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

Racial Discrimination Experiences During Pregnancy Are Associated with Suicidal Ideation in Depressed Postpartum Women

OBJECTIVE

Self-directed violence with suicidal intent is one of the main causes of maternal mortality. We aimed to evaluate the impact of several predictors on suicidal ideation (SI) in postpartum women.

METHODS

A cohort of 1,822 women, over 18 years old, was assessed in two Brazilian cities with contrasting sociodemographic profiles. Participants were followed from pregnancy (22nd-25th weeks) until postpartum (mean = 116.8 days, SD = 81.5 after delivery). The main outcome was SI assessed using item-10 of the Edinburgh Postpartum Depression Scale. Potential predictors of SI were allocated into seven different domains: sociodemographic characteristics, environmental stressors and social support during pregnancy, maternal mental health during pregnancy and postpartum, substance use during pregnancy, obstetric data, and newborn characteristics.

RESULTS

SI prevalence was 3.1%. In the univariate analysis, having more children, lower family income, lower education, history of depression, stressors during pregnancy (perceived stress, hopelessness, anxiety, depression, alcohol use, smoking and history of violence, greater number of stressful events, lower social support, and racially discriminatory experience), newborn with low APGAR in the first minute, non-breastfeeding, and postpartum depression, were positively associated with SI. In the multiple predictors model (X2 = 136,502; df = 6; p < 0.001), only racial discrimination during pregnancy (PR: 1.13; 95% CI 1.01-1.27) and postpartum depression (PR: 1.23; 95% CI 1.20-1.27) remained associated with SI.

CONCLUSIONS

Although racial discrimination was not assessed in the postpartum, such experiences during pregnancy seem to contribute to an increased risk of SI among depressed postpartum women. This underscores the importance of addressing racial disparities and fostering an inclusive and supportive environment to safeguard maternal mental health.

Associations between maternal early pregnancy depression and longitudinal fetal growth

BACKGROUND

The impacts of maternal depression during mid-to-late pregnancy on fetal growth have been extensively investigated. However, the association between maternal depression during early pregnancy and fetal intrauterine growth are less clear.

METHODS

A prospective study comprised 23,465 eligible pregnant women and their offspring was conducted at a hospital-based center in Shanghai. Prenatal depression was assessed used using Patient Health Questionnaire (PHQ-9) before 14 gestational weeks. Differences in fetal growth trajectory of different maternal depressive statuses during three periods (16-23, 24-31, and 32-41 gestational weeks) were compared using a multilevel model with fractional polynomials.

RESULTS

Women with depressive symptoms during early pregnancy had higher longitudinal fetal trajectories, with an estimated increase in fetal weight (β = 0.33; 95 % CI, 0.06-0.61), compared to those without depressive symptoms. Increases in fetal abdominal circumference among women with depressive symptoms were observed before 23 gestational weeks. Offspring born to mothers with early pregnancy depression had a significantly higher birth weight of 14.13 g (95 % CI, 1.33-27.81 g) and an increased risk of severe large size for gestational age (adjusted odds ratio [aOR], 1.64; 95 % CI, 1.32-2.04) and macrosomia (aOR, 1.21; 95 % CI, 1.02-1.43).

LIMITATIONS

Self-rated scale was used to assess depressive symptoms rather than clinical diagnosis. And Long-term effects of early pregnancy depression on offspring were not explored.

CONCLUSIONS

The study revealed an association between maternal depression during early pregnancy and increased fetal biometrics, higher birth weight, and an elevated risk of severe large size for gestational age and macrosomia.

Prospective Associations between Maternal Depressive Symptoms during Early Infancy and Growth Deficiency from Childhood to Adolescence

Maternal health represents an important predictor of child development; yet it often goes unnoticed during pediatric visits. Previous work suggests that mental state affects parenting. The relationship between infant exposure to maternal depressive symptoms suggests conflicting findings on physical growth. Body mass index (BMI) has not been rigorously examined across development. Using a prospective-longitudinal birth cohort of 2120 infants (50.7% boys), we estimated the prospective relationship between symptoms of maternal depressive symptoms at 5 months postpartum and later BMI in typically developing children. We hypothesized that maternal depressive symptom severity would predict later BMI through to adolescence. Mothers self-reported depressive symptoms at 5 months. Child BMI was measured by a trained research assistant at ages 6, 8, 10, 13, and 15 years. We estimated a series of sex-stratified regressions in which BMI was linearly regressed on maternal symptoms, while controlling for potential pre-existing/concurrent individual and family confounding factors. Boys born to mothers with more severe depressive symptoms at age 5 months had a significantly lower BMI than other boys at subsequent ages. There were no such associations observed for girls. Maternal depressive symptoms were prospectively associated with later BMI for sons and not daughters, predicting risk of faltering in growth through to adolescence. Health practitioners should routinely assess maternal psychological functioning during pediatric visits to optimize parent and child flourishment.

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.