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

Association of contraception use and pregnancy intention with perinatal depression risk among Omani mothers-a longitudinal cohort study

Background

Unplanned pregnancy is significantly associated with an increased risk of perinatal depression (antenatal and postnatal depression), emphasizing its prevalence and its potentially detrimental effects on both maternal and child health. This study aimed to investigate the association of contraception use and pregnancy intention with the risk of perinatal depression among Omani mothers.

Methods

A prospective longitudinal study design was employed to investigate perinatal depression risk in mothers attending antenatal health care services in Oman. Perinatal depression risk was assessed using the Edinburgh Postpartum Depression Scale during the third trimester and postpartum visits. Multiple linear regression analyses were utilized to explore relationships between the risk of perinatal depression and pregnancy-related factors, contraception use, and sociodemographic variables.

Results

The study involved 300 participants with a mean age of 30.8 years (SD = 5.47). The majority of participants reported planned pregnancy (74.0%), no use of contraception (66.0%), and being multiparous (72.7%). A significantly higher proportion (87.8%) of women with planned pregnancies were primiparous (p < 0.001). Besides family structure (core family, p = 0.025) and monthly income (1,000 OMR or below, p = 0.021), mothers who were pregnant for the first time (p < 0.001), and those who were primiparous (p < 0.001) did not use contraception. The regression models showed a significant association between the antenatal and postnatal depression scores (p < 0.001, 95% CI 0.401-0.603) according to the Edinburgh Postpartum Depression Scale.

Conclusions

The findings suggest that women with unplanned pregnancies warrant attention for early detection and preventive interventions, irrespective of their emotional stance. Incorporating routine mental health screening into perinatal care can facilitate early detection, and targeted interventions, contributing to improved maternal mental well-being.

Direct and indirect predictors of postpartum depression symptoms among indigenous Bedouin mothers in Israel

Postpartum depression (PPD) is a common and complex phenomenon with negative outcomes for children, women and their families. This study set out to identify both direct and indirect predictors of PPD symptoms among indigenous Bedouin mothers in Israel. The study included 305 women, 18 to 45 years of age, who were interviewed while pregnant and again, 2 to 4 months postpartum. Interviews were conducted in Arabic and included the Edinburgh Postnatal Depression Scale, administered at both points of measurement. Using path analyses, we identified four significant, direct predictors of PPD symptoms. The strongest was depressive symptoms when pregnant, followed by low relative income, low hemoglobin, and number of prior miscarriages. The latter was significantly associated with consanguinity, meaning that women married to a first cousin experienced more miscarriages which, in turn, increased PPD risk. Low relative income was the only variable that had both a direct and indirect effect upon PPD symptoms (via symptoms of depression when pregnant and hemoglobin). Education and polygamy also emerged as indirect predictors of PPD via depressive symptoms reported during pregnancy. Results suggest a high rate of PPD in this perinatal sample of indigenous women. Our findings underscore the need for tailored interventions to reduce PPD, especially for low-income Bedouin women, faced with many barriers and insufficient access to healthcare services.

Association between antenatal depression and adverse perinatal outcomes: a prospective cohort study

BACKGROUND

Antenatal depression might cause adverse pregnancy outcomes. However, previous study results were inconsistent, especially in the low- and middle- income countries. We aimed to study the association between antenatal depression and adverse perinatal outcomes in a Chinese population.

METHODS

We performed a prospective cohort study and enrolled pregnant women from January 2020 to January 2021. Antenatal depressive symptoms in the third trimester of pregnancy were evaluated by the Edinburgh Postpartum Depression Scale (EPDS). Baseline characteristics and pregnancy outcomes were recorded. After adjusting for confounding factors (age, occupation, education level, and annual income), multivariate logistic regression analysis was applied to evaluate the associations between antenatal depression and pregnancy outcomes.

RESULTS

Among the 5209 participants, 1448 (27.7 %) pregnant women were positive for depression. After adjusting for potential confounders, women with antenatal depressive symptoms were significantly more likely to deliver prematurely [Odds ratio (OR) = 1.404, 95 % confidence interval (CI) = 1.020-1.933, P = 0.037] and receive cesarean section (OR = 1.154, 95 % CI = 1.002-1.331, P = 0.048).

LIMITATIONS

EPDS, not a structured diagnostic interview, was used for psychological assessment. In addition, we only screened the women in their third trimester in a single research center. The association between the duration of antenatal depression and perinatal outcomes was not evaluated.

CONCLUSIONS

Depressive symptoms were common among Chinese women in their third trimester of pregnancy. Women with antenatal depressive symptoms had increased cesarean section and preterm delivery risks. Screening and treatment for antenatal depression are needed during the prenatal care.