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

Gestational age at birth and cognitive outcomes in term-born children: Evidence from Chinese and British cohorts

INTRODUCTION

Older gestational age (GA) has been associated with more favourable cognitive outcomes in preterm children. Recent evidence suggests this may also apply to term-born children. This study aims to examine the association between GA and early neurodevelopmental outcomes in children born at term in China and the UK.

METHODS

Participants were term-born children from two cohorts, the Sichuan Multi-stratified Infants and Early Life (SMILE) study in China and the Developing Human Connectome Project (dHCP) in the UK. Early cognitive outcomes were assessed at 6 months in the SMILE study, and at 18 months in the dHCP. Linear regression models were conducted to examine the association between GA at birth and early cognitive outcomes in each cohort separately.

RESULTS

A sample of 1245 participants from the SMILE study and 406 participants for the dHCP were included in the analysis. In the SMILE study, longer GA was associated with better mental developmental (B = 2.47 [1.60, 3.34], P < .001) and psychomotor outcomes (B = 2.91 [2.01, 3.82], P < .001), after controlling for sex, parental education, family yearly income, maternal age, maternal depressive symptoms, and birth weight; in the dHCP, longer GA was associated with better cognitive (B = 1.35 [0.33, 2.37], P = .010) and motor outcomes (B = 1.49 [0.59, 2.39], P = .001), after controlling for sex, relative social deprivation, maternal depressive symptoms and birth weight.

CONCLUSIONS

Older GA in term-born toddlers is associated with more favourable developmental outcomes across different cultural contexts.

Gut microbiota causes depressive phenotype by modulating glycerophospholipid and sphingolipid metabolism via the gut-brain axis

Emerging evidence suggests that changes in the gut microbiota (GM) are related to prenatal depression onset, but the underlying molecular mechanisms remain obscure. This study was conducted to explore how disordered GM is involved in the onset of prenatal depression through the microbiome-gut-brain (MGB) axis. We transplanted fecal microbiota from women with and without prenatal depression into germ-free mice. Fecal metagenomic sequencing and LC-MS untargeted metabolomics analysis were performed to identify the GM composition, function, and metabolites in mice. Lipid metabolomics analysis was then used to characterize the lipid metabolism of brain tissue in mice. We found that mice transplanted with fecal microbiota from women with prenatal depression exhibited depressive-like behaviors as well as characteristic disorders of the phylum Firmicutes. Weighted Gene Correlation Network Analysis identified three microbial and one metabolic module in the gut, alongside two lipid metabolic modules in the brain, as significantly related to all depressive-like behaviors. These modules were enriched for glycerophospholipid and sphingolipid metabolism. In addition, the GM of mice with depressive-like behaviors were enriched and deficient in relevant functions and enzymes in the glycerophospholipid (mainly phosphatidylethanolamine) and sphingolipid (mainly hexosyl-ceramide) metabolic pathways, respectively. Consistently, glycerophospholipid and sphingolipid metabolites in the brains of depressive-like mice were up- and down-regulated. Increased phosphatidylethanolamine and decreased hexosyl-ceramide were significantly related to differential genera in the gut. Collectively, our findings provide a novel microbial and metabolic framework for understanding the role of the MGB axis in prenatal depression, indicating that the GM may be involved in the onset of depressive phenotypes by modulating central glycerophospholipid and sphingolipid metabolic homeostasis.

Husband involvement in antenatal care moderates the link between vitamin D status and depressive symptoms in pregnant women

AIMS

The association between a pregnant mother's vitamin D status and depressive symptoms has yielded inconsistent results. It is possible that other factors play a role in this association, as depression can have multiple causes. Recognizing the significance of the husband's participation in antenatal care, this study aimed to examine whether the husband's involvement moderates the link between the mother's vitamin D status and depressive symptoms during pregnancy.

METHODS

A total of 2983 Chinese married pregnant women, in their 25-35 weeks of pregnancy, completed questionnaires to assess their levels of depressive symptoms and the involvement of their husbands in their antenatal care appointments. Additionally, their serum levels of vitamin D were measured.

RESULTS

After adjusting for maternal age, parity, and socio-economic status, the husband's involvement in antenatal care moderated the association between maternal vitamin D status and depressive symptoms during pregnancy (β = 2.03, p = 0.035). Specifically, when their husbands were not regularly present for antenatal care appointments, mothers with suboptimal vitamin D levels experienced more depressive symptoms than those with optimal levels. However, there were no noticeable differences in depressive symptoms between vitamin D groups for mothers whose husbands attended all antenatal care appointments.

CONCLUSIONS

Pregnant women who have suboptimal vitamin D levels and lack support from their spouses are most vulnerable to experiencing depression. It is crucial to holistically assess the social and physiological needs of expectant mothers to reduce their risk of antenatal depression.

The effects of maternal health literacy, family functioning and self-efficacy on antepartum depression in pregnant women in China: a moderated mediation model

BACKGROUND

Antepartum depression (AD) is associated with a greater risk of adverse outcomes for both mothers and fetuses. Maternal health literacy (MHL), family functioning (FF), and self-efficacy (SE) are important factors affecting antepartum depression (AD) in pregnant women. Therefore, this study aimed to explore the associations between these factors and whether MHL and SE mediate the relationship between FF and AD.

METHODS

This cross-sectional study included 1392 pregnant women from 6 hospitals in Chongqing, China. Data were collected via structured scales, including the Edinburgh Postpartum Depression Scale, the APGAR Family Care Index Scale, the Maternal Health Literacy Scale and the General Self-Efficacy Scale (GSES). Structural equation modeling(SEM) was used to test the hypothesized relationships among the variables.

RESULTS

In our survey, 31.90% participants had depression symptoms. Correlation analysis revealed that all the variables were significantly correlated with AD (p < 0.01). The model indicated that FF had the strongest correlation with AD (β = -0.276, p < 0.01), followed by MHL (β = -0.248, p < 0.01) and self-efficacy (SE) (β = -0.222, p < 0.01). SE fully mediated the relationship between FF and AD and mediated the relationship between MHL and AD. There was no evidence of a mediating effect of MHL on the relationship between FF and AD.

CONCLUSIONS

AD is correlated with MHL, SE and FF. MHL and FF can directly affect AD and mediate AD through SE. Future programs should consider MHL promotion, FF improvement and SE strengthening as breakthrough points when planning educational programs.

Antenatal depression among pregnant women in Ethiopia: An umbrella review

INTRODUCTION

Antenatal depression, ranging from mild to severe, is influenced by hormonal changes during pregnancy and childbearing years, making it a significant public health issue. Antenatal depression, with its far-reaching effects on mothers, infants, and children, continues to be a significant public health issue in developing countries such as Ethiopia. Research on antenatal depression in Ethiopia has produced varied results. Although previous systematic reviews and meta-analyses studies have addressed this topic, a comprehensive summary of existing reviews has not been available. Therefore, this umbrella review aims to consolidate the findings on antenatal depression and associated factors among pregnant women in Ethiopia.

METHODS

This review included five systematic reviews and meta-analyses from various databases, including PubMed, PsycINFO, Research4life, CINHALE and Science Direct. Only reviews published between January 1, 2010, and July 30, 2024, were considered. The search, conducted from August 5 to 15, 2024, used CoCoPop questions and included only English-language reviews. Study quality was assessed with the AMSTAR tool, and data extraction and analysis were performed using Microsoft Excel 2016 and STATA 14.0. The I2 and Cochran's Q tests were used to assess heterogeneity. Pooled effect sizes were calculated based on the pooled prevalence of antenatal depression and odds ratios for associated factors, with a 95% confidence interval indicating statistical significance.

RESULTS

This umbrella review encompassed 50 primary studies from five systematic reviews and meta-analyses, involving a total of 25,233 pregnant women. The pooled prevalence of antenatal depression in Ethiopia was found to be 24.60% (95% CI: 22.46-26.73). Significant associations were identified between antenatal depression and several factors: unplanned pregnancy (POR = 2.29; 95% CI: 1.75, 2.82), poor social support (POR = 2.10; 95% CI: 1.37, 2.84), history of abortion (POR = 2.49; 95% CI: 1.64, 3.34), history of depression (POR = 3.57; 95% CI: 2.43, 4.71), and history of obstetric complications (POR = 2.94; 95% CI: 1.61, 4.28).

CONCLUSIONS

The significant prevalence of antenatal depression (24.60%) among pregnant women in Ethiopia is closely linked to factors such as unplanned pregnancy, poor social support, history of abortion, previous depression, and obstetric complications. To tackle this issue, it is recommended to enhance social support networks, increase access to family planning services to minimize unplanned pregnancies, conduct regular mental health screenings, and incorporate mental health services into antenatal care.

The mediating role of rumination in the relationship between negative cognitive styles and depression among pregnant women in Guangzhou, China

Backgrounds

Negative cognitive styles (NCSs) have been identified as risk factor for the onset of depression. However, little empirical evidence is available to support its role in psychological disorders in the perinatal period. Moreover, less is known about the underlying mechanism in the relation between NCSs and depression in pregnant women. The purpose of this study was to examine the mediation effect of rumination on the relationship between NCSs and antenatal depression (AD). Specifically, the mediation effects of two subtypes of rumination were tested.

Methods

A cross-sectional study was conducted from February to May 2023 using anonymous online questionnaire among women in their third trimester of pregnancy in the antenatal care clinic of a tertiary hospital. The Edinburgh Postnatal Depression Scale was used to screen antenatal depression. Attributional Style Questionnaire and Ruminative Responses Scale were employed to assess NCSs and rumination respectively. Correlational analysis of the associations between NCSs, rumination, and AD was conducted. Bootstrap mediation analysis and multiple mediation models were applied to investigate whether rumination, and its brooding and reflection components would mediate the relationship between NCSs and AD.

Results

NCSs had a significant positive effect on depression in pregnant women (c=1.45, SE=0.03, p<0.001, 95%CI: 0.92∼1.70). Rumination mediated the relationship between NCSs and depression in pregnant women (point estimate=0.41, 95%CI: 0.13∼0.79, effect size=0.22, K2 = 0.19). Multiple mediation analysis revealed that brooding, instead of reflection, mediated the relationship between NCSs and depression in pregnant women (point estimate=0.41, 95%CI: 0.15∼0.78).

Conclusion

This study provided novel evidence for the role of rumination, specifically its brooding subtype, in shaping the link between NCSs and depression in pregnant women, highlighting potentially useful targets for interventions aimed at preventing the onset of AD.

Associations between antenatal depressive symptoms in different trimesters and perinatal outcomes: A prospective multicenter cohort study in China

BACKGROUND

Evidence exists that maternal antenatal depression may have adverse impacts on perinatal outcomes. However, the results of those studies are inconsistent and mainly focus on maternal depressive symptoms in the second or third trimester.

METHODS

This prospective cohort study used a sub-sample of participants from the Sino-Canadian Healthy Life Trajectories Initiative trial. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depressive symptoms in the first, second, and third trimesters, respectively. Infant growth indicator measurements were conducted in the first year of life. Logistic regression, Spearman correlation analyses and Generalized estimation equation (GEE) models were used to test the hypotheses.

RESULTS

2053 participants were recruited in this study, 326 of whom had at least one EPDS score ≥ 10 during pregnancy. A higher EPDS score in the first (aOR=1.053, 95 % CI: 1.004-1.103) or in the second trimester (aOR=1.060, 95 % CI: 1.007-1.115) was associated with greater risk of macrosomia. A higher EPDS score in the third trimester was associated with higher risks of preterm birth (aOR=1.079, 95 % CI: 1.006-1.157) and the infant being small for gestational age (aOR=1.097, 95 % CI: 1.015-1.185). GEE models showed that a greater EPDS score in the third trimester was associated with higher infant subscapular skinfold thickness (adjusted β=0.026, 95 % CI: 0.003-0.050).

CONCLUSION

Maternal depressive symptoms in different trimesters were differentially associated with infant weight and growth parameters at birth and postnatally. The present study further highlights the importance of depression screening in all trimesters of pregnancy, including the first trimester.

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.

Gaps between current practice in perinatal depression screening and guideline recommendations: a systematic review

OBJECTIVE

Screening for perinatal depression is recommended by many guidelines to reduce the disease burden, but current implementation practices require clarification.

METHOD

Fifteen databases were searched for observational studies using a pre-tested search strategy. In addition, the websites of academic organizations were searched for guidelines, recommendations, and reports. Literature published between January 1, 2010, and December 19, 2021, in either English or Chinese, was included. The standard form of the Joanna Briggs Institute (JBI) was used to assess risk of bias of the included studies.

RESULTS

The data analysis covered 103 studies, 21 guidelines, 11 recommendations, five position statements, three reports, two committee opinions, three consensuses, one consultation, and one policy statement. All but one guideline recommended that mothers be routinely screened for perinatal depression at least once during the perinatal period. In addition, 39 documents recommended that perinatal mothers at risk of perinatal depression be provided with or referred to counseling services. In original studies, however, only 8.7% of the original studies conducted routine screenings, and only one-third offered referral services after the screening process. The EPDS emerged as the most frequently used screening tool to measure perinatal depression. 32% (n = 33) of studies reported the technology used for screening. The most commonly used method was face-to-face interviews (n = 22). Screening personnel the agents conducting the screening comprised researchers (n = 26), nurses (n = 15), doctors (n = 11).

CONCLUSIONS

A significant disparity was observed between the recommendations and implementation of perinatal depression screening, highlighting the need to integrate routine screening and referral processes into maternal care services.

Association of Pregnant Women's Perinatal Depression with Sociodemographic, Anthropometric and Lifestyle Factors and Perinatal and Postnatal Outcomes: A Cross-Sectional Study

Background: In recent decades, the incidence of depression has gradually increased in the general population globally. Depression is also common during gestation and could result in detrimental gestational complications for both the mother and the fetus. The survey presented aimed to evaluate whether pregnant women's perinatal depression could be associated with socio-demographic, anthropometry and lifestyle factors, and perinatal and postnatal outcomes. Methods: This is a cross-sectional survey conducted on 5314 pregnant women. Socio-demographic and lifestyle factors were recorded by relevant questionnaires via face-to-face interviews. Anthropometric parameters were measured by qualified personnel. Perinatal depressive symptomatology status was evaluated by Beck's Depression Inventory (BDI-II) questionnaire. Results: Depressive symptoms throughout gestation were found in 35.1% of the enrolled women. Perinatal depression was significantly associated with lower educational and economic level, pre-pregnancy regular smoking and reduced levels of Mediterranean diet adherence levels, a higher prevalence of gestational diabetes and preterm birth, as well as a higher incidence of delivering by caesarean section and abnormal childbirth weight. Perinatal depression was also significantly associated with a higher prevalence of maternal postpartum depression and lower prevalence of exclusive breastfeeding practices, as well as with a higher incidence of childhood asthma. Conclusions: Pregnant women's perinatal depression appears to be associated with various socio-demographic, anthropometry, and lifestyle characteristics and with a higher frequency of several adverse pregnancy complications. The present findings emphasize the importance of pregnant women's perinatal mental health, highlighting the need to develop and apply public strategies and policies for psychological counseling and support of future mothers to minimize probable risk factors that may trigger perinatal depression. Novel well-organized, follow-up surveys of enhanced validity are highly recommended to establish more definitive conclusions.