Antenatal depressive symptoms among pregnant women: Evidence from a Southern Brazilian population-based cohort study

Noncoding RNAs and their influence on maternal mental health: insights into perinatal depression: a review

Perinatal depression profoundly influences the psychological and physiological well-being of women both during and after pregnancy. This condition encompasses depressive symptoms that manifest as antenatal as well as postnatal depression. Noncoding RNAs (ncRNAs), including microRNAs (miRNAs), long noncoding RNAs (lncRNAs), and circular RNAs (circRNAs), are integral to various cellular processes and have been implicated in the pathophysiology of perinatal depression. These ncRNAs are involved in the regulation of gene expression, maintenance of neuronal function, and modulation of stress responses. Dysregulation of ncRNAs, particularly lncRNAs and miRNAs, has been associated with psychiatric disorders, including perinatal depression. This review explores the classification and functions of ncRNAs, their biological roles, and the evidence linking them to perinatal depression. The investigation of ncRNAs in the context of perinatal depression holds promise for the development of novel therapeutic strategies and the enhancement of health outcomes for both mothers and their children. Future research should prioritize the standardization of methodologies and approaches in this field.

Trajectories of maternal depression, anxiety, stress, and child developmental milestones at 24 months

Background: Literature suggests a link between maternal mental health and adverse child developmental outcomes. However, we do not know to what extent this is true in low and middle-income settings, and most studies do not explore mental health longitudinally since birth.Objective: We aimed to assess the association between maternal mental health and early child development outcomes in southern Brazil.Methods: We studied 992 mother-child pairs in a birth cohort from 2019 to 2022. We used standardised instruments to assess maternal depression, anxiety, and distress at different time points during the perinatal period. We used Group Based Trajectory Modelling to create maternal mental health trajectories. We assessed these trajectories associated with the child's social, language, cognitive, and motor development at 24 months using Poisson multiple regression models.Results: Children of mothers with elevated symptoms of depression experienced an 80% [RR = 1.80; 95%CI(1.19-2.71)] increase in language delays, 23% [RR = 1.23; 95%CI(1.01-1.51)] in cognitive delays, and 40% [RR = 1.40; 95%CI(1.07-1.83)] in motor delays. Children of mothers experiencing increasing symptoms of anxiety to moderate levels had 38% [RR = 1.38' 95%CI(1.07-1.82)] more language delays and 20% [RR = 1.20; 95%CI(1.05-1.38)] more cognitive delays. Low subjective distress led to 54% [RR = 1.54; 95%CI(1.15-2.05)] more language delays.Conclusion: Our findings underscore the effect of maternal mental health on child developmental outcomes among this sample in southern Brazil.

Trends in the prevalence of antenatal depression and social support among pregnant women in China, 2016-2021: A repeated cross-sectional study

OBJECTIVES

To evaluate temporal trends and associations between social support and antenatal depression among women in late pregnancy.

STUDY DESIGN

A repeated cross-sectional design was used. A total of 3404 pregnant women at their 30-42 weeks of pregnancy were recruited from the two largest maternity hospitals in Zhejiang Province, China between 2016 and 2021.

METHODS

The primary outcome was the prevalence of antenatal depression, and it was measured by the Chinese version of the Edinburgh Postnatal Depression Scale. We also assessed the level of social support, including support from family members, support from friends, and support from significant others of social support.

RESULTS

From 2016 to 2021, the prevalence of antenatal depression among women in late pregnancy had increased significantly from 31.82 % to 60.59 % (p < 0.001 for trend). In the meantime, level of social support had decreased significantly (p < 0.001 for trend). Logistic regression results suggested that those with higher levels of social support tended to report lower rates of antenatal depression.

CONCLUSIONS

There was an increasing trend of antenatal depression among pregnant women in China between 2016 and 2021, along with a decreasing trend of social support.

Outcomes of antenatal depression in women and the new-born: a retrospective cohort study

OBJECTIVE

To determine what effect maternal antenatal depression has on pregnancy and infant outcomes in the Lleida health region.

METHODS

Retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Variables included age, body mass index, caesarean section, pre-eclampsia, birth weight, and Apgar score. We performed multivariate analysis, with linear regression coefficients and 95% confidence interval (CI).

RESULTS

Antenatal depression was diagnosed in 2.54% pregnant women from a total sample of 17 177. Depression is significantly associated with a higher risk pregnancy and low birth weight. Pre-eclampsia, 1-minute Apgar score, and caesarean section were not significantly associated with depression.

CONCLUSIONS

Antenatal depression increases the risk of pregnancy complications. In addition, depression in the mother increases the probability of low birth weight.

Associations of multiple risk factors with prenatal depression and anxiety: Evidence from the Tianjin Birth Cohort (TJBC) study

BACKGROUND

Antenatal mental disorders are associated with maternal and fetal adverse events. Previous studies have been focused on the postpartum period, rather than pregnancy, yet the association of risk factors with prenatal depression and anxiety through pregnancy has been rarely reported. This study aimed to identify the risk factors of prenatal depression and anxiety, and access their potential roles in developing mental disorders during pregnancy.

METHODS

This is a prospective study in 6470 participants from the Tianjin Birth Cohort in China (TJBC). The degree of prenatal depression and anxiety was evaluated using a questionnaire of Self-Rating Depression scale (SDS) and Self-Rating Anxiety Scale (SAS), which was given to pregnant women at 15-27 (Stage-2), and 28-41 (Stage-3) gestational weeks. The questionnaire also collected demographic, personal, and lifestyle information. The association of different factors with SDS/SAS score was examined by logistic regression analysis.

RESULTS

We observed an overall depression rate of 12.4 % and an overall anxiety rate of 7.7 % during pregnancy in the TJBC. In the Stage-2, the depression rate was 14.5 % and the anxiety rate was 9.5 %. In the Stage-3, the depression rate dropped to 9.7 % while the anxiety rate dropped to 5.3 %. With univariate analysis, we found that age, education, social support, marriage satisfaction, secondhand smoke (SHS), sleeping time and stress were common factors of prenatal mental health. Working status, family income, gravidity, smoking, electronic using, recreational activities were associated with depression risk, whereas BMI, disease history, changing eating habits, and feeding animal were associated with anxiety risk. Using logistic regression, we found that low education level, low social support, low marriage satisfaction, thyroid disfunction, Stage-2(second trimester), and stress were related to prenatal mental health.

CONCLUSION

The prevalence anxiety and depression in Tianjin is normal as national level. Age appropriateness, a good education level, sufficient social support, marital satisfaction, normal thyroid function, and absence of stress are associated with relieving depression and anxiety during gestation. However, due to individual difference, expectant mothers should seek professional support and guidance to address their mental health needs during gestation.

Risk factors of the antenatal depression in a sample of Italian pregnant women: a preliminary study

BACKGROUND

Antenatal depression is characterized by low mood, insomnia, disorganised behaviour, irritability, and agitation during the pregnancy. If underestimated, antenatal depression is untreated during the pregnancy. It is associated to higher levels of suicide, higher risk of depression after childbirth, preeclampsia, preterm birth, low birth weight, poor interactions between child and mother and severe obstetric outcomes. New data underlined the importance to prevent the risk of depression during the pregnancy. This study examines the predictive validity of potential risk factors, such as socio-demographic and psychological factors, in developing the antenatal depression.

METHODS

The sample was composed by Italian pregnant women (N = 247, mean age of 33.77, SD = 4.78 years). This sample completed the Edinburg Postnatal Depression Scale (EPDS), the Teate Depression Inventory (TDI) and questionnaires about demographic variables. To study associations among variables examined bivariate correlations were computed. To analyse the role of socio-demographic factors and the psychological dimension to predict the severity of the antenatal depression a logistic regression was performed.

RESULTS

Results showed significantly positive correlations between the EPDS and the TDI, and no associations among the EPDS and all socio-demographic factors. Therefore, only the psychological factors were significant predictive risk factors of antenatal period. Finally, higher score of the depression measured via TDI predicted higher score of the EPDS.

CONCLUSIONS

Our results had implications in clinical field. Indeed, the early diagnosis of depression during the pregnancy can help operators in the gynaecological field to prevent the depression in the post-partum period.

Exploring prenatal depression and postpartum depression: Findings from a prospective cohort study at University Hospital Obstetrics in Damascus

The perinatal period is crucial for both mother and newborn, and mental health, including prenatal and postpartum depression (PPD), is a significant aspect. Screening for these disorders allows for early treatment and helps prevent risks to both mother and child. This prospective cohort study was carried out at University Hospital Obstetrics in Damascus City. The first phase was during the third trimester of pregnancy and the second phase involved a follow-up assessment after 6 weeks of delivery. The Arabic-validated version of the Edinburgh Postnatal Depression Scale questionnaire (EPDS) was used. A cutoff of 13 or higher was used to determine the presence of probable depression in both assessments. Of 347 pregnant women, 38.6% had prenatal depression (PND). 295 patients have achieved the second assessment, of which 30.2% had PPD. Furthermore, 42.6% who had PND developed PPD on follow-up. Binary logistic regression indicated that PND was predicted by non-Syrian nationality, paternal absence, poor financial status, number of previous pregnancies, and a history of depression independent of pregnancy. PPD was predicted by a history of PPD, and work status. Findings underscore potential value of early screening for depressive symptoms as a predictive measure. It is recommended that women with a history of depression receive heightened attention and care, irrespective of the timing of their depressive episodes.

Association between childhood trauma and postpartum depression among Brazilian puerperal women

OBJECTIVE

to evaluate the association between different forms of childhood trauma and postpartum depression in Brazilian puerperal women.

METHOD

this cross-sectional survey included 253 puerperal women who were evaluated using the Edinburgh Postnatal Depression Scale and the Childhood Trauma Questionnaire. Multivariate logistic regression analyses were performed to verify the association of different types of trauma and the co-occurrence of forms of abuse and neglect with postpartum depression.

RESULTS

postpartum depression was identified in 93 women (36.8%; 95% Confidence Interval: 30.8-42.7). All forms of childhood trauma assessed (emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse) were independently associated with postpartum depression after adjusting for confounding variables. Emotional abuse remained associated with postpartum depression when the co-occurrence of all forms of childhood trauma was analyzed.

CONCLUSION

the results suggest an association between the different forms of childhood trauma and postpartum depression. In this sense, childhood trauma is an indicator for Nursing professionals to screen for risk factors of postpartum depression during obstetric_follow-up.

Depression during pregnancy and associated factors among women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Pregnancy is one of the most remarkable experiences in a woman's life. Prenatal depression, characterized by stress and worry associated with pregnancy, can reach severe levels. On a global scale, mental and addictive disorders affect more than one billion people, causing 19% of years lived with disability. It is estimated that 25-35% of pregnant women experience depressive symptoms, with 20% meeting the diagnostic criteria for major depression.

METHODS

A systematic review and meta-analysis were conducted to examine depression during pregnancy in Ethiopia. The search was conducted from March 1-31, 2023. Data extraction used Microsoft Excel, and analysis was performed using STATA version 17. The New Castle-Ottawa Scale quality assessment tool was employed to evaluate the methodological quality of included studies. The Cochrane Q test and I2 statistics were used to assess heterogeneity. A weighted inverse variance random-effects model estimated the pooled level of antenatal depression (APD). Publication bias was detected using a funnel plot and Begg's and Egger's tests.

RESULTS

Out of 350 studies searched, 18 were included in the analysis. The overall pooled prevalence of depression in Ethiopia was 27.85% (95% CI: 23.75-31.96). Harari region reported the highest prevalence (37.44%), while Amhara region had the lowest (23.10%). Factors significantly associated with depression included unplanned pregnancies, low social support, low income, previous history of depression, intimate partner violence, and history of abortion.

CONCLUSION

This systematic review and meta-analysis demonstrate that approximately one-quarter of pregnant women in Ethiopia experience depression during pregnancy. Unplanned pregnancy, low social support, low income, previous history of depression, history of abortion, and intimate partner violence are determinants of depression. To address this high prevalence, the Ethiopian government and stakeholders should develop policies that incorporate counseling during pregnancy follow-ups. Improving the quality of life for pregnant women is crucial for the well-being of families, communities, and the nation as a whole.

Sleep quality and perinatal depression in pregnant women treated in a primary care centre in Lima, Peru

OBJECTIVE

The aim is to evaluate the association between sleep quality and perinatal depression in pregnant women between the 12th week of gestation and the 36th week of gestation in a maternity and child centre in Lima.

METHODS

Analytical cross-sectional study in pregnant women cared for in a primary care centre between August and December 2019. The data were collected through a self-administered survey. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The evaluation of perinatal depression was performed with the Edinburgh Postnatal Depression Scale (EPDS). For the multivariate analysis, Poisson regression with robust variances was used to calculate the crude and adjusted prevalence ratios and their respective confidence intervals.

RESULTS

The sample was composed of 200 participants. The median [IQR] age was 26 [22-32] years, and 111 (55.5%) pregnancies were unplanned. 52% presented a poor quality of sleep and the risk of perinatal depression was 31.5%. Poor quality of sleep was associated with a significantly higher frequency of perinatal depression (aPR = 4.8 for those with poor quality of sleep warranting medical attention, and aPR = 6.6 for those with poor quality of sleep warranting medical attention and treatment).

CONCLUSIONS

There is a possible association between poor sleep quality and perinatal depression in pregnant women between weeks 12 and 36 of gestation. Operational research should be promoted to assess whether interventions to improve sleep quality could have a positive impact on reducing perinatal depression.

Prevalence and Risk Factors of Depression and Anxiety among Women in the Last Trimester of Pregnancy: A Cross-Sectional Study

Pregnancy represents a psychologically and emotionally vulnerable period, and research indicates that pregnant women have a higher prevalence of symptoms of anxiety and depression, debunking the myth that hormonal changes associated with pregnancy protect the mother. In recent years, several researchers have focused on the study of prenatal anxiety/depression-emotional disorders manifested by mood lability and low interest in activities-with a high prevalence. The main objective of this research was to conduct an antenatal screening in a cohort of pregnant women hospitalized for delivery in order to assess the prevalence of anxiety and depression. The secondary objective was to identify the risk factors associated with depression and anxiety in women in the third trimester of pregnancy. We carried out a prospective study in which we evaluated 215 pregnant women in the third trimester of pregnancy hospitalized for childbirth at the Obstetrics and Gynecology Clinic of the Târgu-Mureș County Clinical Hospital. The research was carried out between December 2019 and December 2021. The results showed that age and the environment of origin are the strongest predictors of mental health during pregnancy (OR = 0.904, 95%CI: 0.826-0.991; p = 0.029). For women from urban areas, there is an increased probability of falling at a higher level on the dependent variable (moderate depression) (OR = 2.454, 95%CI: 1.086-5.545; p = 0.032). In terms of health behaviors, none of the variables were statistically significant predictors of the outcome variable. The study highlights the importance of monitoring mental health during pregnancy and identifying relevant risk factors to provide appropriate care to pregnant women and the need for interventions to support the mental health of pregnant women. Especially in Romania, where there is no antenatal or postnatal screening for depression or other mental health conditions, these results could be used to encourage the implementation of such screening programs and appropriate interventions.

Progesterone and Its Metabolites Play a Beneficial Role in Affect Regulation in the Female Brain

Premenstrual dysphoric disorder is a female affective disorder that is defined by mood symptoms. The condition is linked to unstable progesterone concentrations. Progestin supplementation is given in cases of threatened or recurrent miscarriage and for luteal phase support. Progesterone is essential for implantation, immune tolerance, and modulation of uterine contractility. For a long time, the administration of progestins was associated with an unfavorable impact on mood, leading to negative affect, and, therefore, was contraindicated in existing mood disorders. Establishing the role of the natural progesterone derivative allopregnanolone in advances in the treatment of postpartum depression has shed new light on the general pathophysiology of mood disorders. Allopregnanolone directly interacts with gamma-aminobutyric acid type A (GABA-A) receptors even at nanomolar concentrations and induces significant anti-depressant, anti-stress, sedative, and anxiolytic effects. Postpartum depression is caused by a rapid drop in hormones and can be instantly reversed by the administration of allopregnanolone. Premenstrual dysphoric disorder can also be considered to result from insufficient neuroactive steroid action due to low progesterone derivative concentration, unstable hormone levels, or decreased receptor sensitivity. The decrease in progesterone levels in perimenopause is also associated with affective symptoms and an exacerbation of some psychosomatic syndromes. Bioidentical progesterone supplementation encounters several obstacles, including limited absorption, first-pass effect, and rapid metabolism. Hence, non-bioidentical progestins with better bioavailability were widely applied. The paradoxical, unfavorable effect of progestins on mood can be explained by the fact that progestins suppress ovulation and disturb the endocrine function of the ovary in the luteal phase. Moreover, their distinct chemical structure prevents their metabolism to neuroactive, mood-improving derivatives. A new understanding of progesterone-related mood disorders can translate the study results from case series and observational studies to cohort studies, clinical trials, and novel, effective treatment protocols being developed.

Increased depressive-like behaviour of postpartum Flinders sensitive and resistant line rats is reversed by a predictable postpartum stressor

During the peripartum period, women are at an increased risk to develop perinatal distress, presenting as symptoms of depression and/or anxiety. Yet, due to practical and ethical restrictions, our understanding of this condition remains limited. Animal studies that focus on the neuropsychiatric mechanisms associated with the postpartum period, often ignore the genetical predisposition factor. We therefore investigated whether pregnancy could alter the bio-behavioural profile of the Flinders sensitive and resistant line rats, and whether these effects are exacerbated by a postpartum stressor. Postpartum dams were compared to nulliparous controls in behavioural tests, analysing depressive- and anxiety-like behaviours. Next, postpartum dams were subjected to a maternal separation and early weaning (MSEW) regimen, with their behaviour and serotonergic and noradrenergic concentrations compared to rats not separated from their pups. Regardless of strain, pregnancy decreased time spent in the open arms of the elevated plus maze and hippocampal serotonin concentrations. Time spent immobile in the forced swim test was also increased, with a significant effect in the FRL and a strong trend in the FSL rats. MSEW reversed these behaviours in both strains and increased social interaction with a male counterpart in the FSL rats, without influencing hippocampal or cortical serotonin or norepinephrine. Taken together, these results suggest that pregnancy influences postpartum behaviour, in a strain-dependent manner. Contrary to what we expected, MSEW overall decreased depressive- and anxiety-like behaviours, with strain specific differences, indicating that a chronic, predictable stressor may not necessarily adversely affect postpartum behaviour.

The lifetime costs of perinatal depression and anxiety in Brazil

BACKGROUND

Each year, an estimated 860,000 Brazilian women experience depression and anxiety perinatally. Despite well-known devastating impacts of these conditions on mothers and children, they remain neglected in low- and middle-income countries. Knowing the costs of untreated perinatal depression and anxiety can inform decision-making.

METHODS

Simulation modelling is used to examine lifetime costs of perinatal depression and anxiety for a hypothetical cohort of women and their children, followed until children are aged 40 years. Costs are measured from a societal perspective, including healthcare expenditure, productivity and health-related quality of life losses; 2017 data are taken from country-specific sources. Present values are calculated using a discount rate of 3 %.

RESULTS

Lifetime cost of perinatal depression and anxiety in Brazil are USD 4.86 billion or R$ 26.16 billion, including costs linked to poorer quality of life (USD 2.65 billion), productivity loss (USD 2.16 billion) and hospital care (USD 0.05 billion). When the costs associated with maternal suicide are included, total costs increase to USD 4.93 billion.

LIMITATIONS

Several costs could not be included in the analysis because of a lack of data. The study is reliant of longitudinal data on associations between perinatal depression and anxiety and impacts on mothers and children. Therefore, no causality can be inferred.

CONCLUSION

Our findings illustrate the economic rationale for investment in this area. This is the first study that estimates the costs of perinatal mental health problems in a low- or middle-income country setting.

Prevalence of and sociodemographic factors associated with antenatal depression among women in Limpopo Province, South Africa

Background. Pregnancy-related depression is a common psychiatric disorder and a major public health concern in both developed and developing countries, but the disorder receives little attention and few resources, particularly in developing countries.Objectives. To assess the prevalence of antenatal depression and its sociodemographic risk factors among pregnant women in Limpopo Province, South Africa.Methods. This was a cross-sectional descriptive study conducted in a district hospital from 8 March to 12 April 2021. Consecutive women attending antenatal care services during the data collection period were included in the study. The Edinburgh Postnatal Depression Scale was used to assess depression symptoms.Results. The prevalence of antenatal depression was 31% (95% confidence interval 26.1 - 36.3). Being unmarried, being a smoker, being without financial support from a partner, having a violent partner and having a less-educated partner were significant predictors of antenatal depression in these women.Conclusion. Nearly one-third of the pregnant women in our study had depressive symptoms. The important predictors of antenataldepression included being unmarried, smoking, lack of financial support from a partner, intimate partner violence and having a lesseducated partner. These findings may help healthcare workers to identify women at risk early, so that support can be offered during pregnancy and childbirth.

Impact of an Early Childhood Development Intervention on the Mental Health of Female Caregivers: Evidence from a Randomized Controlled Trial

Investing in early childhood development is an effective way to enhance human capital accumulation. Caregivers' mental health is one of the most important factors influencing children's development. Previous studies have found that mental health issues in caregivers are widespread all over the world, especially in low- and middle-income countries. In this study, we explored the effects of the "Integrated Program for Early Childhood Development" on the mental health of female caregivers in Southwest China through a randomized intervention trial, with infants aged 5-25 months and their caregivers as the target subjects. The heterogeneity of the effects of different characteristics of the caregivers and the mechanism of the intervention effect were also analyzed. Primary caregivers were provided comprehensive early development interventions for the children in the treatment group via bi-weekly home visiting activities and monthly family group activities. The results showed that the prevalence of depression, anxiety, and stress symptoms among female caregivers in this rural area were 32%, 42%, and 30%, respectively. Whether the child was breastfed, parent's age, parent's education level, primary caregiver type, the ratio of the number of months the mother was at home full time to the child's age, the grandmother's rearing ability, and the family asset index were the factors influencing the mental health of female caregivers. The intervention significantly increased the proportion of depressive symptoms in 28% of the grandmothers. It significantly reduced the anxiety symptoms of daughters-in-law not from the local town, while the social interactions of both local and non-local daughters-in-law were significantly improved.

Psychological Stress Perceived by Pregnant Women in the Last Trimester of Pregnancy

Pregnancy is characterized by changes in neuroendocrine, cardiovascular, and immune function. For this reason, pregnancy itself is perceived as a psychological “stress test”. Research to date has focused on stress exposure. The aim of the study was to evaluate the influence of associated factors on the level of stress experienced by pregnant patients. We conducted a prospective study that included 215 pregnant women in the third trimester of pregnancy, hospitalized in the Obstetrics and Gynecology Clinic II in Târgu-Mureș, between December 2019 and December 2021, who were evaluated by the ABS II scale. All patients included in the study filled in a questionnaire that included 76 questions/items, in which all the data necessary for the study were recorded. The results obtained from the study showed that pregnant women in urban areas (53.49%) are more vulnerable than those in rural areas (46.51%), being influenced by social and professional stressors, social determinants playing a critical role in pregnancy and in the newborn. Patients who have had an imminent abortion in their current pregnancy have a significantly higher score of irrationality than those with normal pregnancy, which shows that their emotional state can negatively influence the phenomenon of irrationality. There is a statistically significant association between pregnancy type I (normal pregnancy or imminent pregnancy) and irrationality class (p = 0.0001; RR: 2.150, CI (95%): 1.154−4.007). In the case of women with desired pregnancies, the risk of developing irrationality class IV−V is 4.739 times higher, with the association being statistically significant (p < 0.0001; RR 4.739; CI (95%): 2.144−10.476). The analysis of the obtained results demonstrates the importance of contributing factors and identifies the possibility of stress disorders, occurring in the last trimester of pregnancy, disorders that can have direct effects on maternal and fetal health. We consider it extremely important to carry out evaluations throughout the pregnancy. At the same time, it is necessary to introduce a screening program to provide psychological counseling in the prenatal care of expectant mothers.

Social and obstetric risk factors of antenatal depression: A cross-sectional study from South-India

PURPOSE

Antenatal depression is as prevalent as postpartum depression and studies on it are very few. It has been relatively neglected leading to adverse effects on the growing child as well as the mother. Hence screening of depression in high risk individuals, planning and adopting important strategies for prevention needs to be undertaken. Our study aimed to assess the modifiable social and obstetric risk factors of antenatal depression.

METHODS

Third trimester pregnant women of 18-40 years attending obstetric out-patient department and admitted in tertiary hospitals who had no past psychiatric illness were screened using Edinburgh postnatal depression scale after obtaining written consent, socio-demographic and obstetric details. Statistical analysis was calculated using IBM version SPSS 23.

RESULTS

Among 222 women recruited, 25.6% had antenatal depression. Significant associations were found between lower level of education (p = 0.02,O.R=1.87), urban population (p = 0.04,O.R=5.139), intimate partner violence (p = 0.01,O.R=15.769), daily alcohol use by husband (p < 0.00,O.R=15.281), poor relationship with in-laws (p < 0.000,O.R=21.733) and parents (p < 0.000,O.R=15.281), number of previous pregnancies (p = 0.026,O.R=5.545), parity (p = 0.04,O.R=4.187), previous abortions (p = 0.007,O.R=2.834), fear of labour (p < 0.000,O.R=5.77) and complications during pregnancy (p < 0.000,O.R=3.017) with antenatal depression. Living in urban area (p = 0.023, A.O.R=3.132), fear of labour (p < 0.000, A.O.R=7.398), intimate partner violence (p = 0.026, A.O.R=36.655), poor relationship with in-laws (p = 0.001, A.O.R=36.855) and parents (p = 0.042, A.O.R=8.377) were found to be predictors of antenatal depression.

CONCLUSION

Antenatal depression is multifactorial in origin and requires a multifactorial approach in prevention and treatment. Routine antenatal screening for depression must be conducted with efforts to build strong family, peer and social support at community level.

Association between depressive symptoms and poor sleep quality among pregnant women in Northern Rural Bangladesh: a community-based cross-sectional study

BACKGROUND

Adequate good quality of sleep is essential for physical fitness during pregnancy as well as being a depressive symptoms-free mind. However, there is little evidence of the relationship between depressive symptoms and poor sleep quality among pregnant women in Bangladesh. This study aimed to find the association between depressive symptoms and poor sleep quality among pregnant women in northern rural Bangladesh.

METHODS

A community-based cross-sectional study was carried out from May 2021 to June 2021 among 481 pregnant women tested positive in the pregnancy test of Jaldhaka and Dimla Upazila of Nilphamari district, Rangpur Division. Data were collected with a structured questionnaire including socio-demographic conditions, sleep quality, and depressive symptoms, comprising the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire- 9 (PHQ-9).

RESULTS

8.94% of the women had depressive symptoms, whereas 38.88% of the participants were bad sleepers. However, women who had depressive symptoms [Adjusted odds ratio (AOR) = 2.55; 95% CI 1.33-4.9] and educational qualifications above 10 years [AOR = 0.60; 95% CI: 0.39-0.92] were associated with poor sleep quality.

CONCLUSIONS

A higher percentage of pregnant women had poor sleep quality, whereas depressive symptoms and academic background of the participants were significantly associated with poor sleep quality. Ensuring adequate sleep time and better quality could be helpful to prevent depressive symptoms.

Levels and Predictors of Anxiety and Depression in Turkish Pregnant Woman During the Covid-19 Pandemic

OBJECTIVE

 In addition to being a medical phenomenon, pandemics affect the individual and society on several levels and lead to disruptions. In the pandemic process, different groups in the population, including pregnant women as a defenseless group, are subjected to psychological threat. The present study aimed to determine the levels of anxiety and depression and related factors in pregnant women during the the coronavirus disease 2019 (Covid-19) pandemic.

METHODS

 The present cross-sectional study was conducted with 269 pregnant women through face-to-face interviews held in Istanbul, Turkey. Regarding the data collection tools, the Cronbach α reliability coefficient was of 0.90 for the Beck Anxiety Inventory, and of 0.85 for the Beck Depression Inventory.

RESULTS

 Among the participating pregnant women, 30.5% had mild, 17.5% had moderate, and 5.9% had severe anxiety symptoms, whereas 35.3% had mild, 16.7% had moderate, and 2.2% had severe depression symptoms. We found that those who were concerned about their health had 5.36 times (p = 0.04) more risk of developing anxiety, and 4.82 times (p = 0.01) more risk of developing depression than those who were not concerned. Those who had a history of psychiatric disease had 3.92 times (p = 0.02) more risk of developing anxiety than those without it.

CONCLUSION

 We determined that about half of the pregnant women included in the study had some degree of anxiety and depression during the COVID-19 pandemic. The risk factors for anxiety and depression among the pregnant women were determined as smoking, concerns about health and getting infected with the coronavirus, history of psychiatric disease, and undergoing regular antenatal care.

Depression in pregnancy "strongly predicts" depression postpartum: Are we inadvertently misleading clinicians and researchers?

BACKGROUND

Many perinatal mental health risk factor studies report that antenatal depression is a signifcant risk factor for women being depressed postnatally. They often describe the strength of the risk as being 'strong' or 'strongly predictive' (or similar phrases), though usually without explaining why these terms are used. It is possible that readers of such research may misunderstand these qualitative descriptors.

METHOD

As part of routine teaching regarding risk analyses, we explored participants' understanding of the conclusion stated in one specific perinatal risk study, which was that antenatal depression "strongly predicts" postnatal depression. Participants were groups of mental health professionals and postgraduate students, in Italy (N = 56) and Australia (N = 34).They completed an Estimate Survey, in which they indicated the actual number of antenatally depressed women they expected would have been depressed postpartum, given the study's conclusion.

RESULTS

The majority of survey respondents (~80%) expected that "strongly predicts" meant that a much higher proportion of women with the risk then became depressed than was actually the case. Some participants expressed major concern at the study's conclusion.

LIMITATION

Participants comprised two small convenience samples of health professionals and postgraduate students, and thus may not be representative of the population.

CONCLUSION

Studies that rely on the statistical significance of their analyses to conclude whether antenatal depression is a strong predictor or risk for postnatal depression may not accord with how health professionals interpret the data, once the absolute risk information is clearly provided. Recommendations for improving the reporting of results in such studies are made.

Maternal depressed mood and child development over the first five years of life in South Africa

BACKGROUND

While the negative impact of peri-natal depression is well-documented in high-income countries, the long-term effects across the life course in low and middle-income countries is less clear. Children's adjustment over the first five years is examined as a function of patterns of maternal depressed mood.

METHODS

Pregnant women in 24 peri-urban townships (N = 1,238) were randomized to a home-visiting intervention or standard care and reassessed five times, with high retention. There were no intervention effects on children past 18 months. Multilevel regression models examined the impact of depressed mood on child outcomes. Using the Edinburgh Postnatal Depression Scale, four patterns of maternal depressed mood were identified: never (40.6%); antenatal (13.0%); early childhood (26.1%); and recurrent episodes of depressed mood (20.3 %).

FINDINGS

Mothers' patterns of depressive symptoms and child outcomes were similar, regardless of intervention. Never depressed mothers were significantly younger, had higher income, less food insecurity, were more likely to have electricity, be living with HIV or have an HIV positive partner, and had fewer problems with alcohol than depressed mothers. Children of mothers who experienced depressed mood weighed less, were more aggressive, and were hospitalized more often than children of never depressed mothers, but were similar in cognitive and social development.

INTERPRETATIONS

Depressed mood, has significant negative impacts on South African children's growth and aggressive behavior. The timing of maternal depressed mood was less important than never having a depressed mood or a recurrent depressed mood.

FUNDING

There were no funding conflicts in executing this trial.

Do depressive symptoms among pregnant women assisted in Primary Health Care services increase the risk of prematurity and low birth weight?

Objective:

to investigate associations between depressive symptoms during pregnancy, low birth weight, and prematurity among women with low-risk pregnancies assisted in public Primary Health Care services.

Method:

prospective cohort with 193 pregnant women, using the Edinburgh Postnatal Depression Scale, telephone interviews, and medical records available in the health services. Associations of interest were obtained using the Cox regression model.

Results:

the participants were aged 24.9 years old (median) and had 11 years of schooling (median); 82.4% lived with their partners, and gestational age at the birth was 39 weeks (median). Twenty-five percent of the participants scored ≥13 on the Edinburgh scale. Depressive symptoms did not appear associated with low birth weight (RR=2.06; CI95%=0.56-7.61) or prematurity (RR=0.86; CI95%=0.24-3.09) in the adjusted analysis. However, premature labor increased the risk of low birth weight (RR=4.81; CI95%=1.01-23.0) and prematurity (RR=7.70; CI95%=2.50-23.7). Additionally, each week added to gestational age decreased the risk of low birth weight (RR=0.76; CI95%=0.61-0.95).

Conclusion:

the presence of depressive symptoms among women with low-risk pregnancies was not associated with low birth weight or prematurity.

Sleep Quality and Perinatal Depression in Pregnant Women Treated in a Primary Care Centre in Lima, Peru

OBJECTIVE

The aim is to evaluate the association between sleep quality and perinatal depression in pregnant women between the 12th week of gestation and the 36th week of gestation in a maternity and child centre in Lima.

METHODS

Analytical cross-sectional study in pregnant women cared for in a primary care centre between August and December 2019. The data were collected through a self-administered survey. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The evaluation of perinatal depression was performed with the Edinburgh Postnatal Depression Scale (EPDS). For the multivariate analysis, Poisson regression with robust variances was used to calculate the crude and adjusted prevalence ratios and their respective confidence intervals.

RESULTS

The sample was composed of 200 participants. The median [IQR] age was 26 [22-32] years, and 111 (55.5%) pregnancies were unplanned. 52% presented a poor quality of sleep and the risk of perinatal depression was 31.5%. Poor quality of sleep was associated with a significantly higher frequency of perinatal depression (aPR=4.8 for those with poor quality of sleep warranting medical attention, and aPR=6.6 for those with poor quality of sleep warranting medical attention and treatment).

CONCLUSIONS

There is a possible association between poor sleep quality and perinatal depression in pregnant women between weeks 12 and 36 of gestation. Operational research should be promoted to assess whether interventions to improve sleep quality could have a positive impact on reducing perinatal depression.

The Experience of Healthy Pregnancy in High Parity Women: A Phenomenological Study in North Jordan

Background and Objectives: High parity women are more likely to have poor quality of life during pregnancy than low parity women. Thus, the aim of this study was to explore the lived experience of healthy pregnancy among high parity women in North Jordan. Materials and Methods: A descriptive phenomenological design was employed in this study to complement previously published quantitative results. Fourteen pregnant women, who had four children or more, were recruited purposely according to inclusion criteria from Irbid city in North Jordan. Data were collected using face-to-face, semi-structured interviews. Colaizzi's method was employed to analyze the verbatim data. Results: There were three main themes which emerged from participants significant statements: they had new discomforts, antenatal care and follow-up, and social issues. Each extracted theme was linked to some factors (subthemes), which had a positive or negative impact on the quality of life of high parity women during pregnancy. High parity women who experienced multiple stressors had a poor quality of life. Conclusions: Experiencing new discomforts, less or no antenatal care, and a lack of social support negatively affected the quality of life among high parity women. Antenatal interventions should be designed based on high parity women's perceptions of their health and wellbeing in order to improve their quality of life and ultimately prevent maternal morbidity and mortality. Further quantitative studies are needed to explore the impact of previous mentioned factors on maternal quality of life and outcomes.

Risk factors for antenatal depression: A review

Depression is the most prevalent mental disorder in pregnancy, and yet it is less studied than postpartum depression despite the consequences it may have on both the pregnant woman and her offspring. Therefore, it would be important to know which risk factors may favour the appearance of antenatal depression in order to carry out appropriate prevention interventions. The aim of the present review was to identify the main risk factors of antenatal depression. We searched in databases PubMed and PsycINFO for articles published about the factors associated with antenatal depression from January 2010 through December 2020. The literature review identified three main groups of antenatal depression risk factors: sociodemographic, obstetric, and psychological. First, among the sociodemographic variables, the low level of studies and the economic income clearly stood out from the rest. Then, not having planned the pregnancy was the main obstetric variable, and finally, the main psychological risk factors were having a history of psychological disorders and/or depression as well as presenting anxiety, stress, and/or low social support during pregnancy. This review shows that the antenatal depression is affected by multiple factors. Most can be identified at the beginning of the pregnancy, and some are risk factors potentially modifiable through appropriate interventions, such as psychological factors. For this reason, it is important to carry out a good screening for depression during pregnancy and consequently, be able to prevent its appearance or treat it if necessary.

Influence of perceived stress on prenatal depression in Surinamese women enrolled in the CCREOH study

BACKGROUND

Prenatal depression may have adverse health effects on mothers and their offspring. Perceived stress is an important risk factor for depression during pregnancy. Studies have shown that both perceived stress and depression may negatively influence birth outcomes. While 20% of pregnancies in Suriname, a middle-income Caribbean country located in northern South America, results in adverse birth outcomes, data on prenatal depression and its risk factors are lacking. This study aimed to assess the influence of perceived stress on depression during pregnancy in Surinamese women.

METHODS

Survey data were used from 1143 pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study that addresses the impact of chemical and non-chemical environmental exposures in mother/child dyads in Suriname. The Edinburgh Depression Scale and Cohen Perceived Stress Scale were used to screen for probable depression (cut-off ≥ 12) and high stress (cut-off ≥ 20), respectively. The association between perceived stress and depression was examined using bivariate and multiple logistic regression analyses, adjusted for social support (including resilience) and maternal demographics.

RESULTS

The prevalence of high perceived stress during the first two trimesters and the third trimester were 27.2% and 24.7% respectively. 22.4% of the participants had probable depression during first or second trimester and 17.6% during the third trimester. Women experiencing high stress levels during the first two trimesters had 1.92 increased odds (95% CI 1.18-3.11, p = 0.008) of having probable depression during the third trimester of pregnancy than those with low stress levels. Pregnant women with low individual resilience during early pregnancy (52.1%) had 1.65 (95% CI 1.03-2.63, p = 0.038) increased odds of having probable depression during later stages of pregnancy compared to those with high individual resilience. Low educational level (p = 0.004) and age of the mother (20-34 years) (p = 0.023) were significantly associated with probable depression during the third trimester.

CONCLUSIONS

Early detection and management of stress and depression during pregnancy are important. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.

Prevalence of Depression during Pregnancy in Spanish Women: Trajectory and Risk Factors in Each Trimester

The aims of this research were to determine the trajectories of probable depression and major depression during pregnancy and to identify the associated and predictor variables (sociodemographic, pregnancy-related, and psychological) for both conditions in each trimester of pregnancy. A longitudinal study was carried out with 569 pregnant Spanish women who were assessed in the first, second, and third trimesters of pregnancy. Depression was assessed using the Edinburgh Postnatal Depression Scale and a clinical interview. Measures of anxiety and stress were also included. The prevalence of probable depression in the first, second, and third trimesters was 23.4%, 17.0%, and 21.4%, respectively, and that of major depression was 5.1%, 4.0%, and 4.7%. Thus, the prevalence of both conditions was the highest in the first and third trimesters. The trajectories of probable depression and major depression followed the same pattern throughout pregnancy. All of the psychological variables studied were associated with both conditions in all three trimesters, with perceived stress being a predictor at all times. The association between the other variables and both conditions of depression was similar. Two exceptions stand out: having had previous miscarriages, which was only associated with probable depression and was also a predictor, in the first trimester; and complications during pregnancy, which was only associated with probable and major depression in the third trimester. These findings should be taken into account in routine pregnancy follow-ups, and necessary interventions should be started in the first trimester.

Communication Across Maternal Social Networks During England's First National Lockdown and Its Association With Postnatal Depressive Symptoms

Postnatal/postpartum depression (PND/PPD) had a pre-COVID-19 estimated prevalence ranging up to 23% in Europe, 33% in Australia, and 64% in America, and is detrimental to both mothers and their infants. Low social support is a key risk factor for developing PND. From an evolutionary perspective this is perhaps unsurprising, as humans evolved as cooperative childrearers, inherently reliant on social support to raise children. The coronavirus pandemic has created a situation in which support from social networks beyond the nuclear family is likely to be even more important to new mothers, as it poses risks and stresses for mothers to contend with; whilst at the same time, social distancing measures designed to limit transmission create unprecedented alterations to their access to such support. Using data from 162 mothers living in London with infants aged ≤6 months, we explore how communication with members of a mother's social network related to her experience of postnatal depressive symptoms during the first "lockdown" in England. Levels of depressive symptoms, as assessed via the Edinburgh Postnatal Depression Scale, were high, with 47.5% of the participants meeting a ≥11 cut-off for PND. Quasi-Poisson regression modelling found that the number of network members seen in-person, and remote communication with a higher proportion of those not seen, was negatively associated with depressive symptoms; however, contact with a higher proportion of relatives was positively associated with symptoms, suggesting kin risked seeing mothers in need. Thematic qualitative analysis of open text responses found that mothers experienced a burden of constant mothering, inadequacy of virtual contact, and sadness and worries about lost social opportunities, while support from partners facilitated family bonding. While Western childrearing norms focus on intensive parenting, and fathers are key caregivers, our results highlight that it still "takes a village" to raise children in high-income populations and mothers are struggling in its absence.

Mental health of adolescents associated with sexual and reproductive outcomes: a systematic review

Objective

To systematically review the literature on the mental health of adolescents associated with sexual and reproductive outcomes, and compare the mental health outcomes with that of other age groups.

Methods

We searched seven databases for relevant peer-reviewed articles published between 1 January 2010 and 25 April 2019. Our inclusion criteria required that the study included age-disaggregated data on adolescents, and focused and assessed mental health outcomes associated with pregnancy or sexually transmitted infections. We extracted data on the specific health event, the mental health outcome and the method of measuring this, and comparisons with other age groups.

Findings

After initially screening 10 818 articles by title and abstract, we included 96 articles in our review. We observed that a wide-ranging prevalence of mental ill-health has been reported for adolescents. However, most studies of mental health during pregnancy did not identify an increased risk of depression or other mental disorders among adolescents compared with other age groups. In contrast, the majority of studies conducted during the postpartum period identified an increased risk of depression in adolescents compared with other age groups. Three studies reported on mental health outcomes following abortion, with varying results. We found no studies of the effect of sexually transmitted infections on mental health among adolescents.

Conclusion

We recommend that sexual and reproductive health services should be accessible to adolescents to address their needs and help to prevent any adverse mental health outcomes.

Dental caries and depression in pregnant women: The role of oral health self-perception as mediator

OBJECTIVE

This study investigated the role of oral health self-perception as mediator of association between dental caries and depression among pregnant women from the 2015 Pelotas Birth Cohort Study, Brazil.

MATERIALS AND METHODS

Overall, 2,496 pregnant women participated of this oral health sub-study. Data related to demographic and socioeconomic conditions, lifetime and current depression, and oral health self-perception were collected. Participants were also assessed for dental caries (DMF-T index). Depression was assessed using the Edinburgh Postnatal Depression Scale. For analysis, six outcomes related to dental caries experience were considered. Causal mediation analysis was performed using parametric regression models.

RESULTS

When it was assumed that all subjects had poor perception about oral health, it was observed that the presence of moderate/severe depressive signals and symptoms was higher in subjects with dental caries experience (OR 1.13; CI 95% 1.06-1.20), with severity of untreated dental caries (OR 2.08; CI 95% 1.16-3.78), untreated dental caries (OR 1.18; 95% CI 1.07-1.29), tooth loss (OR 1.08; 95% CI 1.02-1.14), and filled tooth (OR 1.07; 95% CI 1.02-1.16).

CONCLUSIONS

Our findings show the effect of dental caries on depression is mediated by self-perception about oral health in pregnant women.

Risk factors and experiences of prepartum depression in urban- low-income settlement Nairobi Kenya: a mixed-method study

Background: Prepartum depression is common among pregnant women and has not been studied much in low and middle-income countries. Evidence shows that mental illnesses are prevalent in urban than in rural areas. The study objective was to determine the magnitude of prepartum depression, risk factors, and real-life experiences of depression among pregnant women.

Method: A mixed-method cross-sectional study was conducted. It included 262 pregnant women attending antenatal clinics in two public health facilities in urban low-income settlement Nairobi, Kenya. Edinburgh Postnatal Depression Scale (EPDS) with cut-off >13 was used to classify clinical depressive illness. Further, a focus group discussion was conducted with 20 women identified with depression. Univariable analysis with Odd's Ratio was used to test associations. Variables with a p<0.05 in multivariable regression were considered significant.

Result: Out of the 262 women, 33.6% were found to have clinical depression as indicated by EPDS score of >13. Women's gestational age was statistically significantly associated with prepartum depression [OR 4.27 (95% C.I. 2.08 - 8.79),  p<0.001]. Income level ≤ 5000 KES was statistically significantly associated with prepartum depression [OR 3.64 (95% C.I.1.25 -10.60), p=0.018]. Further, thematic analysis of qualitative indicated that poverty, lack of social support, domestic violence, and unfriendly health care were major contributors to prepartum depression.

Conclusion: Significant numbers of pregnant women were found to experience depression. This prevalence rate indicates a high disease burden of women who live with depression, which is not diagnosed because screening of depression is not done in primary health care centers. This study calls for a need and consideration for screening for perinatal depression in primary health care facilities, mainly in resource-poor areas. Interventions targeting means of resolving conflicts in families are highly needed. Such steps would help achieve key sustainable development goals where maternal and child health remains key priority.

Female infants are more susceptible to the effects of maternal antenatal depression; findings from the Pelotas (Brazil) Birth Cohort Study

BACKGROUND

We utilised data from the 2015 Pelotas Birth Cohort, a large prospective cohort in southern Brazil, to examine the association of moderate and severe antenatal depression with child birth outcomes and explore interactions with sociodemographic characteristics.

METHODS

Data was available for n = 3046 participants and their infants. We measured antenatal depression using the Edinburgh Postnatal Depression Scale (EPDS, ≥13 for moderate and ≥17 for severe depression). Outcome measures included gestational age, birth weight, length and head circumference, using the Intergrowth-21st standards. We controlled for known confounders including obstetric risk.

RESULTS

We did not find differences in childbirth outcomes by maternal depression status for participants with at least moderate depression, although there was an increased risk for female offspring to be small for gestational age (SGA, OR 2.33[1.37,3.97]). For severe depression (EPDS≥17) we found an increased risk for lower APGAR scores (OR 1.63[1.02,2.60]) and being SGA (OR 1.77[1.06,2.97], with an increased risk for female offspring in particular to be in lower weight centiles (-10.71 [-16.83,-4.60]), to be SGA (OR 3.74[1.89, 7.44]) and in the lower 10th centile for length (OR 2.19[1.25,3.84]).

LIMITATIONS

include the use of a maternal report questionnaire to ascertain depressive symptoms.

CONCLUSIONS

In this recent large longitudinal cohort in Brazil we did not find independent effects of depression on adverse birth outcomes or interactions with sociodemographic characteristics. We found an increased risk of being SGA for female offspring of women with moderate and severe depression, in line with other research suggesting females may be more susceptible to antenatal disturbances.

FUNDING

This work was supported by the Wellcome Trust, United Kingdom (095582), the Brazilian National Research Council (CNPq) and the Coordination for the Improvement of Higher Education Personnel (CAPES). EN was supported by the UK Economic and Social Research Council GCRF Postdoctoral Fellowship (ES/P009794/1).

Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India

Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA). Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA. Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 - 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 - 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 - 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA. Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.

Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India

Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA). Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA. Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 - 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 - 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 - 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA. Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.

Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India

Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA).

Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA.

Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 – 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 – 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 – 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA.

Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.

Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis

Background

Depression in pregnancy (antenatal depression) in many low and middle-income countries is not well documented and has not been given priority for intervention due to competing urgencies and the belief that it does not immediately cause fatalities, which mainly emanated from lack of comprehensive research on the area. To fill this research gap, this systematic review was conducted to investigate the burden of antenatal depression and its consequences on birth outcomes in low- and middle-income countries.

Methods

We systematically searched the databases: CINHAL, MEDLINE, EMCare, PubMed, PSyc Info, Psychiatry online, and Scopus for studies conducted in low and middle-income countries about antenatal depression and its association with adverse birth outcomes. We have included observational studies (case control, cross-sectional and cohort studies), written in English-language, scored in the range of “good quality” on the Newcastle Ottawa Scale (NOS), and were published between January 1, 2007 and December 31, 2017. Studies were excluded if a standardized approach was not used to measure main outcomes, they were conducted on restricted (high risk) populations, or had fair to poor quality score on NOS. We used Higgins and Egger’s to test for heterogeneity and publication bias. Primary estimates were pooled using a random effect meta-analysis. The study protocol was registered in PROSPERO with protocol number CRD42017082624.

Result

We included 64 studies (with 44, 035 women) on antenatal depression and nine studies (with 5,540 women) on adverse birth outcomes. Antenatal depression was higher in the lower-income countries (Pooled Prevalence (PP) = 34.0%; 95%CI: 33.1%-34.9%) compared to the middle-income countries (PP = 22.7%, 95%CI: 20.1%-25.2%) and increased over the three trimesters. Pregnant women with a history of economic difficulties, poor marital relationships, common mental disorders, poor social support, bad obstetric history, and exposure to violence were more likely to report antenatal depression. The risk of having preterm birth (2.41; 1.47–3.56) and low birth weight (1.66; 1.06–2.61) was higher in depressed mothers compared to mothers without depression.

Conclusions

Antenatal depression was higher in low-income countries than in middle-income countries and was found to be a risk factor for low birth weight and preterm births. The economic, maternal, and psychosocial risk factors were responsible for the occurrence of antenatal depression. While there could be competing priority agenda to juggle for health policymakers in low-income countries, interventions for antenatal depression should be reprioritized as vitally important in order to prevent the poor maternal and perinatal outcomes identified in this review.

Magnitude of Antenatal Depression and Associated Factors among Pregnant Women in West Badewacho Woreda, Hadiyya Zone, South Ethiopia: Community Based Cross Sectional Study

BACKGROUND

Antenatal depression is prevalent and serious problems that is associated with psychosocial factors, obstetric history, and history of psychiatric illness. Evidence on prevalence and factors associated with antenatal depression at community level is limited in Ethiopia. The aim of this study was assessing the prevalence of antenatal depression and associated factors among pregnant women in West Badewacho Woreda, Hadiyya Zone, South Ethiopia, 2018.

METHODS

A community based cross sectional study was conducted from March 15 to April 12, 2018. To draw a total sample size of 541 pregnant women, multistage sampling technique was used. Pretested semi-structured questionnaire and standardized scale was used to collect data from each study subject. Data were entered and cleaned using Epi-Data version 3.1 and exported to SPSS version 23 for analysis. Bivariate analysis was carried out to see crude association between each independent variable and outcome variable. Odds ratios at 95%CI were computed to measure the strength of the association between the outcome and the independent variables. P-value < 0.05 was considered as statistically significant in multivariate analysis.

RESULTS

The prevalence of antenatal depression in the study population was 23.3% (CI: 19.8-26.8). Factors significantly associated with antenatal depression were marital status other than married (single, widowed, divorced) [AOR: (2.807; 95%CI: (1.268, 6.227); p-value = 0.042], history of previous depression [AOR: 3.414; 95%CI: (1.154, 12.999); p-value = 0.001] family history of mental illness [AOR: 3.874; 95%CI: (1.653, 7.052); p-value = 0.028], recent violence from intimate partner [AOR: 3.223; 95%CI: (1.359, 7.643); p-value = 0.008], unsatisfactory marital relation [AOR: 7.568; 95%CI: (3.943, 14.523); p-value < 0.001], lack of adequate social support [AOR: 5.491; 95%CI: (2.086, 14.451); p-value < 0.001] and unplanned current pregnancy [AOR: 2.013; 95%CI: (1.025, 3.953); p-value = 0.042].

CONCLUSION

The prevalence of antenatal depression in west Badewacho woreda was high and it is associated with marital status, unplanned current pregnancy, history of previous depression, family history of mental illness, recent violence from intimate partner, poor marital satisfaction level, and poor social support. Improving maternal and child health services and introducing screening for depression as part of routine antenatal assessment to curb antenatal depression should get due attention.

Prevalence of common mental disorder and associated factors among pregnant women in South-East Ethiopia, 2017: a community based cross-sectional study

Background

Mothers suffering from common mental disorder (CMD), such as anxiety and depression may not be able to function properly, which could adversely affect the mother-infant bond and even result in increased infant morbidity and mortality. The purpose of this study was to assess the prevalence of CMD and its determinants among pregnant women in Southeast Ethiopia.

Methods

Data was collected from 743 pregnant women via interview-administered, standardised questionnaires during Dec–Jan 2017. The WHO Self-Reported Questionnaire (SRQ) was used to screen CMD. Multivariate logistic regression was conducted and ORs and 95% confidence intervals were calculated.

Results

The prevalence of CMD during pregnancy was 35.8% (95% CI: 34–38%) and the main determinants of CMD were: illiteracy, presence of health risk, financial instability, physical or emotional abuse, having sexual intercourse without her willingness, family history of psychiatric illness and history of chronic medical illness.

Conclusion

CMD prevalence during pregnancy was high, indicating a need to regularly screen pregnant women for CMD and its determinants as part of routine obstetric care.

Antidepressants during pregnancy: a French drug utilisation study in EFEMERIS cohort

BACKGROUND

Previous studies have suggested that exposure to some antidepressants (AD) during pregnancy could be associated with an increased risk of congenital malformations and neurodevelopment disorders for the child. We conducted a study to describe the use of AD during pregnancy in France.

METHODS

We performed a drug utilisation study in EFEMERIS, a French cohort of pregnant women. At the time of the present study, 89,170 pregnant women, who were pregnant from 2005 to 2014 in Haute-Garonne were included. Prevalence and incidence of AD prescriptions during pregnancy, characteristics of AD users, and trends in AD use over the 10-year period were studied.

RESULTS

During the 10-year study period, 1620 women registered in EFEMERIS (1.8%) received at least one prescription and dispensation for AD during pregnancy: 1363 during the first (1.5%), 591 during the second (0.7%), and 412 during the third (0.5%) trimester. A total of 2874 women (3.2%) got a prescription for an AD during the 3 months before and/or during pregnancy; 2187 of them (76.1%) stopped AD before pregnancy or during the first trimester. Selective serotonin reuptake inhibitors represented the most prescribed class during pregnancy (1.3%). A very slight decrease in the prevalence of AD prescriptions in pregnant women over time (1.7% in 2014 vs 2% in 2005) and some variations within classes were observed.

CONCLUSIONS

Nearly, 2% of women received antidepressant drugs during pregnancy. This assessment encourages following research on these drugs including the potential risk of neurodevelopmental disorders in children after an exposure to antidepressants during pregnancy.

The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study

BACKGROUND

This study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence.

METHODS

We used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression.

RESULTS

The prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06-2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06-2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26-5.04 and OR = 4.27; 95%CI 1.80-10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26-4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58-9.42).

LIMITATIONS

Disrespect and abuse experiences during childbirth were self-reported.

CONCLUSIONS

Disrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.

Anxiety and depression symptoms among pregnant women with different smoking habits

Smoking during pregnancy is a major public health issue. The aim of this study isto describe the smoking habits of women during pregnancy and its association with clinically significant depressive and anxiety symptoms. 382 women answered to a socio-demographic questionnaire, the Hospital Anxiety Depression Scale (HADS) and the Edinburgh Postnatal Depression Scale (EPDS) at 33 weeks of gestation. Among pregnant woman, 284 are non-smokers, 38 are smokers and 60 quitted smoking during pregnancy. There was a significant association between maternal smoking status and marital status, education level and family income per month. Among smokers, the rate of quitters was quite similar among partnered and unpartnered women and higher in women with university degree and with higher family monthly income.  There was a significant association between maternal smoking status and clinically significant anxious symptoms [χ2(2)=8.535, p=0.014].  Among mothers with non-university education, smokers are more likely to have clinically significant anxiety symptoms than quitters (53.6% vs 24.3%) while among mothers in higher income families, smokers are more likely to have clinically significant depressive symptoms than quitters (100% vs 11.1%). This study provides important data to inform effective public health strategies directed to pregnant women.

Physical Activity and Depressive Disorders in Pregnant Women-A Systematic Review

Background and Objectives: Pregnancy is a unique period in the life of every woman. The lifestyle of a pregnant woman has a significant impact on her and her child's health. Regular physical activity is one of the elements that help maintain normal mental and physical well-being. In pregnant women who regularly have moderate physical activity, there is a lower risk of developing obesity and overweight. Physical exercises have an impact on maintaining proper muscular tonus, reduce pain and prepare for the exertion during labour. Based on the available literature, the aim of this study was to present the impact of physical activity on depressive disorders in pregnant women. Materials and Methods: A review of the literature was carried out in the Medline PubMed database. The basic search terms were: "pregnancy" AND "physical activity AND depression". The work included only English-language publications published in the years 2000-2018. Results: A total of 408 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 354 articles were rejected, and 54 articles were fully read, of which five were rejected due to lack of access to the full version. Finally, 17 references were included in the review. Conclusions: Physical activity, at least once a week, significantly reduces the symptoms of depression in pregnant women and may be an important factor in the prevention of depression in this period.

The impact of resilience on prenatal anxiety and depression among pregnant women in Shanghai

BACKGROUND

Prenatal anxiety/depression has been a major public health problem globally with higher prevalence in developing countries, which leads to negative health outcomes for both mothers and children. Maternal stress varies over the course of pregnancy and the stress occurring in early pregnancy is the most critical. However, few studies have focused on the impact of resilience to stress on mental health of pregnant women.

AIMS

To explore the effect of resilience to stress on prenatal anxiety/depression in pregnant women.

METHODS

2813 participants were recruited from Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) in this study. The Life Event Scale for Pregnancy Women (LESPW) was used to assess stress at 12-16 weeks of pregnancy and at 32-36 weeks of pregnancy, respectively. Resilience was assessed by the revised Resilience Scale for Adults (RSA) at 12-16 weeks of pregnancy. The prenatal anxiety and depression were assessed at 32-26 weeks of pregnancy by Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Survey, Depression Scale (CES-D), respectively. Hierarchical linear regression analyses were conducted to explore the direct effect of stress and resilience on prenatal anxiety and depression. The indirect effects of mediation were analyzed by structural equation models, and the indirect effect of modification was examined by stratification analysis.

RESULTS

There were 11.1% and 10.3% of pregnant women in Shanghai MCPC indicating anxiety and depressive mood, respectively. The stress caused by both subjective and objective events at 32-36 weeks of pregnancy is less than that at 12-16weeks of pregnancy. We found that resilience was a protective factor for maternal mental health and meanwhile it was both an effect modifier and a mediator to the association between stress and prenatal anxiety/depression, with the mediating effect ratio of 15.1% and 23.8%, respectively.

LIMITATIONS

The existence of recall bias, missing data, and restricted residential areas of the participants may limit the generalizability of the study. The measurements of resilience, prenatal anxiety, and depression were not designed specifically for pregnant women, so that they might have missed some important indications of mental issues related to pregnant women only.

CONCLUSIONS

Resilience could be a direct and indirect protective factor for prenatal anxiety and depression caused by pregnancy stress.

Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression: The PAMELA Randomized Clinical Trial

IMPORTANCE

Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited.

OBJECTIVE

To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018.

INTERVENTIONS

Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week.

MAIN OUTCOMES AND MEASURES

Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained).

RESULTS

A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, -0.6; 95% CI, -1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis.

CONCLUSIONS AND RELEVANCE

Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02148965.

Depression in pregnant women hospitalized due to intrauterine growth restriction: Prevalence and associated factors

OBJECTIVE

Pregnancies complicated with intrauterine growth restriction (IUGR) may require hospitalization in a high-risk pregnancy unit (HRPU). A complicated pregnancy and hospital admission may negatively affect the pregnant woman's mental health. Several factors have been identified as possible risk factors for depression, which is proven to lead to several adverse perinatal outcomes. The purpose of this study was to screen for depression in women admitted to an HRPU due to IUGR pregnancy and also to identify associated risk factors.

STUDY DESIGN

All pregnant women admitted at ≥ 24 gestational weeks with the diagnosis of IUGR were eligible for the study. The Greek version of the Edinburgh Postnatal Depression Scale was used as screening tool on admission. A cut-off score ≥ 13 was used to identify depression, while possible risk factors were also investigated.

RESULTS

Overall, 73 women were eligible for the study and agreed to complete the questionnaire. The mean age of the pregnant women was 31.4 ± 6.7 years and the mean gestational week at admission was 33.6 ± 2.9 weeks. The prevalence of depressive symptoms (score ≥ 13) was 32.9% (24/73). In the multivariable model, depressive symptoms were significantly correlated with lower gestational age (OR: 3.459 95%CI: 1.124-10.648) and smoking during pregnancy (OR: 3.926 95% CI: 1.141-13.507).

CONCLUSIONS

About one third of pregnant women hospitalized in the HRPU with IUGR pregnancies showed signs of depression at the time of admission. Early-IUGR and smoking were found to be associated with antenatal depressive symptoms.

Caregiver Depression and Early Child Development: A Mixed-Methods Study From Rural China

Half of rural toddlers aged 0-3 years in China's Qinling Mountainous region are cognitively delayed. While recent studies have linked poor child development measures to the absence of positive parenting behaviors, much less is known about the role that caregiver depression might play in shaping child development. In this paper, a mixed methods analysis is used to explore the prevalence of depression; measure the association between caregiver depression and children's developmental delays, correlates of depression, and the potential reasons for caregiver depression among women in rural China. The analysis brings together results from a large-scale survey of 1,787 caregivers across 118 villages in one northwestern province, as well as information from in-depth interviews with 55 female caregivers from these same study sites. Participants were asked to respond to the Depression, Anxiety and Stress Scale-21 (DASS-21) as well as a scale to measure children's social-emotional development, the Ages and Stages Questionnaire: Social-Emotional (ASQ-SE). We also administered a test of early childhood development, the Bayley Scales of Infant and Toddler Development (BSID-III), to all of the study household's infants and toddlers. The results show that the prevalence of depression may be as high as 23.5 percent among all female caregivers (defined as scoring in the mild or higher category of the DASS-21). Grandmothers have higher prevalence of depression than mother caregivers (p < 0.01). Caregiver depression also is significantly associated with a 0.53 SD worsening of children's social-emotional development (p < 0.01) and a 0.12 SD decrease in children's language development (p < 0.05). Our qualitative findings reveal six predominant reasons for caregiver depression: lack of social support from family and friends; the burden of caregiving; lack of control and agency within the household; within-family conflict; poverty; the perception of material wealth as a measure of self-worth. Our findings show a serious lack of understanding of mental health issues among rural women, and suggest that rural communities could benefit greatly from an educational program concerning mental health and its influence on child development. Our findings confirm the need for a comprehensive approach toward rural health, with particular attention paid to mental health awareness and support to elderly caregivers.