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Trajectories of antenatal depression and adverse pregnancy outcomes

      Background

      Antenatal depression affects approximately 1 of 7 pregnancies, with an increasing prevalence across gestation. Data regarding the associations between antenatal depression and adverse pregnancy outcomes yielded conflicting results. However, previous studies evaluated the cross-sectional prevalence of depression at various time points and not the depressive symptom trajectory across gestation.

      Objective

      This study aimed to identify whether the trajectory of antenatal depressive symptoms is associated with different risks of adverse pregnancy outcomes.

      Study Design

      This was a secondary analysis of a large multisite prospective cohort of nulliparous women across the United States. The Edinburgh Postpartum Depression Scale was administered at 2 study visits: between 6 and 14 weeks’ gestation and between 22 and 30 weeks’ gestation. The Edinburgh Postpartum Depression Scale score trajectories were categorized as improved, stable, or worsened based on whether the scores changed by at least 1 standard deviation between the 2 visits. The frequencies of adverse pregnancy outcomes (hypertensive disorders of pregnancy, abruption, cesarean delivery, preterm birth [ie, <37 weeks’ gestation], small for gestational age neonates, neonatal intensive care unit admission, and maternal readmission) were compared with depression trajectories across gestation in bivariable and multivariable analyses. Secondary analyses evaluated the frequencies of spontaneous and medically indicated preterm births and frequencies of spontaneous and medically indicated preterm births before 35, 32, and 28 weeks’ gestation.

      Results

      Of the 8784 women who completed the 2 antenatal Edinburgh Postpartum Depression Scale screens, 1141 (13.0%) had improved, 6663 (75.9%) had stable, and 980 (11.2%) had worsened depressive symptom trajectories across gestation. Compared with women with improved or stable depressive symptoms, those with worsened symptoms were more likely to experience preterm birth (8.3% vs 7.4% vs 9.9%, respectively; P=.018). After controlling for potential confounders, worsened depressive symptoms remained associated with more frequent preterm birth (adjusted odds ratio, 1.68; 95% confidence interval, 1.10–2.57).

      Conclusion

      Women with depression symptoms that worsen as pregnancy progresses have increased odds of preterm birth. Future research is warranted to optimize and implement effective prevention, screening, and treatment protocols for antenatal depressive symptoms as a strategy to prevent preterm birth.

      Key words

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      References

        • Wisner K.L.
        • Sit D.K.
        • McShea M.C.
        • et al.
        Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.
        JAMA Psychiatry. 2013; 70: 490-498
        • Gavin N.I.
        • Gaynes B.N.
        • Lohr K.N.
        • Meltzer-Brody S.
        • Gartlehner G.
        • Swinson T.
        Perinatal depression: a systematic review of prevalence and incidence.
        Obstet Gynecol. 2005; 106: 1071-1083
        • Ko J.Y.
        • Rockhill K.M.
        • Tong V.T.
        • Morrow B.
        • Farr S.L.
        Trends in postpartum depressive symptoms - 27 states, 2004, 2008, and 2012.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 153-158
        • Banti S.
        • Mauri M.
        • Oppo A.
        • et al.
        From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research & screening unit study.
        Compr Psychiatry. 2011; 52: 343-351
        • Norhayati M.N.
        • Hazlina N.H.
        • Asrenee A.R.
        • Emilin W.M.
        Magnitude and risk factors for postpartum symptoms: a literature review.
        J Affect Disord. 2015; 175: 34-52
        • O’Hara M.W.
        • McCabe J.E.
        Postpartum depression: current status and future directions.
        Annu Rev Clin Psychol. 2013; 9: 379-407
        • Nicholson W.K.
        • Setse R.
        • Hill-Briggs F.
        • Cooper L.A.
        • Strobino D.
        • Powe N.R.
        Depressive symptoms and health-related quality of life in early pregnancy.
        Obstet Gynecol. 2006; 107: 798-806
        • Hu R.
        • Li Y.
        • Zhang Z.
        • Yan W.
        Antenatal depressive symptoms and the risk of preeclampsia or operative deliveries: a meta-analysis.
        PLoS One. 2015; 10e0119018
        • de Paz N.C.
        • Sanchez S.E.
        • Huaman L.E.
        • et al.
        Risk of placental abruption in relation to maternal depressive, anxiety and stress symptoms.
        J Affect Disord. 2011; 130: 280-284
        • Chung T.K.
        • Lau T.K.
        • Yip A.S.
        • Chiu H.F.
        • Lee D.T.
        Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes.
        Psychosom Med. 2001; 63: 830-834
        • Grote N.K.
        • Bridge J.A.
        • Gavin A.R.
        • Melville J.L.
        • Iyengar S.
        • Katon W.J.
        A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.
        Arch Gen Psychiatry. 2010; 67: 1012-1024
        • Oberlander T.F.
        • Warburton W.
        • Misri S.
        • Aghajanian J.
        • Hertzman C.
        Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data.
        Arch Gen Psychiatry. 2006; 63: 898-906
        • Orr S.T.
        • James S.A.
        • Blackmore Prince C.
        Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland.
        Am J Epidemiol. 2002; 156: 797-802
        • El Marroun H.
        • Jaddoe V.W.
        • Hudziak J.J.
        • et al.
        Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes.
        Arch Gen Psychiatry. 2012; 69: 706-714
        • Wisner K.L.
        • Bogen D.L.
        • Sit D.
        • et al.
        Does fetal exposure to SSRIs or maternal depression impact infant growth?.
        Am J Psychiatry. 2013; 170: 485-493
        • Dowse E.
        • Chan S.
        • Ebert L.
        • et al.
        Impact of perinatal depression and anxiety on birth outcomes: a retrospective data analysis.
        Matern Child Health J. 2020; 24: 718-726
        • Clapp M.A.
        • Little S.E.
        • Zheng J.
        • Robinson J.N.
        A multi-state analysis of postpartum readmissions in the United States.
        Am J Obstet Gynecol. 2016; 215: 113.e1-113.e10
        • Stein A.
        • Pearson R.M.
        • Goodman S.H.
        • et al.
        Effects of perinatal mental disorders on the fetus and child.
        Lancet. 2014; 384: 1800-1819
        • Marcus S.
        • Lopez J.F.
        • McDonough S.
        • et al.
        Depressive symptoms during pregnancy: impact on neuroendocrine and neonatal outcomes.
        Infant Behav Dev. 2011; 34: 26-34
        • Christensen A.L.
        • Stuart E.A.
        • Perry D.F.
        • Le H.N.
        Unintended pregnancy and perinatal depression trajectories in low-income, high-risk Hispanic immigrants.
        Prev Sci. 2011; 12: 289-299
        • Kuo S.Y.
        • Chen S.R.
        • Tzeng Y.L.
        Depression and anxiety trajectories among women who undergo an elective cesarean section.
        PLoS One. 2014; 9: e86653
        • Kuo S.Y.
        • Yang Y.L.
        • Kuo P.C.
        • Tseng C.M.
        • Tzeng Y.L.
        Trajectories of depressive symptoms and fatigue among postpartum women.
        J Obstet Gynecol Neonatal Nurs. 2012; 41: 216-226
        • Mora P.A.
        • Bennett I.M.
        • Elo I.T.
        • Mathew L.
        • Coyne J.C.
        • Culhane J.F.
        Distinct trajectories of perinatal depressive symptomatology: evidence from growth mixture modeling.
        Am J Epidemiol. 2009; 169: 24-32
        • Haas D.M.
        • Parker C.B.
        • Wing D.A.
        • et al.
        A description of the methods of the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b).
        Am J Obstet Gynecol. 2015; 212: 539.e1-539.e24
        • Cox J.L.
        • Holden J.M.
        • Sagovsky R.
        Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.
        Br J Psychiatry. 1987; 150: 782-786
        • Alexander G.R.
        • Himes J.H.
        • Kaufman R.B.
        • Mor J.
        • Kogan M.
        A United States national reference for fetal growth.
        Obstet Gynecol. 1996; 87: 163-168
        • Wikman A.
        • Axfors C.
        • Iliadis S.I.
        • Cox J.
        • Fransson E.
        • Skalkidou A.
        Characteristics of women with different perinatal depression trajectories.
        J Neurosci Res. 2020; 98: 1268-1282
        • Curry S.J.
        • Krist A.H.
        • et al.
        • US Preventive Services Task Force
        Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement.
        JAMA. 2019; 321: 580-587
        • Siu A.L.
        • US Preventive Services Task Force (USPSTF)
        • Bibbins-Domingo K.
        • et al.
        Screening for depression in adults: US Preventive Services Task Force recommendation statement.
        JAMA. 2016; 315: 380-387
        • Cox E.Q.
        • Sowa N.A.
        • Meltzer-Brody S.E.
        • Gaynes B.N.
        The perinatal depression treatment cascade: baby steps toward improving outcomes.
        J Clin Psychiatry. 2016; 77: 1189-1200
      1. The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression.
        Obstet Gynecol. 2015; 125: 1268-1271
        • Sandman C.A.
        • Wadhwa P.D.
        • Chicz-DeMet A.
        • Dunkel-Schetter C.
        • Porto M.
        Maternal stress, HPA activity, and fetal/infant outcome.
        Ann N Y Acad Sci. 1997; 814: 266-275
        • Hiles S.A.
        • Baker A.L.
        • de Malmanche T.
        • Attia J.
        A meta-analysis of differences in IL-6 and IL-10 between people with and without depression: exploring the causes of heterogeneity.
        Brain Behav Immun. 2012; 26: 1180-1188
        • Howren M.B.
        • Lamkin D.M.
        • Suls J.
        Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis.
        Psychosom Med. 2009; 71: 171-186
        • Raedler T.J.
        Inflammatory mechanisms in major depressive disorder.
        Curr Opin Psychiatry. 2011; 24: 519-525
        • Köhler C.A.
        • Freitas T.H.
        • Maes M.
        • et al.
        Peripheral cytokine and chemokine alterations in depression: a meta-analysis of 82 studies.
        Acta Psychiatr Scand. 2017; 135: 373-387
        • Gomes J.
        • Au F.
        • Basak A.
        • Cakmak S.
        • Vincent R.
        • Kumarathasan P.
        Maternal blood biomarkers and adverse pregnancy outcomes: a systematic review and meta-analysis.
        Crit Rev Toxicol. 2019; 49: 461-478
        • Howard L.M.
        • Molyneaux E.
        • Dennis C.L.
        • Rochat T.
        • Stein A.
        • Milgrom J.
        Non-psychotic mental disorders in the perinatal period.
        Lancet. 2014; 384: 1775-1788
        • Metz T.D.
        • Rovner P.
        • Hoffman M.C.
        • Allshouse A.A.
        • Beckwith K.M.
        • Binswanger I.A.
        Maternal deaths From suicide and overdose in Colorado, 2004-2012.
        Obstet Gynecol. 2016; 128: 1233-1240
        • Kohler O.
        • Krogh J.
        • Mors O.
        • Benros M.E.
        Inflammation in depression and the potential for anti-inflammatory treatment.
        Curr Neuropharmacol. 2016; 14: 732-742
        • Baron E.
        • Bass J.
        • Murray S.M.
        • Schneider M.
        • Lund C.
        A systematic review of growth curve mixture modelling literature investigating trajectories of perinatal depressive symptoms and associated risk factors.
        J Affect Disord. 2017; 223: 194-208
        • Lisonkova S.
        • Sabr Y.
        • Mayer C.
        • Young C.
        • Skoll A.
        • Joseph K.S.
        Maternal morbidity associated with early-onset and late-onset preeclampsia.
        Obstet Gynecol. 2014; 124: 771-781