

BACKGROUND

Pregnancy is a time of increased vulnerability for the development of anxiety and depression. The purpose of this study was to compare the risk of developing adverse maternal and perinatal outcomes between pregnant women with moderate-severe depression and those who had mild depression.

METHODS

Our study was performed in a prospective cohort of 360 depressed pregnant women, recruited and followed up to delivery at the Adventist Hospital in Bekwai Municipality, Ghana. The research began in February 2020 and the follow-up was completed in August 2020. The pregnant women who had depression were classified into two groups: those who had moderate-severe depression (Patient Health Questionnaires-9 (PHQ-9) score ≥15) and those who had mild depression (PHQ-9 score <15). Crude and adjusted relative risk (RR) with their corresponding 95% confidence intervals (95% CIs) for women with moderate-severe depression as compared with women with mild depression were then estimated.

RESULT

Out of a total of 360 pregnant women, 43 (11.9%) screened positive for moderate-severe depression. After adjusting for potential confounders, women with moderate-severe depression during pregnancy, as compared with women who had mild depression had an increased risk of pre-eclampsia (RR _adjusted = 2.01; 95% CI:1.21-3.33); Caesarean section (RR _adjusted = 1.78; 95% CI:1.18-2.70); and episiotomy (RR _adjusted = 1.66; 95% CI: 1.06-2.60). On the other hand, no statistically significant association of severity of depression and perinatal outcomes was observed.

CONCLUSION

Compared with mild depression, symptoms of moderate-severe depression in pregnancy significantly increased risks of adverse maternal outcomes such as pre-eclampsia, caesarean section delivery, and episiotomy.

Prenatal Depression in Women in the Third Trimester: Prevalence, Predictive Factors, and Relationship With Maternal-Fetal Attachment

Objective: The prevalence of prenatal depression in pregnant women has found to be high, which may adversely affect the intimacy of a mother to her fetus. Few studies have investigated the relationship between prenatal depression and maternal-fetal attachment in pregnant Chinese women. This study is thus designed to evaluate the prevalence rate, predictive factors of prenatal depression in Chinese pregnant women in the third trimester of pregnancy, and the effect of prenatal depression on maternal-fetal attachment.

Methods: A total of 340 pregnant women in the third trimester of pregnancy were recruited from a hospital in Anhui Province. The Edinburgh Postpartum Depression Scale (EPDS) was rated to assess the prenatal depression; the Pittsburgh Sleep Quality Index (PSQI) and Zung Self-Rating Anxiety Scale (SAS) were used to assess sleep quality and anxiety level for all participants. The Maternal Antenatal Attachment Scale (MAAS) was used to assess maternal-fetal attachment.

Results: The prevalence of prenatal depression in the participants was high (19.1%) in our study. The scores of prenatal anxiety and sleep disorders were higher with prenatal depression than in those without prenatal depression (47.6 ± 9.5 vs. 38.9 ± 6.9; 8.3 ± 3.3 vs. 6.1 ± 2.7, all p < 0.01). MAAS quality was lower in prenatal depression women than those in non-prenatal depression women (43.8 ± 5.6 vs. 46.4 ± 4.5, p < 0.01). Correlation analysis showed that prenatal depression was associated with parity, prenatal education, education level, marital satisfaction, anxiety and sleep disorders (all p < 0.05). Furthermore, binary logistic regression results showed that anxiety and sleep disorders were risk factors for prenatal depression. Prenatal education, higher marriage satisfaction were protective factors for prenatal depression. In addition, correlation analysis also showed that prenatal depression was positively correlated with MAAS intensity, but negatively correlated with MAAS quality.

Conclusions: Our results indicated a high prevalence of prenatal depression in women in the third trimester. Prenatal education and higher marital satisfaction were protective factors for prenatal depression; antenatal anxiety and sleep disorders during pregnancy were risk factors for prenatal depression. Prenatal depression was negatively correlated with MAAS quality, but positively correlated with MAAS intensity.

Association between maternal antenatal depression and neonatal Apgar score: A systematic review and meta-analysis of prospective cohort studies

INTRODUCTION

Antenatal depression is common, but most women with the condition choose to remain untreated. The Apgar score, an important indicator of newborn health, has been reported to be influenced by antenatal depression; thus, maternal antenatal depression, as reflected by a poor Apgar score, may harm children's health.

AIM

To conduct a systematic review and meta-analysis to explore whether maternal antenatal depression is associated with the neonatal Apgar score.

METHODS

We registered the protocol for this study with PROSPERO (CRD42019137585). We searched PubMed, Embase, Web of Science, and the Cochrane Library for published papers that reported the association between depression and Apgar score from inception to December 4, 2019. Two reviewers independently screened and selected the studies according to the inclusion and exclusion criteria, and extracted data according to the predesigned table. Stata version 12.0 software was used to analyze data.

RESULTS

We finally identified 13 studies for inclusion, including a total of 12017 women. We did not find an association between antenatal depression and the 1 min Apgar score of neonates (mean difference= -0.03, 95% CI= -0.15-0.09) or the risk of a low Apgar score (OR=1.82, 95% CI=0.51 to 3.13). We found that antenatal depression increased the risk of a low Apgar score at 5 min (OR= 1.91, 95% CI= 1.23-2.59), but the association between the 5 min Apgar score and antenatal depression was not significant (mean difference= -0.001, 95% CI= -0.07-0.07). The results of the subgroup analyses also indicated that there was no association between the 5 min Apgar score and antenatal depression.

CONCLUSIONS

Antenatal depression increased the risk of a low 5 min Apgar score; however, we did not find a difference in the mean and distribution of neonatal Apgar scores of mothers with depression and mothers without depression.

Stress, anxiety and depression perceived by couples with recurrent miscarriage

AIM

Recurrent miscarriage is considered a major life event. The main purposes of this study were to compare the differences in stress, anxiety, social support, sleep quality and depressive symptoms in couples experiencing recurrent miscarriage compared to peers who experience full-term normal childbirth in southern Taiwan.

METHODS

Convenience sampling and snowball sampling were used respectively to recruit 78 couples with and 80 couples without recurrent miscarriage from October 2014 to July 2015. Five structured questionnaires including Perceived Stress Scale, State- Anxiety Inventory, Interpersonal Support Evaluation List, Pittsburgh Sleep Quality Index and Edinburgh Depression Scale were administered.

RESULTS

Women who experienced recurrent miscarriage perceived significantly higher levels of stress, anxiety and depressive symptoms than their husbands. Women in the recurrent miscarriage group reported significantly greater depressive symptoms than women of the other group. A stepwise multiple regression analysis indicated key predictors of depressive symptoms among women of childbearing age, accounting for 62.9% of the variance, were anxiety, stress, social support and history of recurrent miscarriage.

CONCLUSION

Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than their peers who experienced normal childbirth. Health professionals can use the knowledge gained from these findings to evaluate women with recurrent miscarriage for stress, anxiety and depressive symptoms and develop supportive interventions.

Occupational Hazard Exposures and Depressive Symptoms of Pregnant Workers

OBJECTIVES

The aim of this study was to explore the prevalence of exposure to occupational hazards and depressive mood with associated underlying risk factors among pregnant workers.

METHODS

Women at 12 weeks of gestation (n = 172) were recruited during regular prenatal screening. Data were obtained via questionnaires that explored job details and Edinburgh Postnatal Depression Scale.

RESULTS

The most commonly encountered hazard was prolonged standing. The majority of women reported that the workplace provided no information on the safety or rights of pregnant women, but those exposed to at least four hazards had more access to such services (P < 0.05). Thirteen percent may have suffered from depressive symptomatology. Higher-level work-related burnout, lower job control, and reduced workplace support were significantly associated with possible antenatal depressive symptoms.

CONCLUSION

Pregnant workers are exposed to substantial levels of occupational hazards and may experience depressive symptoms; thus, their work conditions require monitoring and improvement.

Symptoms of Depression and Preterm Birth Among Black Women

OBJECTIVE

To investigate the relationship between depressive symptoms and preterm birth (PTB) while adjusting for social support, both general and from the father of the baby.

DESIGN

Retrospective study design.

SETTING

Participants of the Life-course Influences of Fetal Environments (LIFE) study were recruited from a suburban hospital in Metropolitan Detroit, Michigan.

PARTICIPANTS

The LIFE data consisted of 1,410 self-identified Black women age 18 to 45 years; 1,207 women were included in this analysis.

METHODS

Women were interviewed using a structured questionnaire administered 24 to 48 hours after birth during their postpartum hospitalization. Data on the newborns and their mothers' health were collected through medical record abstraction. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure symptoms of depression. The CES-D scores ≥23 were considered severe symptoms of depression. Modified Poisson regression models were built using a stepwise approach to assess association between symptoms of depression and PTB.

RESULTS

Approximately, 17% of women had a PTB and 20% of women in the sample had a CES-D scores ≥23. Women who had CES-D score ≥23 were about 70% more likely to have a PTB compared with women with CES-D scores <23 (PR = 1.68, 95% CI: 1.24-2.16) after adjustment for both general social support and father of the baby support.

CONCLUSION

Women with CES-D scores ≥23 were almost twice more likely to have PTB compared with women with CES-D scores <23. Referrals for mental healthcare providers might benefit women with symptoms of depression and improve birth outcomes. Nurses should encourage women to seek support beyond the father of the baby.

Positive antenatal Edinburgh Depression Scale: examining behavioral and pharmacological therapy on maternal and neonatal outcomes

Objective: We hypothesized that women with a positive antenatal Edinburgh Depression Screen (EPDS) (≥10), undergoing behavioral or pharmacologic therapy have improved maternal and neonatal outcomes.Study design: This is a retrospective study of singleton pregnancies at UC, San Diego from 2010 to 2014. Patients with an antenatal EPDS were subdivided based on their intervention: negative score, positive score no treatment, behavioral therapy only, and pharmacologic therapy. The primary outcome was rate of preterm birth with secondary outcomes of maternal and neonatal outcomes.Results: Patients with a positive EPDS had a higher rate of preterm delivery, small-for-gestational age, NICU admission and Apgar score <7. Rates of adverse outcomes were highest among women receiving pharmacologic therapy. Rates of adverse outcomes women were not increased in the behavioral therapy group compared to the negative EPDS group. When adjusting for confounding variables, patient with a positive EPDS were more likely deliver preterm with an adjusted odds ratio of 1.71. Among varying treatment modalities, the odds ratio for preterm delivery was not statistically significant.Conclusion: Adverse pregnancy outcomes were highest among those requiring pharmacotherapy. Behavioral therapy had a positive effect on outcomes. Intervention to reduce these adverse outcomes in these patients needs further study.

Relationship Between Common Mental Disorder Symptoms During Pregnancy and Preterm Birth Among Chinese Women in Wuhan

Objectives Few studies focus on the symptoms of common mental disorders during pregnancy (CMDP) and risk of preterm birth subtypes (PTB). The purpose of this study was to estimate the association between CMDP and PTB, and to examine whether or not the association between CMDP and PTB varies with the subtype of PTB in Chinese. Methods This population-based case control study, conducted in Wuhan, China, defined cases as every pregnant woman who had a PTB among all births in Wuhan, from June 10, 2011, to June 9, 2013. The same number of pregnant women who had term births was randomly selected as controls. The Electronic Perinatal Health Care Information System, a questionnaire designed for the study, provided data about the participants. Logistic regression analyses were used to model associations between CMDP and PTB, and to test associations between CMDP and two subtypes of PTB. Results The study recruited 8616 cases and an equal number of controls. We successfully collected maternal information on 6656 cases and controls for a response rate of 77.3 %. The incidence of PTB in Wuhan was 4.5 %. Spontaneous preterm births (SPTB) accounted for 60.1 %, and medically induced preterm births (IPTB) accounted for 39.9 % of preterm births. The prevalence rate of CMDP was 15.8 %. CMDP was slightly associated with PTB (crude OR 1.16, 95 % CI 1.01-1.32; adjusted OR 1.15, 95 % CI 1.00-1.32), further analyses showed CMDP was associated with IPTB (aOR 1.25, 95 % CI 1.04-1.50), but not with SPTB. Conclusion Our data suggest that CMDP is related to an increased risk of PTB, and that this association is primarily due to IPTB rather than SPTB.

Obstetric outcomes in pregnant women with and without depression: population-based comparison

This study used insurance claims data to evaluate obstetric outcomes in pregnant women with and without depression because population study for Asian women on the issue is limited. We identified 5,064 women with depression at pregnancy in 2005–2013, and 20,024 pregnant women without depression, frequency matched by age, pregnant year and parity. Obstetric events during pregnancy and deliveries were evaluated. The depression group had more events than comparisons for hyperemesis (39.3 vs. 35.5%), abortion (3.3 vs. 2.6%), malpresentation (12.3 vs. 10.3%), C-section (40.2 vs. 34.6%) and intrauterine fetal demise (0.7 vs. 0.4%); risks of these events were significant for childbearing depressed women, not for the 35+ years subgroup. These incidences were higher in depressed women taking antidepressant than those without the medication, but were significant in childbearing depressed subgroup for hyperemesis and C-section with odds ratios of 1.18 (95% confidence intervals (CI), 1.02–1.36) and 1.29 (95% CI, 1.11–1.49), respectively. Incident preterm and low birth weight births were also higher in the depression group than in comparisons, but weren’t significant. In conclusion, women with depression during pregnancy may develop more adverse events than comparisons and are more likely to have a C-section delivery.

Prenatal depression and adverse birth outcomes: an updated systematic review

Complications related to preterm birth (PTB) and low birth weight (LBW) are leading causes of infant morbidity and mortality. Prenatal depression is a hypothesized psychosocial risk factor for both birth outcomes. The purpose of this systematic review was to examine evidence published between 1977 and 2013 on prenatal depression and risks of these primary adverse birth outcomes. A systematic search of the PUBMED and PsycINFO databases was conducted to identify studies testing the associations between prenatal depressive symptoms, or diagnoses of depression, and risk of PTB or LBW. We systematically selected 50 published reports on PTB and length of gestation, and 33 reports on LBW and BW. Results were reviewed by two independent reviewers and we evaluated the quality of the evidence with an established systematic review method, the Newcastle Ottawa Scale. We then undertook a narrative synthesis of the results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Less than a quarter of 50 published reports found that prenatal depression was significantly associated with PTB or gestational age. In contrast, slightly more than half of the 33 reports found that prenatal depression was associated with LBW or BW. When weighing methodological features, we determined that the effects of prenatal depression on LBW are more consistent than effects on length of gestation or PTB. Although the evidence may not be strong enough to support routine depression screening for risk of adverse outcomes, screening to enable detection and timely treatment to reduce risk of postpartum depression is warranted. Further rigorous research on prenatal depression and adverse birth outcomes is needed.

Antenatal depressive symptoms and the risk of preeclampsia or operative deliveries: a meta-analysis

BACKGROUND

The purpose of the study was to investigate the association between depression and/or depressive symptoms during pregnancy and the risk of an operative delivery or preeclampsia, and to quantify the strength of the association.

METHODS

A search of the PubMed, SCI/SSCI, Proquest PsycARTICLES and CINAHL databases was supplemented by manual searches of bibliographies of key retrieved articles and review articles. We aimed to include case control or cohort studies that reported data on antenatal depression and /or depressive symptoms and the risk of an operative delivery and/or preeclampsia.

RESULTS

Twelve studies with self-reported screening instruments were eligible for inclusion with a total of 8400 participants. Seven articles that contained 4421 total participants reported the risk for an operative delivery, and five articles that contained 3979 total participants reported the risk for preeclampsia. The pooled analyses showed that both operative delivery and preeclampsia had a statistically significant association with antenatal depressive symptoms (RR = 1.24; 95% CI, 1.14 to 1.35, and OR = 1.63, 95% CI, 1.32 to 2.02, respectively). When the pre-pregnancy body mass indices were controlled in their initial design, the risk for preeclampsia still existed (OR = 1.48, 95% CI, 1.04 to 2.01), while the risk for an operative delivery became uncertain (RR = 1.01, 95% CI, 0.85 to 1.22).

CONCLUSIONS

Antenatal depressive symptoms are associated with a moderately increased risk of an operative delivery and preeclampsia. An abnormal pre-pregnancy body mass index may modify this association.

Elevated risk of adverse obstetric outcomes in pregnant women with depression

In this study, we evaluated the association between prenatal depression symptoms adverse birth outcomes in African-American women. We conducted a retrospective cohort study of 261 pregnant African-American women who were screened with the Edinburgh Postnatal Depression Scale (EPDS) at their initial prenatal visit. Medical records were reviewed to assess pregnancy and neonatal outcomes, specifically preeclampsia, preterm birth, intrauterine growth retardation, and low birth weight. Using multivariable logistic regression models, an EPDS score ≥10 was associated with increased risk for preeclampsia, preterm birth, and low birth weight. An EPDS score ≥10 was associated with increased risk for intrauterine growth retardation, but after controlling for behavioral risk factors, this association was no longer significant. Patients who screen positive for depression symptoms during pregnancy are at increased risk for multiple adverse birth outcomes. In a positive, patient-rated depression screening at the initial obstetrics visit, depression is associated with increased risk for multiple adverse birth outcomes. Given the retrospective study design and small sample size, these findings should be confirmed in a prospective cohort study.

Depression during pregnancy: a risk factor for adverse neonatal outcomes? A critical review of the literature

OBJECTIVE

We reviewed studies of maternal depression and preterm birth (PTB), low birthweight (LBW) and small-for-gestational-age (SGA) in the context of methodological differences between studies and potential limitations.

METHODS

We conducted a literature search of PubMed (1996-2011) for English-language studies of maternal depression and (1) PTB and gestational age (GA), (2) LBW and birthweight (BW) and (3) SGA. Thirty-six studies met eligibility criteria.

RESULTS

Elevated depression levels, particularly in early- to mid-pregnancy, appear to increase risk of PTB and SGA. Findings suggest an increased risk for LBW, but were less consistent. Methodological differences and limitations likely contributed to conflicting findings. A wide range of depression measures were used with the majority of studies utilizing measures not designed, or validated, for pregnant women. Studies failed to assess depression at multiple pregnancy time points, thus constraining the ability to assess the impact of duration and pattern of exposure to depression. Antidepressant use and co-morbid psychosocial factors were rarely considered as potential confounders or effect modifiers.

CONCLUSIONS

Studies suggest that depression during pregnancy may be an important risk factor for PTB and SGA, and possibly LBW. Improved study methodology is needed to elucidate the consequence of maternal depression on adverse birth outcomes.

[Effects of antenatal depression and antenatal characteristics of pregnant women on birth outcomes: a prospective cohort study]

PURPOSE

This study was done to evaluate the effects of antenatal depression on birth outcomes.

METHODS

The participants were 255 pregnant women who were followed in a prospective study. Of these, 197 cases were examined included birth weight, Apgar scores at 5 minute, premature contraction, complication of labor, delivery types and laboratory data. Descriptive statistics, ANOVA, Chi square test of linear by linear association, Kruskal Wallis test, Relative Risk, univariate and adjusted multiple logistic regression were used for data analysis with SPSS/Win.

RESULTS

Level of antenatal depression was associated with low birth weight (χ²=7.69, p=.010). High risk pregnancy was a predictor of low birth weight (OR=6.98 [1.21-40.30]) and baby's weight (OR=2.12, [1.05-4.28]). Prepregnancy body mass index (BMI) was a predictor of complications in labor (OR=3.59, [1.03-12.48]). But there were no significant effects of antenatal depression on other birth outcomes.

CONCLUSION

The results of this study indicate that women with antenatal depression, high risk pregnancy, prepregnancy BMI≥23 kg/M² should be monitored and managed to ensure favorable birth outcomes.