Abstract
BackgroundAntenatal maternal psychological distress is common in low and middle-income countries (LMIC), but there is a dearth of research on its effect on birth and developmental outcomes in these settings, particularly in Sub-Saharan Africa. This study set out to identify risk factors for antenatal maternal psychological distress and determine whether antenatal maternal psychological distress was associated with infant birth and developmental outcomes, using data from the Drakenstein Child Health Study (DCHS), a birth cohort study in South Africa. MethodsPregnant women were enrolled in the DCHS from primary care antenatal clinics. Antenatal maternal psychological distress was measured using the Self-Reporting Questionnaire 20-item (SRQ-20). A range of psychosocial measures, including maternal childhood trauma, depression, and posttraumatic stress disorder (PTSD) were administered. Birth outcomes, including premature birth, weight-for-age z-score and head circumference-for-age z-score, were measured using revised Fenton growth charts. The Bayley III Scales of Infant and Toddler Development was administered at 6 months of age to assess infant development outcomes, including cognitive, language, and motor domains in a subset of n=231. Associations of maternal antenatal psychological distress with psychosocial measures, and with infant birth and developmental outcomes were examined using linear regression models. Results961 women were included in this analysis, with 197 (21%) reporting scores indicating the presence of psychological distress. Antenatal psychological distress was associated with maternal childhood trauma, antenatal depression, and PTSD, and inversely associated with partner support. No association was observed between antenatal maternal psychological distress and preterm birth or early developmental outcomes, but antenatal maternal psychological distress was associated with a smaller head circumference at birth (coefficient=−0.30, 95% CI: −0.49; −0.10). ConclusionAntenatal maternal psychological distress is common in LMIC settings and was found to be associated with key psychosocial measures during pregnancy, as well as with adverse birth outcomes, in our study population. These associations highlight the potential value of screening for antenatal maternal psychological distress as well as of developing targeted interventions.
Highlights
Psychological distress, refers to a heterogenous range of symptoms, including anxiety, anguish, depression, and demoralisation [1, 2]
The prevalence of antenatal depression ranged from 4.3% to 17.4%, with a weighted mean prevalence of 11.3% in five reviewed studies conducted in Nigeria, Morocco, and The Gambia [12]
Sociodemographic information was collected from the mother at enrolment, and many of these measures were adapted from items used in the South African Stress and Health Study [46]
Summary
Psychological distress, refers to a heterogenous range of symptoms, including anxiety, anguish, depression, and demoralisation [1, 2]. Maternal psychological distress may be even more common in low and middle-income countries (LMIC), where there are a range of risk factors for these symptoms and disorders, including underlying socio-economic stressors [5]. Two more recent studies from Nigeria found a weighted mean prevalence of maternal anxiety during pregnancy of 14.8% (95% CI: 12.3%-17.4%) [12] These studies suggest that the prevalence of maternal depression and anxiety disorders are high in Sub-Saharan Africa. Antenatal maternal psychological distress is common in low and middleincome countries (LMIC), but there is a dearth of research on its effect on birth and developmental outcomes in these settings, in Sub-Saharan Africa. This study set out to identify risk factors for antenatal maternal psychological distress and determine whether antenatal maternal psychological distress was associated with infant birth and developmental outcomes, using data from the Drakenstein Child Health Study (DCHS), a birth cohort study in South Africa
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