Abstract
Maternal depression during pregnancy is associated with emotional and behavioral difficulties of offspring during childhood that can increase the risk of depression in adolescence and adulthood. To investigate the association between perinatal maternal depression and an increased long-term risk of depression in their adolescent and adult offspring. A systematic search of the electronic databases of PubMed and PsycINFO was conducted from May 2019 to June 2019. A total of 6309 articles were identified, of which 88 articles were extracted for full-text review by 2 reviewers. Only articles reporting data from prospective longitudinal studies that assessed maternal depression during antenatal and/or postnatal periods and resulting offspring 12 years or older with measures of established psychometric properties were included. Exclusion criteria consisted of all other study designs, mothers with other medical and psychiatric comorbidities, and offspring younger than 12 years. Data were extracted by 2 independent reviewers, and discrepancies were mediated by an expert third reviewer. Meta-analysis was performed using Bayesian statistical inference and reported using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline. The association of depression timing with the sex of offspring was explored using metaregression. Offspring depression was evaluated using standardized depression scales or clinical interviews. Six studies with a total of 15 584 mother-child dyads were included in the meta-analysis, which found the offspring of mothers who experienced perinatal depression to have increased odds of depression (odds ratio [OR], 1.70; 95% credible interval [CrI], 1.60-2.65; posterior probability [PP] [OR >1], 98.6%). Although metaregression found no evidence for an overall association between perinatal depression timing and offspring depression (antenatal vs postnatal, PP [OR >1] = 53.8%), subgroup analyses showed slightly higher pooled odds for the antenatal studies (OR, 1.78; 95% CrI, 0.93-3.33; PP [OR >1] = 96.2%) than for the postnatal studies (OR, 1.66; 95% CrI, 0.65-3.84; PP [OR >1] = 88.0%). Female adolescent offspring recorded higher rates of depression in metaregression analyses, such that a 1% increase in the percentage of female (relative to male) offspring was associated with a 6% increase in the odds of offspring depression (OR, 1.06; 95% CrI, 0.99-1.14; τ2 = 0.31). In this study, maternal perinatal depression, especially antenatal depression, was associated with the risk of depression in adolescence and adulthood. More research into the mechanisms of depression risk transmission and assessments of postinterventional risk reduction could aid in the development of future strategies to tackle depressive disorders in pregnancy.
Highlights
Perinatal depression is a depressive episode that occurs in women during pregnancy or within 12 months after pregnancy
Six studies with a total of 15 584 mother-child dyads were included in the meta-analysis, which found the offspring of mothers who experienced perinatal depression to have increased odds of depression
Metaregression found no evidence for an overall association between perinatal depression timing and offspring depression, subgroup analyses showed slightly higher pooled odds for the antenatal studies (OR, 1.78; 95% credible intervals (CrIs), 0.93-3.33; posterior probability (PP) [odds ratios (ORs) >1] = 96.2%) than for the postnatal studies (OR, 1.66; 95% CrI, 0.65-3.84; PP [OR >1] = 88.0%)
Summary
Perinatal depression is a depressive episode that occurs in women during pregnancy (antenatal depression) or within 12 months after pregnancy (postnatal depression). Studies show that approximately 10% to 20% of women experience perinatal depression.[1] Antenatal depression is estimated to affect 7.4% to 12.8% of women, with women in their second and third trimesters being most susceptible.[2] The prevalence of postnatal depression is estimated to be 10% to 15% of all pregnancies, and it may be as high as 25% in women with low incomes.[3] Women with severe maternal depression are at an increased risk of self-harm, suicide, substance use disorder, marital difficulties, and parenting difficulties.[4,5,6] Perinatal depression affects children by increasing the risk of mental and physical health problems,[7,8] substantially contributing to family and societal burden. The adverse consequences of perinatal depression on childhood development, including increased behavioral difficulties, impaired cognitive ability, and decreased emotional functioning, have been well established.[9,10,11,12] Studies have noted that additional consequences in adolescent offspring include anxiety, experiencing bullying, and depression.[13,14,15] perinatal depression is a significant health concern as a potentially treatable cause of impaired functioning in offspring.[16,17]
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