Maternal Depressive Symptoms in Relation to Perinatal Mortality and Morbidity: Results From a Large Multiethnic Cohort Study

Abstract

To explore whether 1) maternal depressive symptoms during pregnancy are associated with preterm birth (PTB), small for gestational age (SGA), a low Apgar score and child loss; 2) maternal smoking mediates the associations; and 3) the associations differ by ethnic background. Pregnant women in Amsterdam were approached during their first prenatal visit to participate in the Amsterdam Born Children and their Development study. They filled out a questionnaire covering sociodemographic data, life-style, and (psychosocial) health. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale. The baseline sample consisted of 8,052 women; the main ethnic groups were: Dutch, Creole, Turkish, and Moroccan. The prevalence of perinatal outcomes was: 5.4% (PTB); 12.3% (SGA); l 1.5% (low Apgar score); and 1.4% (child loss). The prevalence of high depressive symptomatology was 30.6%. After adjustment for maternal age, parity, education, ethnicity, prepregnancy body mass index, hypertension, alcohol and drug use, and a small mediation effect of maternal smoking, high versus low levels of depressive symptoms were associated with SGA (odds ratio [OR], 1.19; p = .02) and a low Apgar score (OR, 1.74; p = .01), but not with PTB (OR, 1.16; p = .18) and child loss (OR, 1.28; p = .24). Stratified analyses by ethnic background showed a tendency toward higher risks, although insignificant, among Creole women. Several pathways may explain the detrimental effects of maternal depressive symptomatology on perinatal health outcomes, including a psychoendocrinological pathway involving the hormone cortisol or mediation effects by maternal risk behaviors. Further research should explore the underlying pathways, in particular among ethnic subgroups.