Abstract
Little is known about the natural course of depressive symptoms and associated features throughout pregnancy. We examined the course of some psychological and somatic symptoms in each month of pregnancy in a normative sample. A consecutive, unselected sample of women (N = 374) were interviewed retrospectively at 6 weeks postpartum with the Structured Clinical Interview (DSM-IV). Women were asked whether they had experienced each symptom at any time during pregnancy and the occurrence of the symptom for each month of pregnancy. Associated symptoms of depression showed complex changes across pregnancy. Depressed mood (F(df) = 5.15(1); p = 0.02) showed a quadratic pattern with elevations at the beginning and end of pregnancy. Both linear increases (a) and quadratic (b) changes over time were observed for sensitivity to criticism (Fa(df) = 20.9(1), pa = 0.00; Fb(df) = 7.02(1), pb = 0.00), lack of concentration (Fa(df) = 37.0(1), pa = 0.00; Fb(df) = 10.3(1); pb = 0.00), decreased energy (Fa(df) = 13.4(1); pa = 0.00; Fb(df) = 62.6(1); pb = 0.00) and feelings of heavy limbs (Fa (df) = 92.9(1); pa = 0.00; Fb(df) = 67.7(1); pb = 0.00). Only guilt (F(df) = 0.00(1); p = 0.93) showed no significant change over pregnancy. Psychological symptoms changed throughout pregnancy as much as somatic symptoms. A linear increase was found for most symptoms, but significant non-linear changes were also found. The discrepancy between the patterns of depressed mood and most somatic and psychological symptoms suggest complex interactions and potentially important implications for assessment and monitoring treatment.
Highlights
Pregnancy, birth and lactation are marked by large changes in hormone levels, including increasing exposure to psychoactive hormones such as oestrogen, progesterone and cortisol during pregnancy (O’Leary et al, 1991; Yonkers et al, 2009) and sudden withdrawal on parturition (Kammerer et al, 2009)
We examined the course of both psychological and some somatic symptoms in each month of pregnancy in a non-clinical population from a clinical interview
Repeated measures analysis of covariance (ANCOVA) showed no significant association between any of the psychological and somatic symptoms with age, SES, parity and smoking
Summary
Birth and lactation are marked by large changes in hormone levels, including increasing exposure to psychoactive hormones such as oestrogen, progesterone and cortisol during pregnancy (O’Leary et al, 1991; Yonkers et al, 2009) and sudden withdrawal on parturition (Kammerer et al, 2009). Dramatic changes in hormone levels in pregnancy might be expected to predict changing depressive symptoms. At their peak, oestrogen levels are 30 times higher in pregnancy than during the menstrual cycle and cortisol levels in pregnancy are as high as in major depressive disorders (Glynn, 2012). Research has shown that amplification of certain somatic symptoms among pregnant women may be associated with prenatal depressive disorders (Kelly et al 2001; Anderson et al 2003). The current study adds to existing research by charting the patterns of depressive symptoms and associated features over the entire course of pregnancy in a large, non-selected group of pregnant women
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