Depression In Early Pregnancy Research Articles

A prospective examination of depression, anxiety and stress throughout pregnancy

BackgroundPerinatal distress has largely been conceptualised as the experience of depression and/or anxiety. Recent research has shown that the affective state of stress is also present during the perinatal period and thus may add to a broader understanding of perinatal distress. AimThe aims of the present study were to investigate the changes in depression, anxiety and stress symptoms across pregnancy, and to explore the prospective relationships between these symptoms. MethodsTwo-hundred and fourteen pregnant women were recruited when they were less than 16 weeks gestation. Women completed depression, anxiety and stress measures on a monthly basis, from 16 weeks gestation through to 36 weeks gestation. The covariate measures of sleep quality and social support were assessed bi-monthly at 16, 24 and 32 weeks gestation. FindingsLevels of depression, anxiety and stress symptoms were all shown to change over time, with women experiencing fewer symptoms during the middle of their pregnancy. Higher symptoms early in pregnancy predicted higher symptom levels throughout the rest of pregnancy. Higher depression scores early in pregnancy were also shown to predict higher anxiety and higher stress scores in late pregnancy. Increased stress scores during mid pregnancy also predicted higher anxiety scores in late pregnancy. ConclusionCurrent findings indicate that symptom levels of depression, anxiety and stress vary over the course of pregnancy. Increased depression in early pregnancy seemed to be particularly pertinent as it not only predicted later depression symptoms, but also increased anxiety and stress in late pregnancy. Collectively, these results further highlight the importance of emotional health screening early in pregnancy.

6. Adaptive reproduction: How timing of psychosocial stimulus affects birth outcome

In the United States approximately one in eight babies is preterm. Thirty percent of preterm births are attributable to endocrine/immune changes related to stress processing. The evolving contribution of the maturing placenta, an active endocrine and immune organ, to stress processing is understudied. This project evaluated Adaptive Reproduction as a theory for understanding how environmental stressors and psychoneurological states impact birth outcomes. Two hypotheses were tested: (1) does the impact of stress, depression, tobacco use and social support on adverse birth outcomes vary across the gestation? And (2) does the experience of perinatal intimate partner violence (IPV) affect the timing of the impact of these variables on birth outcomes? Multilevel structural equation modeling was performed on data from BabyBEEP (R01 NR05313), a smoking cessation intervention RCT for low-income pregnant women ( N = 695). Thirty-four percent of the women experienced perinatal intimate partner violence. Both hypotheses were supported. When controlling for other variables, stress and social support have paradoxical effects at different stages of pregnancy. In women experiencing perinatal IPV, depression in early pregnancy is associated with preterm birth. Adaptive reproduction provides plausible explanation for why psychoneuroimmune alterations lead to preterm birth and low birthweight. This explains how community and individual level preconceptional and prenatal interventions aimed at enhancing functional social support and stress resilience improve outcomes and suggests modifications in timing of the interventions for enhanced effects.

Prenatal depressive symptoms and abnormalities of glucose tolerance during pregnancy among Hispanic women

The aim of this study is to prospectively examine the association between maternal depressive symptoms in early pregnancy and risk of abnormal glucose tolerance (AGT) and impaired glucose tolerance (IGT) in mid-pregnancy. We evaluated this association among 934 participants in Proyecto Buena Salud, a prospective cohort study of Hispanic (predominantly Puerto Rican) women in Western Massachusetts. Depressive symptoms were assessed in early pregnancy using the 10-item Edinburgh Postnatal Depression Scale. Scores ≥13 indicated at least probable minor depression and scores ≥15 indicated probable major depression. AGT and IGT were diagnosed using American Diabetes Association criteria. In early pregnancy, 247 (26.5%) participants experienced at least minor depression and 163 (17.4%) experienced major depression. A total of 123 (13.2%) were classified with AGT and 56 (6.0%) were classified with IGT. In fully-adjusted models, the odds ratio for AGT associated with minor depression was 1.20 (95% CI 0.77-1.89) and for major depression was 1.34 (95% CI 0.81-2.23). The odds ratio for IGT associated with minor depression was 1.22 (95% CI 0.62-2.40) and for major depression was 1.53 (95% CI 0.73-3.22). We did not observe an association with continuous screening glucose measures. Findings in this prospective cohort of Hispanic women did not indicate a statistically significant association between minor or major depression in early pregnancy and AGT or screening glucose values in mid-pregnancy. Due to the small number of cases of IGT, our ability to evaluate the association between depression and IGT risk was constrained.

Omega-6 fatty acids and greater likelihood of suicide risk and major depression in early pregnancy

ObjectiveTo estimate the prevalence of suicide risk (SR) and major depressive episodes (MDEs) in early pregnancy, as well as the relationship of serum fatty acid status to these outcomes. MethodsCross-sectional analyses were performed on data from 234 pregnant women enrolled in a prospective cohort study in Rio de Janeiro, Brazil. SR and MDE were defined according to the Mini International Neuropsychiatric Interview. Fatty acid compositions were determined for serum samples obtained between the 6th and 13th gestational week. Fatty acid data were expressed as the percent of total fatty acids, converted to Z scores and then entered as continuous variables in logistic regression models. ResultsThe prevalence of SR was 19.6% and that of MDE was 17.0%. In the adjusted logistic regressions, a higher likelihood of SR was observed among women with higher arachidonic acid levels [AA (20:4, n-6): OR=1.45, 95%CI 1.02–2.07] and adrenic acid levels [AdA (22:4, n-6): OR=1.43, 95%CI 1.01–2.04]. A higher likelihood of MDE was also observed among women with higher AA levels [OR=1.47, 95%CI 1.03–2.10] and AdA levels [OR=1.59, 95%CI 1.09–2.32]. ConclusionHigher serum levels of AA and AdA were associated with a greater likelihood of SR and MDE among pregnant Brazilian women.

Maternal depression and physical health problems in early pregnancy: Findings of an Australian nulliparous pregnancy cohort study

Objectiveto investigate the relationship between physical health problems and depressive symptoms in early pregnancy. Designbaseline questionnaire, prospective pregnancy cohort study. Settingsix metropolitan public maternity hospitals in Victoria, Australia. Participants1507 nulliparous women recruited in early pregnancy. Findingsnine per cent of women (131/1500) scored ≥13 on the EPDS indicating probable clinical depression in early pregnancy (mean gestation=15 weeks). The five most commonly reported physical health problems were as follows: exhaustion (86.9%), morning sickness (64.3%), back pain (45.6%), constipation (43.5%) and severe headaches or migraines (29.5%). Women scoring ≥13 on the EPDS reported a mean of six physical health problems compared with a mean of 3.5 among women scoring <13 on the EPDS. Women reporting five or more physical health problems had a three-fold increase in likelihood of reporting depressive symptoms (Adj OR=3.13, 95% CI 2.14–4.58) after adjusting for socio-demographic factors, including maternal age. Conclusionsthe findings from this large multi-centre study show that women experiencing a greater number of physical health problems are at increased risk of reporting depressive symptoms in early pregnancy. Implications for practiceearly detection and support for women experiencing physical and psychological health problems in pregnancy is an important aspect of antenatal care. The extent of co-morbid physical and psychological health problems underlines the need for comprehensive primary health care as an integral component of antenatal care.

FC11-04 - Patterns of depression and trajectories of treatment over the perinatal period

IntroductionPerinatal depression is an important problem with potentially deleterious health outcomes; however, we know little about the trajectories of depression and treatment.PurposeWe report the patterns of maternal depression and trajectories of treatment response in early and late pregnancy and during postpartum in 649 women recruited from the general population of pregnant women in Western Canada. Women who scored ≥ 12 on the Edinburgh Postnatal Depression Scale were classified as depressed.FindingsFifty-two percent of participants were primiparas, 90% were partnered, 83.3% Caucasian, 67% earn more than $40,000 per year, 90% completed high school, and 77% had planned pregnancy. The unadjusted prevalence of depression in early pregnancy (17 weeks) was 14%, late pregnancy (30 weeks) 11.5%, and postpartum (4.1 weeks) was 9.8%. All of the psychosocial factors measured - history of depression, mood instability, lack of social support, relationship problems, worry, and stressors heighten depression symptoms throughout parturition. Our practice of referring women who screened positive for depression changed prevalence rates of women who were depressed and in treatment. The number of women in treatment increased from 12.2% in early pregnancy to 24.8% at postpartum. Women were significantly more likely to get symptom relief counselling in pregnancy compared to psychotropic medication use in postpartum, with the exception of those women with history of depression and treatment engagement.SummaryIncreased understanding of the patterns and nature of maternal depression and treatment response is essential to early identification of women who are depressed and lead to treatment that is more effective.

Risk factors in pregnancy for post‐traumatic stress and depression after childbirth

The objective of this study was to find risk factors in pregnancy for post-traumatic stress and depression 1 month after childbirth. Furthermore, the relation between post-traumatic stress and depression was explored. A prospective longitudinal study. Pregnant women in Linköping and Kalmar, Sweden. A total of 1224 women were assessed in pregnancy, week 12-20 and 32, as well as 1 month postpartum. Post-traumatic stress and depression after delivery were assessed 1 month postpartum. Potential risk factors were assessed in early and late pregnancy. Variables measured during pregnancy were trait anxiety, depression, fear of childbirth, childbirth-related traumatic stress, stress coping capacity, social support, parity, educational level, age, gestation week, parity, educational level, civil status, previous psychological/psychiatric counselling, and previous experience of any traumatic events. Delivery mode was assessed from the medical records. Prevalence of post-traumatic stress (criteria A, B, C, D, E, and F according to DSM-IV) and depression (Beck's depression inventory). One month postpartum, 12 (1.3%) women had post-traumatic stress (met symptom criteria B, C, and D for post-traumatic stress disorder according to Diagnostic and statistical manual of mental disorders, 4th edition [DSM-IV]). The most important risk factors in pregnancy were depression in early pregnancy (OR=16.3), severe fear of childbirth (OR=6.2), and 'pre'-traumatic stress (in view of the forthcoming delivery) in late pregnancy (OR=12.5). The prevalence of depression was 5.6%. Post-traumatic stress and depression were positively related 1 month postpartum and were predicted by mainly the same factors. Risk factors for post-traumatic stress and depression after childbirth can be assessed in early pregnancy. Post-traumatic stress and depression also seem to share the same underlying vulnerability factors.

Depression in early pregnancy can lead to preterm delivery.

Pregnant women with symptoms of depression are at an increased risk of preterm delivery and this is exacerbated by social and reproductive risk factors, obesity and stressful events.

Assessment and relationship of sleep quality to depression in early pregnancy

Sleep quality is integral to optimal physical functioning and mental health during pregnancy. There has, however, been little work conducted to determine the most appropriate measure of sleep quality in this clinical group, a surprising observation given the complex and dynamic psychobiology of pregnancy. The Pittsburgh Sleep Quality Index (PSQI) was evaluated to determine the usefulness of this measure in early pregnancy. The psychometric properties of the PSQI were evaluated in women at 14 weeks of pregnancy and revealed the instrument to have good internal consistency and convergent and divergent reliability properties. Confirmatory factor analysis suggested that the removal of the PSQI sleeping medications sub‐scale from the global sleep quality total score calculation would improve the utility of this measure in early pregnancy. Women classified as depressed on the basis of Edinburgh Postnatal Depression Scale (EPDS) scores were found to have significantly poorer sleep quality scores on the majority of PSQI sub‐scales. The relationship between sleep quality and depression was found to be statistically significant and clinically relevant during early pregnancy and the PSQI would appear to be an appropriate measure to assess sleep quality in this group.

Is the hospital anxiety and depression scale (HADS) a reliable screening tool in early pregnancy?

The factor structure and internal reliability of the Hospital Anxiety and Depression Scale (HADS) was investigated to determine the suitability of the instrument for screening during early pregnancy. The study used a cross-sectional design with all observations taken at the antenatal booking clinic. Confirmatory factor analysis (CFA) of the HADS revealed that a three-factor solution offered the most parsimonious account of the data. However, the CFA further revealed that none of the factor models tested provided a consistent and good fit to the data. It was concluded that the HADS does not reliably assess distinct domains of anxiety and depression in early pregnancy. These findings suggest that the HADS is not a suitable screening tool for symptoms of anxiety and depression in this clinical group.

Psychosocial study of depression in early pregnancy.

The psychosocial correlates of depression during pregnancy were explored. Pregnant women attending the antenatal clinic of a general hospital (n = 1329) received a set of questionnaires including Zung's Self-Rating Depression Score (SDS). SDS high scores (> 49) (the cases: n = 179) were compared with low scores (< 38) (the controls; n = 343). The cases were characterised by: first delivery; more nausea, vomiting, and anorexia; more menstrual pains and premenstrual irritability; early paternal loss; lower maternal care and higher paternal overprotection; higher public self-consciousness score; more smoking and use of medication in pregnancy; unwanted pregnancy; negative psychological response to the pregnancy by the woman and husband; poor intimacy by the husband; and having remarried. Depression in early pregnancy is determined mainly by psychosocial factors.