Depressive disorders during pregnancy: prevalence and risk factors in a large urban sample

Childhood Maltreatment and Perinatal Mood and Anxiety Disorders: A Systematic Review

Perinatal mood and anxiety disorders (PMADs) compromise maternal and child well-being and may be influenced by traumatic experiences across the life course. A potent and common form of trauma is childhood maltreatment, but its specific impact on PMADs is not well understood. A systematic review was undertaken to synthesize empirical literature on the relationship between maternal histories of childhood maltreatment and PMADs. Of the 876 citations retrieved, 35 reports from a total of 26,239 participants met inclusion criteria, documenting substantial rates of childhood maltreatment and PMADs. Robust trends of association were observed between childhood maltreatment and perinatal depression, as well as post-traumatic stress disorder, but findings for anxiety were less consistent. Examining multivariate results suggested that childhood maltreatment predicts PMADs above and beyond sociodemographic, psychiatric, perinatal, and psychosocial factors, but may also be partially mediated by variables such as later victimization and moderated by protective early relationships. Future research should test mediating and moderating pathways using prospective cohorts, expanding to cross-cultural settings and other disorder outcomes. Treatment and prevention of childhood maltreatment and its sequelae may help mitigate risk for perinatal psychopathology and its impact on maternal and child outcomes.

Suicidal ideation in pregnancy: an epidemiologic review

Suicidal behaviors are the leading causes of injury and death worldwide, and are leading causes of maternal deaths in some countries. One of the strongest risk factors, suicidal ideation, is considered a harbinger and distal predictor of later suicide attempt and completion, and also presents an opportunity for interventions prior to physical self-harm. The purpose of this systematic epidemiologic review is to synthesize available research on antepartum suicidal ideation. Original publications were identified through searches of the electronic databases using the search terms pregnancy, pregnant women, suicidal ideation, and pregnan* and suicid* as root searches. We also reviewed references of published articles. We identified a total of 2626 articles through the electronic database search. After irrelevant and redundant articles were excluded, 57 articles were selected. The selected articles were original articles that focused on pregnancy and suicidal ideation. Of the 57 included articles, 20 reported prevalence, 26 reported risk factors, 21 reported consequences of antepartum suicidal ideation, and 5 reported on screening measures. Available evidence indicates that pregnant women are more likely than the general population to endorse suicidal ideation. Additionally, a number of risk factors for antepartum suicidal ideation were identified including intimate partner violence, <12-year education, and major depressive disorder. There is a need for enhanced screening for antepartum suicidal ideation. The few screening instruments that exist are limited as they were primarily developed to measure antepartum and postpartum depression. Given a substantial proportion of women with suicidal ideation that does not meet clinical thresholds of depression and given the stress-diathesis model that shows susceptibility to suicidal behavior independent of depressive disorders, innovative approaches to improve screening and detection of antepartum suicidal ideation are urgently needed.

Prevalence and related factors of common mental disorders during pregnancy in Japan: a cross-sectional study

Background

Common mental disorders (CMD) during pregnancy can have a clearly harmful influence on both mothers and children. Some studies have reported related factors for mental disorders, such as region-specific background. This study examined the prevalence of CMD and its related factors in mid-pregnancy in Japan.

Methods

Pregnant women between 12 and 24 weeks gestation and aged ≥20 years were consecutively recruited at a maternity hospital in Japan between May 2014 and September 2014. CMD were diagnosed using the Mini-International Neuropsychiatric Interview (MINI), self-rated depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale, and interpersonal traumatic experience was measured using the Life Events Checklist.

Results

Among 297 eligible pregnant women, 177 participated in the study. Two participants (1.1 %) met the criteria for major depressive disorder. The most frequent diagnosis was agoraphobia (n = 7; 3.9 %). Eleven participants (6.2 %) met the criteria for one or more diagnoses, with 2 participants having two mental disorders and 3 having three mental disorders. Six participants developed CMD after gestation. Logistic regression analysis revealed history of psychiatric disorder, past interpersonal traumatic experience, and feeling pressure to have a child were associated with CMD.

Conclusion

These findings indicate a lower prevalence of CMD in mid-pregnancy in Japan than reported in most other countries. Besides the related factors reported previously, feeling pressure to have a child might increase risk for CMD among pregnant women in Japan. Asian cultural background might be related to the lower CMD prevalence and risk factors identified in this study.

A Socioecological Framework to Assessing Depression Among Pregnant Teens

To examine individual, interpersonal, family, and community correlates associated with moderate-to-severe depressive symptoms among pregnant adolescents. A total of 249 primarily African American and Hispanic pregnant adolescents ages 15-18 years were recruited into either an intervention group utilizing Centering Pregnancy prenatal care and case management, or to a comparison group receiving case management only. Moderate-to-severe depressive symptoms were defined as a score ≥16 on the Center for Epidemiologic Studies Depression Scale (CES-D). Intervention and comparison groups did not significantly differ on demographic characteristics or depression scores at baseline. A total of 115 (46.1 %) participants met criteria for moderate-to-severe depressive symptoms at entry into the program. Pregnant adolescents who were moderately-to-severely depressed were more likely to be African American, to have reported limited contact with the father of the baby, and to have experienced prior verbal, physical or sexual abuse. Depressed adolescents also experienced high levels of family criticism, low levels of general support, and exposure to community violence. A significant number of pregnant adolescents were affected by depression and other challenges that could affect their health. Comprehensive interventions addressing these challenges and incorporating partners and families are needed.

The Broken Thread of Health Promotion and Disease Prevention for Women During the Postpartum Period

Postpartum maternal health affects maternal functional status, future pregnancy outcomes, maternal chronic disease development, and infant health. After pregnancy, however, many mothers may find that they face gaps in care related to their health and caregiving roles. Research shows that they were unprepared, uninformed, and unsupported during the postpartum period as they struggle with physical and emotional symptoms, infant caregiving, breastfeeding concerns, and lifestyle adjustments. Limited follow-up after a diagnosis of gestational hypertension or gestational diabetes and screening for postpartum depression are additional gaps in preventive and supportive care. Integrative reviews revealed modest efficacy and limitations of recent postpartum health promotion and disease prevention interventions. System, clinical, and community strategies are identified to address these gaps in women's postpartum health services.

Web-based interventions for prevention and treatment of perinatal mood disorders: a systematic review

BACKGROUND

Perinatal depression is strikingly common with a prevalence of 10-15%. The adverse effects of perinatal depression on maternal and child health are profound with considerable costs. Despite this, few women seek medical attention. E-health, providing healthcare via the Internet is an accessible and effective solution for the treatment of depression in the general population. We aimed to conduct a systematic review of web-based interventions for the prevention and treatment of mood disorders in the perinatal period, defined as the start of pregnancy to 1 year post-partum.

METHODS

Six databases were searched until 26(th) March 2015. Two researchers independently screened articles for eligibility. Of the 547 screened articles, four met the inclusion criteria. These included three randomised-controlled trials and one feasibility trial, with total data from 1274 participants. MOOSE and PRISMA guidelines were adhered to for the conduct and reporting of the systematic review.

RESULTS

All studies were conducted in the post-partum period. All reported an improvement in maternal mood following intervention. A significant improvement in depressive symptoms was measured using validated rating scales, such as the Edinburgh Postnatal Depression Scale (EPDS), either at post-treatment or follow-up which ranged from 3 to 12 months post study completion. For the two RCTs utilising the EPDS, the EPDS score reductions were (mean ± SEM) 8.52 ± 0.22 (Range 19.46 to10.94) and 9.19 ± 0.63 (Range, 20.24 to 11.05) for treatment groups and 5.16 ± 0.25 (Range 19.44 to 14.28) and 6.81 ± 0.71 (Range 21.07 to 14.26) for comparator groups. However attrition within studies ranged from 13 to 61%. One study was rated as 'good' quality.

CONCLUSIONS

Preliminary data suggests web-based therapies for perinatal depression delivered in the post-partum period may play a role in improving maternalmood but more studies are needed, particularly with interventions delivered antenatally. Further research is needed to address the limitations of the existing evidence base.

Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy

In preparation for developing a website to enhance emotional wellness and healthy lifestyle during the perinatal period, this study examined women's informational needs and barriers. Seventy-four women who were pregnant or had given birth completed an online survey inquiring about information needs and preferred sources related to psychosocial aspects and lifestyle behaviors. Information related to healthy diet choices and weight management, followed by exercise, was rated highly as a need. Information related to depression, stress, and anxiety was also rated as important. Health-care providers and the Internet were found to be preferred sources of information. Evidence-based websites can serve as a powerful low-cost educational resource to support and reinforce the health promotion advice received from their health-care providers.

Identifying the women at risk of antenatal anxiety and depression: A systematic review

BACKGROUND

Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This systematic review aims to identify the main risk factors involved in the onset of antenatal anxiety and depression.

METHODS

A systematic literature analysis was conducted, using PubMed, PsychINFO, and the Cochrane Library. Original papers were included if they were written in English and published between 1st January 2003 and 31st August 2015, while literature reviews and meta-analyses were consulted regardless of publication date. A final number of 97 papers were selected.

RESULTS

The most relevant factors associated with antenatal depression or anxiety were: lack of partner or of social support; history of abuse or of domestic violence; personal history of mental illness; unplanned or unwanted pregnancy; adverse events in life and high perceived stress; present/past pregnancy complications; and pregnancy loss.

LIMITATIONS

The review does not include a meta-analysis, which may have added additional information about the differential impact of each risk factor. Moreover, it does not specifically examine factors that may influence different types of anxiety disorders, or the recurrence or persistence of depression or anxiety from pregnancy to the postpartum period.

CONCLUSIONS

The results show the complex aetiology of antenatal depression and anxiety. The administration of a screening tool to identify women at risk of anxiety and depression during pregnancy should be universal practice in order to promote the long-term wellbeing of mothers and babies, and the knowledge of specific risk factors may help creating such screening tool targeting women at higher risk.

Comparison of pre-procedural anxiety and depression scores for patients undergoing chorion villus sampling and amniocentesis: An alternative perspective on prenatal invasive techniques

OBJECTIVE

To compare the pre-procedural anxiety and depression levels of patients undergoing chorion villus sampling (CVS) and amniocentesis (AC).

METHODS

Patients referred to our department for fetal karyotype analysis with a positive first or second trimester screening test for aneuploidy between January 2013 to June 2015 were included. CVS and AC procedures were performed in patients with gestation periods of between 11-14 and 16-20 weeks, respectively. Anxiety was evaluated using the Spielberger State-Trait Anxiety Inventory (STAI), and depression was assessed using the Beck Depression Inventory II (BDI-II).

RESULTS

A total of 1,400 patients were included. Compared to first trimester controls, patients undergoing CVS had significantly higher STAI-state and BDI-II results. Likewise, patients undergoing AC had higher STAI-state and BDI-II scores than controls in the second trimester. In terms of STAI-trait results, no difference was found between the groups. Our results also showed that, compared to AC group, patients undergoing CVS had similar STAI-state, STAI-trait and but higher BDI-II scores.

CONCLUSION

We conclude that evaluating the stress and depression levels of these patients should be one of the routine procedures in pregnancy follow-up.

A case-control study of sporadic retinoblastoma in relation to maternal health conditions and reproductive factors: a report from the Children's Oncology group

Background

The early age at retinoblastoma occurrence, the most common eye malignancy in childhood, suggests that perinatal factors may contribute to its etiology.

Methods

In a large multicenter study of non-familial retinoblastoma, we conducted structured interviews with the parents of 280 cases and 146 controls to elicit information on health during the perinatal period. We used unconditional logistic regression to assess associations between retinoblastoma and parental fertility treatment, birth control use in the year prior to pregnancy, maternal health conditions and the use of prescription medications during pregnancy, and whether mothers breastfed the index child.

Results

Bilateral retinoblastoma was related to maternal underweight (body mass index <18.5) prior to pregnancy [Odds Ratio (OR) = 4.5, 95 % confidence interval (CI) 1.0, 20]. With regards to unilateral retinoblastoma, we observed a negative association with the use of condoms in the year prior to pregnancy (OR = 0.4, CI 0.2, 0.9), and a trend towards a positive association with maternal diabetes (OR = 2.2, CI 0.8, 6.6).

Conclusions

Results from our study suggest a role for several maternal health and reproductive factors. Given that there are few epidemiologic studies of retinoblastoma, our results require replication in studies which utilize medical record review.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1773-0) contains supplementary material, which is available to authorized users.

Untreated depression during pregnancy: Short- and long-term effects in offspring. A systematic review

Aim of this systematic review is to assess short- and long-lasting effects of antenatal exposure to untreated maternal depressive symptoms. Pertinent articles were identified through combined searches of Science.gov, Cochrane library, and PubMed databases (through August 2015). Forty-three, selected articles revealed that untreated gestational depression and even depressive symptoms during pregnancy may have untoward effects on the developing fetus (hyperactivity, irregular fetal heart rate), newborns (increased cortisol and norepinephrine levels, decreased dopamine levels, altered EEG patterns, reduced vagal tone, stress/depressive-like behaviors, and increased rates of premature deaths and neonatal intensive care unit admission), and children (increased salivary cortisol levels, internalizing and externalizing problems, and central adiposity). During adolescence, an independent association exists between maternal antenatal mood symptoms and a slight increase in criminal behaviors. In contrast, the relationship between gestational depression and increased risks of prematurity and low birth weight remains controversial. Given this background, when making clinical decisions, clinicians should weigh the growing evidences suggesting the detrimental and prolonged effects in offspring of untreated antenatal depression and depressive symptoms during pregnancy against the known and emerging concerns associated with in utero exposure to antidepressants.

Improving mental and physical health outcomes in general healthcare settings: a Gedenkschrift in honor of Wayne Katon, MD (1950-2015)

This special article pays tribute to Wayne Katon, MD (1950-2015) with a Gedenkschrift, or review, of his prolific academic career. Abstracts of all of Dr. Katon's Medline citations were reviewed to develop a narrative of his seminal epidemiological and interventional research findings. Specifically, we describe: (a) how Dr. Katon's clinical work and observational epidemiology and health services research informed and guided interventional studies; (b) the evolution of multidisciplinary interventional trials from primary care-based psychiatric consultation to primary care-based collaborative care for depression to multicondition collaborative care; and (c) how Dr. Katon's research has informed the work of other leading researchers in the field of psychosomatic medicine and helped develop a new generation of researchers at the interface of psychiatry and primary care. For more than three decades, Dr. Katon led a multidisciplinary research team that conducted seminal epidemiological studies and randomized trials and that influenced the thinking and research in the field of psychiatry in a number of areas: (a) the importance and impact of mental disorders presenting in primary care settings and (b) the organization of effective multidisciplinary care for primary care patients with common mental disorders and comorbid medical conditions. Dr. Katon's work revolutionized the care of psychiatric illnesses in primary care and other medical care settings to the benefit of countless patients worldwide.

Racial/Ethnic Disparities in Depressive Symptoms Among Pregnant Women Vary by Income and Neighborhood Poverty

We examined racial/ethnic disparities in depressive symptoms during pregnancy among a population-based sample of childbearing women in California (N = 24,587). We hypothesized that these racial/ethnic disparities would be eliminated when comparing women with similar incomes and neighborhood poverty environments. Neighborhood poverty trajectory descriptions were linked with survey data measuring age, parity, race/ethnicity, marital status, education, income, and depressive symptoms. We constructed logistic regression models among the overall sample to examine both crude and adjusted racial/ethnic disparities in feeling depressed. Next, stratified adjusted logistic regression models were constructed to examine racial/ethnic disparities in feeling depressed among women of similar income levels living in similar neighborhood poverty environments. We found that racial/ethnic disparities in feeling depressed remained only among women who were not poor themselves and who lived in long-term moderate or low poverty neighborhoods.

Prenatal depression: Early intervention

Frequently undiagnosed and untreated, prenatal depression affects approximately one in four childbearing women. Screening and appropriate management is essential to prevent adverse consequences to both the woman and her unborn infant. Early conversations between the woman and her nurse practitioner are essential to making medical management decisions.

Depression, Anxiety, and Pharmacotherapy Around the Time of Pregnancy in Hawaii

BACKGROUND

Depression and anxiety are common conditions among pregnant and postpartum women, but population-based information is lacking on treatments and help-seeking behaviors.

PURPOSE

This study described the prevalence of depression, anxiety, pharmaceutical treatment, and help-seeking behaviors among a multiethnic population of women with recent live births in Hawaii.

METHOD

Hawaii Pregnancy Risk Assessment Monitoring System data from 4735 respondents were weighted to be representative of all pregnancies resulting in live births in Hawaii in 2009-2011 and were used to estimate the prevalence of several indicators related to anxiety and depression before, during, and after pregnancy among women with recent live births.

RESULTS

Of Hawaii women with live births in 2009-2011, 7.3 % reported visiting a healthcare worker to be checked or treated for depression or anxiety in the year before their most recent pregnancy, 4.9 % reported having depression in the 3 months before pregnancy, 5.9 % reported having anxiety in the same period, 9.1 % screened positive for postpartum depression, and 6.9 % reported asking a doctor, nurse, or other healthcare worker for help for anxiety postpartum. The prevalence of antianxiety and antidepressant prescription drug use was 2.3 % in the month before pregnancy and 1.4 % during pregnancy. Hawaii had lower prevalence of pre-pregnancy depression, anxiety, and depression/anxiety health visits than other US states. Pre-pregnancy depression and anxiety and postpartum anxiety help-seeking behaviors differed significantly by race/ethnicity.

CONCLUSION

Depression and anxiety are common among pregnant and postpartum women in Hawaii. More research could better inform heath care professionals and patients of the treatment options available and their potential risks and benefits.

Depression during Pregnancy

A proportion of women enter pregnancy with active psychiatric symptoms or disorders, with or without concomitant psychotropic medication. Studies report that exposure to untreated depression and stress during pregnancy may have negative consequences for birth outcome and child development. Studies also report that antenatal exposure to antidepressant medications may have adverse consequences for birth outcome and child development. Antidepressant medication use during pregnancy leads to a small increased risk of miscarriage, a possible small increased risk of congenital cardiac malformations, a small increased risk of preterm birth, a small increased risk of persistent pulmonary hypertension of the newborn (PPHN), and transient neonatal symptoms in up to one-third of neonates. In addition, there is a possible increased risk of delayed motor development in children. Several recent systematic reviews and meta-analyses of the existent literature emphasize that there are minimal definitive conclusions to guide treatment recommendations. This review describes best practices for the management of depression in pregnancy, and it provides suggestions for future research.

Assessment of burden of depression during pregnancy among pregnant women residing in rural setting of chennai

INTRODUCTION

Depression during perinatal period leads to adverse pregnancy outcome and of child growth. Our study aimed to examine the burden of antenatal depression and associated risk factors among pregnant women living in rural settings of Chennai, a southern state of India.

MATERIALS AND METHODS

A pilot cross-sectional study was conducted in the rural settings of Chennai, one of the Southern States of India during August through September 2013. Hundred pregnant women who agreed to participate were enrolled in this study. Edinburg postnatal depression scale was used to assess the depression level of the study participants. Information was also gathered about socio-demographics, obstetric and disease history, social support and marital satisfaction was gathered. Descriptive analysis was performed using univariate statistics to report means and standard deviations for the continuous variables and frequency distribution for the categorical variables.

RESULTS

Majority of the participants (65%) had scored 13 or higher on the Edinburg Depression Scale reflecting high likelihood of depression. Majority of the participants (66%) had been bothered due to low feeling, depressed or hopelessness during the previous month. Enriched marital satisfaction scale (p=.025) had shown significant association with Edinburg depression scale.

CONCLUSION

Pregnancy is very crucial period not only for mother but whole family. This study has shown very high frequency of depression among the participants. There is a need for a longitudinal study to design interventions that can address emerging burden of antenatal depression among pregnant women living in rural settings.

Client experiences of guided internet cognitive behavior therapy for postpartum depression: a qualitative study

Postpartum depression (PPD) afflicts up to 15 % of women following childbirth and negatively impacts both mother and child. Therapist-assisted internet cognitive behavior therapy (TAICBT) is a promising intervention for the treatment of PPD; however, women's perceptions of TAICBT have not been examined. Responses to 10 open-ended questions from 24 women who received TAICBT for PPD were thematically analyzed. The majority of women expressed that the TAICBT program afforded flexibility, accessibility, and convenience, as well as anonymity and privacy. Some participants described the program as helping them take a step in the right direction and enhance their self-awareness and parenting skills. Participants also described having the internet therapist individualize their treatment. Challenges related to the TAICBT program were also identified by a minority of participants including managing time to log onto the program, the fast pace, completion of homework around childcare duties, and challenges of not having a face-to-face therapist. Participants also made suggestions for future programming. The large majority of participants consistently described their internet therapist favorably; however, challenges related to the internet therapy were also identified. Results should be integrated in the development of future programming.

Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women: validation of a short assessment tool - the KINDEX Greek version

Background

Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer women in psychosocial risk to the adequate mental health and social services. We also examined the criterion-related concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist. Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for the psychosocial risk assessment to the obstetric care providers.

Methods

Two obstetricians and five midwives carried out 93 KINDEX interviews (duration 20 minutes) with pregnant women to assess psychosocial risk factors present during pregnancy. Afterwards they referred women who they identified having two or more psychosocial risk factors to the mental health attention unit of the hospital. During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a randomized subsample of 50 pregnant women based on established diagnostic instruments for stress and psychopathology, like the PSS-14, ESI, PDS, HSCL-25.

Results

Significant correlations between the results obtained through the assessment using the KINDEX and the risk areas of stress, psychopathology and trauma load assessed in the validation interview demonstrate the criterion-related concurrent validity of the KINDEX. The referral accuracy of the medical staff is confirmed through comparisons between pregnant women who have and have not been referred to the mental health attention unit.

Conclusions

Prenatal screenings for psychosocial risks like the KINDEX are feasible in public health settings in Greece. In addition, validity was confirmed in high correlations between the KINDEX results and the results of the validation interviews. The KINDEX Greek version can be considered a valid tool, which can be used by non-trained medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and social services. These kind of assessments are indispensable for the promotion of a healthy family environment and child development.

"I just start crying for no reason": the experience of stress and depression in pregnant, urban, African-American adolescents and their perception of yoga as a management strategy

PURPOSE

Perinatal health disparities are of particular concern with pregnant, urban, African-American (AA) adolescents, who have high rates of stress and depression during pregnancy, higher rates of adverse pregnancy and neonatal outcomes, and many barriers to effective treatment. The purpose of this study was to explore pregnant, urban, AA teenagers' experience of stress and depression and examine their perceptions of adjunctive nonpharmacologic management strategies, such as yoga.

METHODS

This community-based, qualitative study used nontherapeutic focus groups to allow for exploration of attitudes, concerns, beliefs, and values regarding stress and depression in pregnancy and nonpharmacologic management approaches, such as mind-body therapies and other prenatal activities.

FINDINGS

The sample consisted of pregnant, AA, low-income adolescents (n=17) who resided in a large urban area in the United States. The themes that arose in the focus group discussions were that 1) stress and depression symptoms are pervasive in daily life, 2) participants felt a generalized sense of isolation, 3) stress/depression management techniques should be group based, interactive, and focused on the specific needs of teenagers, and 4) yoga is an appealing stress management technique to this population.

CONCLUSIONS

Findings from this study suggest that pregnant, urban, adolescents are highly stressed; they interpret depression-like symptoms to be signs of stress; they desire group-based, interactive activities; and they are interested in yoga classes for stress/depression management and relationship building. It is imperative that health care providers and researchers focus on these needs, particularly when designing prevention and intervention strategies.

The effect of antenatal depression and selective serotonin reuptake inhibitor treatment on nerve growth factor signaling in human placenta

Depressive symptoms during pregnancy are common and may have impact on the developing child. Selective serotonin reuptake inhibitors (SSRIs) are the most prescribed antidepressant treatment, but unfortunately, these treatments can also negatively affect the behavioral development and health of a child during pregnancy. In addition, serotonin (5-HT) exerts neurotrophic actions with thus far not fully known effects in the offspring. The neurotrophic growth factor (NGF) is involved in neuronal cell survival and differentiation, and altered placenta levels have been found to increase the risk for pregnancy complications, similar to those found in women treated with SSRIs. We therefore investigated whether the NGF signaling pathway was altered in the placenta from women treated with SSRIs (n = 12) and compared them with placenta from depressed (n = 12) and healthy mothers (n = 12). Results from immunohistochemical stainings revealed that placental NGF protein levels of SSRI-treated women were increased in both trophoblasts and endothelial cells compared with depressed and control women. In addition, downstream of the NGF receptor TrkA, increased levels of the signaling proteins ROCK2 and phosphorylated Raf-1 were found in stromal cells and a tendency towards increased levels of ROCK2 in trophoblasts and endothelial cells in SSRI-treated women when compared to healthy controls. SSRI-treated women also displayed increased levels of phosphorylated ROCK2 in all placental cell types studied in comparison with depressed and control women. Interestingly, in placental endothelial cells from depressed women, NGF levels were significantly lower compared to control women, but ROCK2 levels were increased compared with control and SSRI-treated women. Taken together, these results show that the NGF signaling and downstream pathways in the placenta are affected by SSRI treatment and/or antenatal depression. This might lead to an altered placental function, although the clinical relevance of our findings still needs to be investigated.

The latent symptom structure of the Beck depression inventory: second edition in Latina pregnant women

Pregnancy represents a unique period of time when women are at an increased risk of developing depression. Although the Beck Depression Inventory-Second Edition (BDI-II) is one of the most widely used self-report measures of depression symptomology, its psychometric properties and underlying factor structures have not been determined for antenatal women and among Latinas. The current study evaluated the latent symptom structure of the BDI-II in a community-based sample of Latina pregnant women (N = 217) identified to be at high risk for depression. Exploratory factor analyses were used to identify underlying salient individual item loadings for two- and three-factor models. Confirmatory factor analyses then examined several different indices to determine the best model fit. Examination of exploratory and confirmatory factor analyses supports a three-factor oblique structure of the BDI-II composed of Cognitive-Affective, Somatic, and Pregnancy Symptoms. The three-factor model provides clinicians with the ability to target specific constellations of depressive symptoms instead of relying on the BDI-II total score that represents the overall severity of depression in this population.

Depressive disorder in pregnant Latin women: does intimate partner violence matter?

AIMS AND OBJECTIVES

To identify the association of antenatal depressive symptoms with intimate partner violence during the current pregnancy in Brazilian women.

BACKGROUND

Intimate partner violence is an important risk factor for antenatal depression. To the authors' knowledge, there has been no study to date that assessed the association between intimate partner violence during pregnancy and antenatal depressive symptoms among Brazilian women.

DESIGN

Cross-sectional study.

METHODS

Three hundred and fifty-eight pregnant women were enrolled in the study. The Edinburgh Postnatal Depression Scale and an adapted version of the instrument used in the World Health Organization Multi-country Study on Women's Health and Domestic Violence were used to measure antenatal depressive symptoms and psychological, physical and sexual acts of intimate partner violence during the current pregnancy respectively. Multiple logistic regression and multiple linear regression were used for data analysis.

RESULTS

The prevalence of antenatal depressive symptoms, as determined by the cut-off score of 12 in the Edinburgh Postnatal Depression Scale, was 28·2% (101). Of the participants, 63 (17·6%) reported some type of intimate partner violence during pregnancy. Among them, 60 (95·2%) reported suffering psychological violence, 23 (36·5%) physical violence and one (1·6%) sexual violence. Multiple logistic regression and multiple linear regression indicated that antenatal depressive symptoms are extremely associated with intimate partner violence during pregnancy.

CONCLUSION

Among Brazilian women, exposure to intimate partner violence during pregnancy increases the chances of experiencing antenatal depressive symptoms.

RELEVANCE TO CLINICAL PRACTICE

Clinical nurses and nurses midwifes should pay attention to the particularities of Brazilian women, especially with regard to the occurrence of intimate partner violence, whose impacts on the mental health of this population are extremely significant, both during the gestational period and postpartum.

Prevalence and Predictors of Depressive Symptoms in Pregnant African American Women

African American women may be especially vulnerable to antepartum depression, a major health concern during pregnancy. This study investigated the prevalence and predictors of depressive symptoms in a sample of African American women who were between 14-17 weeks pregnant, a timeframe that is typically thought to be a time of general well-being. Two-thirds reported a CES-D score ≥ 16 indicative of depressive symptomatology. Age, perceived stress (as measured by the Perceived Stress Scale [PSS]), and anxiety (as measured by the State Trait Anxiety Inventory [STAI]) predicted depressive symptoms; the interaction between PSS and STAI scores was also a significant predictor. Our study findings suggest that early identification of stress and anxiety, in addition to depressive symptoms, is vital for intervention with this group.

Postpartum depression on the neonatal intensive care unit: current perspectives

As the most common complication of childbirth affecting 10%–15% of women, postpartum depression (PPD) goes vastly undetected and untreated, inflicting long-term consequences on both mother and child. Studies consistently show that mothers of infants in the neonatal intensive care unit (NICU) experience PPD at higher rates with more elevated symptomatology than mothers of healthy infants. Although there has been increased awareness regarding the overall prevalence of PPD and recognition of the need for health care providers to address this health issue, there has not been adequate attention to PPD in the context of the NICU. This review will focus on an overview of PPD and psychological morbidities, the prevalence of PPD in mothers of infants admitted to NICU, associated risk factors, potential PPD screening measures, promising intervention programs, the role of NICU health care providers in addressing PPD in the NICU, and suggested future research directions.

Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: a systematic review

Antidepressant and anxiolytic medications are widely prescribed and used by pregnant women for acute and maintenance therapy. These drugs are able to pass the placental barrier, and may potentially influence fetal and brain development. It is possible that exposure to prenatal antidepressants or anxiolytic medication may disturb neurotransmitter systems in the brain and have long-lasting consequences on neurodevelopment in the offspring. As all medication during pregnancy may pose a certain risk to the developing fetus, the potential benefits of the medication must be weighed against the risks for both mother and her unborn child. Therefore, information to guide patients and physicians to make a well-balanced decision for the appropriate treatment during pregnancy is needed. In this systematic review, an overview of maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes is provided. Some studies indicate a relation between prenatal exposure to antidepressants and adverse neurodevelopmental outcomes such as delayed motor development/motor control, social difficulties, internalizing problems and autism, but cannot rule out confounding by indication. Overall, the results of the observational studies have been inconsistent, which makes translation of the findings into clinical recommendations difficult. More well-designed observational studies and also randomized controlled trials (e.g., maintenance treatment vs. cessation) are needed to move forward and provide a comprehensive evaluation of the risks and benefits of antidepressant and anxiolytic use during pregnancy.

Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset

The objectives of this study were to evaluate the prevalence of depressive symptoms in the third trimester of pregnancy and at 3 months postpartum and to prospectively identify risk factors associated with elevated depressive symptoms during pregnancy and with postpartum onset. About 364 women attending antenatal clinics or at the time of their ultrasound were recruited and completed questionnaires in pregnancy and 226 returned their questionnaires at 3 months postpartum. Depressed mood was assessed by the Edinburgh Postnatal Depression Scale (EPDS; score of ≥ 10). The rate of depressed mood during pregnancy was 28.3% and 16.4% at 3 months postpartum. Among women with postpartum depressed mood, 6.6% were new postpartum cases. In the present study, belonging to a non-Caucasian ethnic group, a history of emotional problems (e.g. anxiety and depression) or of sexual abuse, comorbid anxiety, higher anxiety sensitivity and having experienced stressful events were associated with elevated depressed mood during pregnancy. Four risk factors emerged as predictors of new onset elevated depressed mood at 3 months postpartum: higher depressive symptomatology during pregnancy, a history of emotional problems, lower social support during pregnancy and a delivery that was more difficult than expected. The importance of identifying women at risk of depressed mood early in pregnancy and clinical implications are discussed.

Antenatal depression and antidepressants during pregnancy: unraveling the complex interactions for the offspring

During pregnancy the risk for a woman to develop a depressive episode is as high as 20%. Antenatal depression is not harmless for the developing child as several changes, including neurodevelopmental alterations, have been reported. Sometimes it is unavoidable to treat a pregnant mother with antidepressants, especially when she is suicidal. Currently, selective serotonin reuptake inhibitors (SSRIs) are the pharmacological choice of antidepressant treatment. SSRIs do not cause gross teratogenic alterations and are generally considered safe for use in pregnancy. However, although SSRIs may relieve the maternal symptoms, they definitively cross the placenta partially influencing the neurodevelopment of the fetus. In this review an overview is given of the effects on the offspring of maternal antenatal depression and the putative neurodevelopmental effects of SSRI treatment during pregnancy. Although we primarily focus on human data, some animal data are discussed to describe possible mechanisms on how SSRIs are affecting underlying biological mechanisms associated with depression. In summary, maternal depression may have long-lasting effects on the offspring, whereas prenatal SSRI exposure also increases the risk for long-lasting effects. It remains to be determined whether the effects found after SSRI treatment in pregnant women are only due to the SSRI exposure or if the underlying depression is also contributing to these effects. The possibility of epigenetic alterations as one of the underlying mechanisms that is altered by SSRI exposure is discussed. However much more research in this area is needed to explain the exact role of epigenetic mechanisms in SSRI exposure during pregnancy.

Potential for a stress reduction intervention to promote healthy gestational weight gain: focus groups with low-income pregnant women

BACKGROUND

Prepregnancy body mass index and excessive gestational weight gain (GWG) are associated with adverse maternal and infant outcomes. Because stress contributes to obesity and eating behaviors, stress reduction interventions during pregnancy may be a novel way to influence GWG, positively affect maternal and infant outcomes, and address the obesity epidemic intergenerationally.

METHODS

Our research team is developing a mindfulness-based stress reduction and nutrition intervention for low-income, overweight and obese pregnant women, with healthy GWG as the primary outcome measure. To inform development of the intervention, we conducted focus groups with our target population. Focus group transcripts were analyzed for themes related to sources and importance of stress, relationship between stress and eating, and motivation for a stress reduction pregnancy intervention.

FINDINGS

Fifty-nine low-income pregnant women from the San Francisco Bay Area participated in focus groups and completed a questionnaire. The vast majority of women (80%) reported experiencing significant stress from a variety of sources and most recognized a relationship between stress and eating in their lives.

CONCLUSIONS

This at-risk population seems to be extremely interested in a stress reduction intervention to support healthy GWG during pregnancy. The women in our groups described high levels of stress and a desire for programs beyond basic dietary recommendations. These findings inform practitioners and policymakers interested in pregnancy as a "window of opportunity" for behavior change that can affect the metabolic and weight trajectory both for women and their offspring.

Perinatal psychiatric disorders: an overview

Perinatal mental illness has a significant implication on maternal health, birth outcomes, and the offspring's development. Prevalence estimates of perinatal psychiatric illnesses range widely, with substantial heterogeneity in different population studies, with a lower prevalence rate in high- rather than low- or middle-income countries. Because of the potential negative impact on maternal and child outcomes and the potential lability of these disorders, the perinatal period is a critical time to identify psychiatric illnesses. Thus, obstetricians and midwives play a crucial role in assessing women's mental health needs and to refer identified women promptly for multidisciplinary specialist assessment. However, there is still limited evidence on best practice assessment and management policies during pregnancy and postpartum. This review focuses on the prevalence of common perinatal mental disorders and antenatal screening policies to identify women at risk. The effect of these conditions and their management on pregnancy, fetal outcomes, and child development are discussed.

Exercise During Pregnancy Attenuates Prenatal Depression

Recent studies have estimated the prevalence of depression during pregnancy to be between 10% and 30%, which is higher than that in the postpartum period. Pharmacological treatment during pregnancy is difficult because of the possible side effects of antidepressants on the mother and the fetus. The aim of this study was to examine whether a supervised exercise program (EP) reduces depressive symptoms in pregnant women. A randomized controlled trial was designed. One hundred eighty four healthy pregnant women from Fuenlabrada Hospital were included (31.37 ± 3.62 years). Women from the exercise group (EG) participated in a supervised EP consisting of three, 55- to 60-min sessions per week throughout pregnancy. The main outcome measure was the patients’ depression level assessed by means of the Center for Epidemiologic Studies Depression Scale (CES-D). A total of 167 pregnant women were analyzed; 90 were allocated to the EG and 77 to the control group (CG). Significant differences were found between groups at the end of the study in CES-D scores (EG: 7.67 ± 6.30 vs. CG: 11.34 ± 9.74, p = .005) and in percentages of pregnant women depressed (EG: n = 11/12.2% vs. CG: n = 19/24.7%, p = .04). Our results show that supervised physical exercise during pregnancy reduces the level of depression and its incidence in pregnant women.

A prospective cohort study of antipsychotic medications in pregnancy: the first 147 pregnancies and 100 one year old babies

BACKGROUND

Many women diagnosed with varying psychiatric disorders take antipsychotic medications during pregnancy. The safety of antipsychotic medications in pregnancy is largely unknown.

METHODS

We established the National Register of Antipsychotic Medications in Pregnancy in 2005. Women who are pregnant and taking an antipsychotic medication are interviewed every 6 weeks during pregnancy and then followed until their babies are one year old. The baby's progress is closely followed for the first year of life.

FINDINGS

As of April 18 2012, 147 pregnancies had been followed through to completion. There were 142 live births and data is available for 100 one year old babies. 18% of babies were born preterm, with a higher dose of antipsychotic medication correlating to an increased likelihood of premature delivery; 43% of babies required special care nursery or intensive care after birth; 37% had any degree of respiratory distress and 15% of babies developed withdrawal symptoms. Congenital anomalies were seen in eight babies. Most pregnancies resulted in the birth of live, healthy babies. The use of mood stabilisers or higher doses of antipsychotics during pregnancy increased the likelihood of babies experiencing respiratory distress or admission to Special Care Nursery or Neonatal Intensive Care Units.

CONCLUSION

There is a great need for safety and efficacy information about the use of antipsychotic medications in pregnancy. Live, healthy babies are the most common outcome following the use of antipsychotic medication in pregnancy, but clinicians should be particularly mindful of neonatal problems such as respiratory distress.

The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms

Perinatal depression impacts maternal and child health, and little is known about effective interventions. The effects of prenatal Hatha yoga on cortisol, affect and depressive symptoms were investigated in 51 women. Twice during pregnancy, yoga group participants reported on affect and provided a saliva sample before and after a 90-min prenatal Hatha yoga session. Corresponding measures were obtained from yoga and control group participants on days of usual activity. Depressive symptoms were assessed in pregnancy and post partum. Cortisol was lower (p < .01) and positive affect higher (p < .001) on yoga compared to usual activity days. Negative affect and contentment (p < .05) improved more in response to the yoga session. Yoga group participants showed fewer postpartum (p < .05) but not antepartum depressive symptoms than control group participants. Findings indicate that prenatal Hatha yoga may improve current mood and may be effective in reducing postpartum depressive symptoms.

Cross-cultural validity of the Spanish version of PHQ-9 among pregnant Peruvian women: a Rasch item response theory analysis

OBJECTIVE

We sought to evaluate the validity of the Spanish language version of the patient health questionnaire-9 (PHQ-9) depression scale in a large sample of pregnant Peruvian women using Rasch item response theory (IRT) approaches. We further sought to examine the appropriateness of the response formats, reliability and potential differential item functioning (DIF) by maternal age, educational attainment and employment status.

METHODS

This cross-sectional study was conducted among 1520 pregnant women in Lima, Peru. A structured interview was used to collect information on demographic characteristics and PHQ-9 items. Data from the PHQ-9 were fitted to the Rasch IRT model and tested for appropriate category ordering, the assumptions of unidimensionality and local independence, item fit, reliability and presence of DIF.

RESULTS

The Spanish language version of PHQ-9 demonstrated unidimensionality, local independence, and acceptable fit for the Rasch IRT model. However, we detected disordered response categories for the original four response categories. After collapsing "more than half the days" and "nearly every day", the response categories ordered properly and the PHQ-9 fit the Rasch IRT model. The PHQ-9 had moderate internal consistency (person separation index, PSI=0.72). Additionally, the items of PHQ-9 were free of DIF with regard to age, educational attainment, and employment status.

CONCLUSIONS

The Spanish language version of the PHQ-9 was shown to have item properties of an effective screening instrument. Collapsing rating scale categories and reconstructing three-point Likert scale for all items improved the fit of the instrument. Future studies are warranted to establish new cutoff scores and criterion validity of the three-point Likert scale response options for the Spanish language version of the PHQ-9.

Smoking patterns, depression, and sociodemographic variables among Flemish women during pregnancy and the postpartum period

BACKGROUND

Relationships among feelings of depression, smoking behavior, and educational level during pregnancy have been documented. Feelings of depression may contribute to persistent smoking during pregnancy. No longitudinal studies assessing feelings of depression in women with different antepartum and postpartum smoking patterns are available.

OBJECTIVES

The aim was to determine relationships between depressive symptoms, sociodemographic characteristics, and smoking pattern during and after pregnancy.

METHODS

An observational, prospective, noninterventional study was conducted. Data were collected during two stages of pregnancy (T0: <;16 weeks and T1: 32-34 weeks) and postpartum (T2: >6 weeks) in 523 Flemish women. Feelings of depression (measured using the Beck Depression Inventory [BDI]), smoking behavior, and sociodemographic variables were analyzed using a general linear mixed model implemented in SAS Proc MIXED.

RESULTS

Smokers and initial smokers reported significantly more depressive symptoms at all time points compared with recent ex-smokers, nonsmokers, and initial nonsmokers (p <; .001). The three-way interaction among time point, smoking pattern, and educational level was significant (p = .02). Evolution of mean BDI over time differed by educational level. Among participants with a secondary school certificate or less, differences were observed between smokers and nonsmokers, recent ex-smokers and initial nonsmokers, and nonsmokers and initial nonsmokers. Among participants with a college or university degree, no differences were observed.

DISCUSSION

A wide variety of smoking patterns were observed during pregnancy and early postpartum. Smoking patterns were associated with depression and showed complex interactions with educational level. Assessment and intervention for both smoking and depression are needed throughout the perinatal period to support the health of mothers, their infants, and families.

Views and experiences of suicidal ideation during pregnancy and the postpartum: findings from interviews with maternal care clinic patients

INTRODUCTION

Perinatal suicidality (i.e., thoughts of death, suicide attempts, or self-harm during the period immediately before and up to 12 months after the birth of a child) is a significant public health concern. Few investigations have examined the patients' own views and experiences of maternal suicidal ideation.

METHODS

Between April and October 2010, researchers identified 14 patient participants at a single university-based medical center for a follow-up, semi-structured interview if they screened positive for suicidal ideation on the Patient Health Questionnaire-9 (PHQ-9) short form. In-depth interviews followed a semi-structured interview guide. Researchers transcribed all interviews verbatim and analyzed transcripts using thematic network analysis.

RESULTS

Participants described the experience of suicidality during pregnancy as related to somatic symptoms, past diagnoses, infanticide, family psychiatric history (e.g., completed suicides and family member attempts), and pregnancy complications. The network of themes included the perinatal experience, patient descriptions of changes in mood symptoms, illustrations of situational coping, and reported mental health service use.

IMPLICATIONS

The interview themes suggested that in this small sample, pregnancy represented a critical time period to screen for suicide and to establish treatment for the mothers in the study. These findings may assist health care professionals in the development of interventions designed to identify, assess, and prevent suicidality among perinatal women.

Antenatal depression in a multi-ethnic, community sample of Canadian immigrants: psychosocial correlates and hypothalamic-pituitary-adrenal axis function

OBJECTIVES

Immigrant women living in Canada present with higher rates of prenatal depressive symptomatology than Canadian-born women; however, the associated psychosocial correlates remain understudied. Antenatal depression and stress negatively affect maternal health and infant development, in part through changes in maternal hypothalamic-pituitary-adrenal (HPA) axis activity. We aimed to examine the factors associated with prenatal depressive symptoms, including altered HPA axis function, in an ethnically diverse community sample of Canadian immigrant women.

METHODS

Seventy-eight pregnant immigrant women were recruited from the community at 19 weeks' gestation and provided information on health, mood, stressful life events (SLEs), and social support. Fifty-seven of these women also provided saliva samples for measurement of the cortisol awakening response and nighttime cortisol levels.

RESULTS

Seventeen per cent of the sample had a high level of prenatal depressive symptoms, and these women reported more perceived stress, more somatic symptoms, lower social support, and were less often working or attending school during pregnancy. Controlling for wake time, parity, and region of origin, high levels of prenatal depressive symptoms were associated with elevated nighttime cortisol levels, whereas SLEs were not associated with any measures of HPA axis activity.

CONCLUSIONS

High levels of prenatal depressive symptoms are common in immigrant women living in Canada, and are associated with identifiable factors. Preliminary evidence suggests a similar pattern of HPA axis activity characterizing depressive symptomatology in this subpopulation as previously seen in clinically depressed patients.

Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women

BACKGROUND

The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women.

METHOD

Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants.

RESULTS

A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n=382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR]=1.81, p=0.005). Women reporting substance use problems (OR=2.37, p<0.0001) and IPV (OR=3.98, p<0.0001) had higher odds for depressive symptoms.

CONCLUSION

In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues.

Coping strategies as psychological risk factor for antenatal anxiety, worries, and depression among Greek women

A range of psychosocial, medical, and demographic variables may influence pregnant women's psychological status. However the association between coping strategies, anxiety, worries, and depression during pregnancy is a relatively neglected area of research. Therefore, the aim of this study was to examine the relationship between coping strategies, antenatal anxiety, pregnancy worries, and depressive symptomatology after controlling for the effects of background variables. The study sample consisted of 163 pregnant women, with gestational age ranging from 11 to 26 weeks, attending antenatal screening at a Greek public hospital. Coping strategies were measured with Brief COPE, pregnancy worries were measured with Cambridge Worry Scale (CWS), anxiety was assessed using State-Trait Anxiety Inventory (STAI-X version), and depression was measured with Center for Epidemiologic Studies-Depression scale (CES-D). Pearson's correlation coefficients were calculated among all study variables, followed by hierarchical multiple linear regression. In the univariate analysis, low annual income, unemployment, conception after an IVF treatment, and a previous history of miscarriage were associated with anxiety, depression, and worries. Additionally, almost all coping strategies (denial, behavioral disengagement, self-blame, self-distraction, substance use, acceptance, positive reframing, active coping, and seeking emotional support) were significantly associated with antenatal anxiety, worries, and depression. Linear regression analysis showed that only previous history of miscarriage, conception after IVF, as well as denial, behavioral disengagement and acceptance coping strategies were significantly related to anxiety, worries and depressive symptomatology. The risk factors found in this study could help clinicians target anxiety and depression screening to high-risk populations of pregnant women. Provision of adequate training for obstetricians and midwives in the detection and management of anxiety and depression among pregnant women should help to decrease the psychological burden during pregnancy.

From antenatal to postnatal depression: associated factors and mitigating influences

INTRODUCTION

Postnatal depression has a serious impact on new mothers and their children and families. Risk factors identified include a history of depression, multiparity, and young age. The study aimed to investigate factors associated with experiencing antenatal depression and developing subsequent postnatal depression.

METHODS

The study utilized survey data from 5332 women about their experience and well-being during pregnancy, in labor, and postnatally up to 3 months. Prespecified sociodemographic and clinical variables were tabulated against the incidence of antenatal depression and postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables.

RESULTS

Risk factors for antenatal depression were multiparity, black and minority ethnic (BME) status, physical or mental health problems, living in a deprived area, and unplanned pregnancy. Different factors for postnatal depression were evident among women who had experienced antenatal depression: multiparity and BME status were protective, whereas being left alone in labor and experiencing poor postnatal health increased the risk of postnatal depression.

CONCLUSION

This study confirms previous research on risk factors for antenatal depression and stresses the importance of continuous support in labor and vigilance in the postnatal period regarding the potential ill effects of continuing postnatal health problems.