Levels Of Prenatal Depressive Symptoms Research Articles

A Mixed Methods Longitudinal Investigation of Maternal Depression Across the Perinatal Period Among Mothers Who Gave Birth During the COVID-19 Pandemic

BackgroundDepression during the perinatal period is associated with negative outcomes for both mothers and children, including higher rates of chronic depression in mothers and physical, emotional, and cognitive issues in children. This study aimed to determine how the stressors of the COVID-19 pandemic contributed to prenatal and postpartum depressive symptoms among a sample of peripartum mothers who gave birth during the pandemic. This study also examined risk factors for postpartum depression, including prenatal depressive symptoms, demographic characteristics, timing of birth during the pandemic, pregnancy intention, birth expectations and experiences, and pandemic-related concerns. MethodsThis mixed methods study included data from online surveys using a convenience sample of 284 expectant mothers with due dates from April 2020 to September 2021, and qualitative interviews with a subset of participants. Depressive symptoms and risk for clinical depression were assessed using the Edinburgh Postnatal Depression Scale during the third trimester of pregnancy and again within 8 weeks postpartum. Multiple regression models examined potential risk factors to determine which variables most predicted participants’ postpartum depressive symptoms and risk of clinical depression. ResultsAmong this nonrepresentative, mostly white, and highly resourced sample, one-third of participants (33.8%) met the criteria for risk of clinical depression during the prenatal period, and 32.7% met this threshold in the postpartum period. Participants who reported higher levels of prenatal depressive symptoms, gave birth earlier in the pandemic, reported lower income, or had more pandemic-related concerns tended to report more postpartum depressive symptoms, adjusting for demographic characteristics and other variables of interest. Peripartum mothers who reported symptoms consistent with risk of clinical depression prenatally were almost four times more likely to screen positive for depression in the postpartum period, even after adjusting for other variables. In interviews, participants attributed negative emotions in pregnancy to uncertainty related to pandemic-related changes in care and expressed grief about missed pregnancy and postpartum experiences. In the postpartum period, some participants reported that their births were ultimately less stressful than anticipated. ConclusionsFindings highlight the need for consistent and frequent depression screenings across the perinatal period, especially among participants who report depressive symptoms prenatally. Participants who gave birth early in the pandemic were at the highest risk of postpartum depression and may continue to need additional supports.

Risk Perception and Maternal Prenatal Depressive Symptoms in the Early Stage of COVID-19 Pandemic in China: Role of Negative Emotions and Family Sense of Coherence.

Prenatal depression is associated with adverse health outcomes for both mothers and their children. The worldwide COVID-19 pandemic has presented new risks and challenges for expectant mothers. The aims of the study were to investigate the underlying mechanism between COVID-19 risk perception of Chinese pregnant women and their prenatal depressive symptoms and potential protective factors such as family sense of coherence (FSOC). A total of 181 Chinese pregnant women (Mage = 31.40 years, SD = 3.67, ranged from 23 to 43) participated in an online survey from April 22 to May 16, 2020. Risk perception and negative emotions (fear and anxiety) related with COVID-19, FSOC, and prenatal depressive symptoms were assessed. The experience of maternal COVID-19 related negative emotion fully mediated the positive relationship between COVID-19 risk perception and prenatal depressive symptoms of pregnant women (β = 0.12, 95% CI [0.06, 0.19]). When confronting COVID-19 related fear and anxiety, expectant mothers from higher coherent families experienced a significantly lower level of prenatal depressive symptoms. Contextual negative emotional experience was demonstrated to explain how risk perception impacts depressive symptoms during severe public health crisis for pregnant women. FSOC may be a psychological resource protecting pregnant women from experiencing adverse psychological outcomes during COVID-19 pandemic.

Associations of prenatal maternal depressive symptoms with cord blood glucocorticoids and child hair cortisol levels in the project viva and the generation R cohorts: a prospective cohort study

BackgroundPrior studies have reported conflicting results regarding the association of prenatal maternal depression with offspring cortisol levels. We examined associations of high levels of prenatal depressive symptoms with child cortisol biomarkers.MethodsIn Project Viva (n = 925, Massachusetts USA), mothers reported their depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy, cord blood glucocorticoids were measured at delivery, and child hair cortisol levels were measured in mid-childhood (mean (SD) age: 7.8 (0.8) years) and early adolescence (mean (SD) age: 13.2 (0.9) years). In the Generation R Study (n = 1644, Rotterdam, The Netherlands), mothers reported depressive symptoms using the Brief Symptom Inventory (BSI) during pregnancy, and child hair cortisol was measured at a mean (SD) age of 6.0 (0.5) years. We used cutoffs of ≥ 13 for the EPDS and > 0.75 for the BSI to indicate high levels of prenatal depressive symptoms. We used multivariable linear regression models adjusted for child sex and age (at outcome), and maternal pre-pregnancy BMI, education, social support from friends/family, pregnancy smoking status, marital status, and household income to assess associations separately in each cohort. We also meta-analyzed childhood hair cortisol results from both cohorts.Results8.0% and 5.1% of women respectively experienced high levels of prenatal depressive symptoms in Project Viva and the Generation R Study. We found no associations between high levels of maternal depressive symptoms during pregnancy and child cortisol biomarkers in either cohort.ConclusionsThe present study does not find support for the direct link between high levels of maternal depressive symptoms and offspring cortisol levels.

Fetal heart rate variability and infant self-regulation: the impact of mother’s prenatal depressive symptoms

ABSTRACT Background Foetal heart rate (FHR) variability is considered a marker of foetal neurobehavioral development associated with infant self-regulation and thus may be an early precursor of the adverse impact of mother’s prenatal depressive symptoms on infant self-regulation. Objective This study analysed the mediator role of FHR variability in the association between mother’s prenatal depressive symptoms and infant self-regulation at three months. Methods The sample comprised 86 first-born infants and their mothers. Mothers reported on depressive symptoms at the first trimester of pregnancy and on depressive symptoms and infant self-regulation at three months postpartum. FHR variability was recorded during routine cardiotocography at the third trimester of pregnancy. A mediation model was tested, adjusting for mother’s postnatal depressive symptoms. Results Higher levels of mother’s prenatal depressive symptoms were associated with both lower FHR variability and lower infant self-regulation at three months. FHR variability was associated with infant self-regulation and mediated the association between mother’s prenatal depressive symptoms and infant self-regulation at three months. Conclusion Findings suggested FHR variability as an early precursor of infant self-regulation that underlies the association between mother’s prenatal depressive symptoms and infant self-regulation. Infants of mothers with higher levels of prenatal depressive symptoms could be at risk of self-regulation problems, partially due to their lower FHR variability.

Social media use as a risk factor for depressive symptoms during pregnancy

BackgroundAccumulating research has shown associations between excessive social media use (SMU) with depressive symptoms. Depression is common during pregnancy, but it is not known whether SMU plays a role in the etiology and clinical course of depressive symptoms during pregnancy. MethodsThe current study is a prospective cohort study with Dutch-speaking pregnant women recruited at the first antenatal appointment (N = 697). Depressive symptoms were measured at each trimester of pregnancy using the Edinburgh Depression Scale. Growth mixture modeling was used to determine classes of women based on longitudinal trajectories of depressive symptoms. SMU was assessed at 12 weeks of pregnancy, specifically, intensity (time and frequency) and problematic SMU (Bergen Social Media Addiction Scale). Multinomial logistic regression analyses were used to examine the associations between SMU and trajectories of depressive symptoms. ResultsThree trajectories of depressive symptoms during pregnancy were identified: a low stable (N = 489, 70.2 %), intermediate stable (N = 183, 26.3 %), and high stable (N = 25, 3.6 %) class. SMU Time and Frequency were significantly associated with belonging to the high stable class. Problematic SMU was significantly associated with belonging to the intermediate or high stable class. LimitationsThe study does not allow to draw conclusions about causality. The group sizes of the three trajectories differed considerably. Data were collected during the COVID-19 pandemic which may have influenced the results. SMU was measured by self-report. ConclusionsThese results indicate that both higher intensity of SMU (time and frequency) and problematic SMU may be a risk factor for higher levels of prenatal depressive symptoms during pregnancy.

Prenatal and postnatal depressive symptoms, infant white matter, and toddler behavioral problems

BackgroundMaternal depression is prevalent during and following pregnancy and is related to adverse outcomes in offspring. Perinatal depression is associated with risk for difficulties in offspring; however, the mechanisms underlying this association are not clear. We examined whether maternal prenatal and postnatal depressive symptoms were associated with infant white matter organization and with behavioral problems in toddlerhood. Methods37 mother–infant dyads (20 male; ages 5.95–7.66 months) participated in this study. We conducted diffusion MRI with infants during natural sleep. Mothers reported on their prenatal and postnatal depressive symptoms at six months postpartum. We calculated fractional anisotropy (FA), radial, axial, and mean diffusivity, and assessed offspring behavioral problems at age 18 months. ResultsPrenatal depressive symptoms were associated with FA of the corpus callosum; postnatal depressive symptoms were not associated with FA of limbic tracts or corpus callosum segmentations. Higher levels of prenatal depressive symptoms were associated with higher FA and lower radial diffusivity of the corpus callosum genu; FA of this region was positively associated with behavioral problems at age 18 months. LimitationsThis study had a small sample size; therefore, findings should be replicated. Further, we used retrospective reports of maternal prenatal depression, but validated them in this study. ConclusionsDepressive symptoms during pregnancy may affect infant corpus callosum development and, in turn, offspring behaviors. These findings suggest that early maternal stress accelerates infant neurodevelopment in a manner that may increase risk for behavioral problems. Thus, efforts to reduce maternal prenatal depression should be a public health priority.

The relationship between paternal prenatal depressive symptoms with postnatal depression: The PATH model

The purpose of the study was to determine the relationship between men's prenatal and postnatal depressive symptom (PDS). In a descriptive study, 403 fathers meeting the inclusion criteria were enrolled using Poisson random sampling method from public health clinics in Zanjan, Iran. All participants were selected in the third trimester of pregnancy and were followed up eight weeks after childbirth. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen the participants for depressive symptoms. Data was analyzed using descriptive test, Path analysis at a confidence level of 95%. Results showed that the effect of the prenatal depressive symptoms on PDS had perfect good fitness indices. A high level of prenatal depressive symptoms predicted a high level of PDS. We found significant total mediating effects of state, trait, and total anxiety on PDS. The total moderating effect of income on PDS was not statistically significant. These results suggest that a high level of prenatal depressive symptoms is a risk factor for a high level of PDS. Therefore, health providers should pay more attention to the psychological health of fathers during the pre and postpartum period. The predictor factors should be considered in both intervention and clinical assessment of paternal PDS.

Intergenerational Effects of Childhood Trauma: Evaluating Pathways Among Maternal ACEs, Perinatal Depressive Symptoms, and Infant Outcomes.

Maternal adverse childhood experiences (ACEs) have been associated with negative physical and mental health outcomes in adulthood. Less is known regarding how maternal ACEs relate to perinatal depressive symptoms or the intergenerational effect of maternal childhood trauma history on birth outcomes and infant functioning. To address this gap, an at-risk sample of 398 pregnant women was recruited from Women, Infants, and Children health clinics. Participants completed a prenatal ( M = 4.84 months before due date) and postnatal ( M = 6.76 months after birth) assessment and provided birth outcome data. At the prenatal assessment, mothers completed an ACEs measure which assessed experiences of childhood maltreatment and household dysfunction. Self-report measures of maternal depressive symptoms were obtained at both time points. Mothers reported on infant socioemotional functioning at 6 months. Maternal ACEs predicted higher levels of prenatal depressive symptoms. Childhood maltreatment experiences, in particular, predicted higher postnatal depressive symptoms and a smaller reduction in depressive symptoms across the perinatal period. Regarding intergenerational associations, maternal childhood maltreatment directly predicted higher levels of maladaptive infant socioemotional symptoms, whereas maternal household dysfunction indirectly related to infant socioemotional symptoms through maternal age at first pregnancy and infant birth weight. Limitations and future directions are discussed.

Assessing the Independent and Joint Effects of Unmedicated Prenatal Depressive Symptoms and Alcohol Consumption in Pregnancy and Infant Neurodevelopmental Outcomes

Prenatal alcohol exposure (PAE) is an established risk factor for neurodevelopmental deficits in the offspring. Prenatal depression has been associated with neurodevelopmental deficits in the offspring, although investigations into unmedicated prenatal depression have been inconsistent. We hypothesized that unmedicated prenatal depressive symptoms would independently and jointly with PAE predict neurodevelopmental outcomes in infant offspring. We studied 344 participants from a randomized clinical trial of multivitamin supplements in pregnant women in Ukraine. Women were recruited based upon periconceptional alcohol use and followed up to 12months postpartum. Prenatal depressive symptoms were assessed at approximately 32weeks of gestation using the Beck Depression Inventory score. Neurodevelopment was assessed with the Bayley Scales of Infant Development II Mental Development Index (MDI) and Psychomotor Development Index (PDI) at 6 and 12months postpartum. Generalized linear regression models were constructed to assess the independent and joint effects of prenatal depressive symptoms and PAE in models adjusted for sociodemographic and pregnancy characteristics. PAE was independently associated with deficits in neurodevelopmental outcomes at 6 and 12months, however, level of prenatal depressive symptoms was not. We found marginal evidence of synergism of depressive symptoms and PAE, with larger deficits in those with both exposures observed for the PDI-6months (p=0.05) and MDI-12months (p=0.09). Additionally, there was a suggestion of sexual dimorphism; females had stronger deficits from joint exposures than males (depressive symptom [MDI-6months] female: -8.28, 95% CI -13.06, -3.49; male: 0.68, 95% CI -4.58, 5.94; p for interaction 0.04). While not statistically significant for the MDI or PDI at 12months, the trend persisted. Infants exposed to PAE and prenatal depression may be at an increased risk of neurodevelopmental deficits. Healthcare providers should be aware of this possible synergism in their efforts to mitigate the neurodevelopmental effects of these co-occurring exposures.

Prenatal depression and young low-income mothers’ perception of their children from pregnancy through early childhood

This study investigates the role of prenatal depression on young mothers’ perception of difficulty in child behavior and parent–child interaction from pregnancy through the first two years of child development. 248 low-income, African American women aged between 13 and 21 years reported on their perceptions of child behavior, parent–child interaction, and on depressive symptoms at the third trimester of pregnancy and at 4-, 12- and 24-months postpartum. During pregnancy, a high percentage (47%) of the young mothers scored above the clinical level of prenatal depressive symptoms. These mothers anticipated and perceived significantly more child difficulty and parent–child interaction difficulty than did non-depressed mothers during pregnancy and over the first two years of the child's development. Moreover, prenatal depression uniquely predicted negative maternal perception throughout the early years of child development even after adjusting for postpartum depression history. The enduring association between prenatal depression and a mother's perception of her child is discussed with respect to the importance of pregnancy in mothers’ developing mental schema about their children and the emerging parent–child relationship.

Prenatal Depressive Symptoms and Postpartum Sexual Risk Among Young Urban Women of Color

Study ObjectiveTo determine whether prenatal depressive symptoms are associated with postpartum sexual risk among young, urban women of color. DesignParticipants completed surveys during their second trimester of pregnancy and at 1 year postpartum. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression Scale, excluding somatic items because women were pregnant. Logistic and linear regression models adjusted for known predictors of sexual risk and baseline outcome variables were used to assess whether prenatal depressive symptoms make an independent contribution to sexual risk over time. SettingFourteen community health centers and hospitals in New York City. ParticipantsThe participants included 757 predominantly black and Latina (91%, n = 692) pregnant teens and young women aged 14-21 years. Interventions and Main Outcome MeasuresThe main outcome measures were number of sex partners, condom use, exposure to high-risk sex partners, diagnosis of a sexually transmitted disease, and repeat pregnancy. ResultsHigh levels of prenatal depressive symptoms were significantly associated with increased number of sex partners (β = 0.17; standard error, 0.08), decreased condom use (β = −7.16; standard error, 3.08), and greater likelihood of having had sex with a high-risk partner (odds ratio = 1.84; 95% confidence interval, 1.26-2.70), and repeat pregnancy (odds ratio = 1.72; 95% confidence interval, 1.09-2.72), among participants who were sexually active (all P < .05). Prenatal depressive symptoms were not associated with whether participants engaged in postpartum sexual activity or sexually transmitted disease incidence. ConclusionScreening and treatment for depression should be available routinely to women at risk for antenatal depression.

Antenatal Depression in a Multi-Ethnic, Community Sample of Canadian Immigrants: Psychosocial Correlates and Hypothalamic-Pituitary-Adrenal Axis Function

Immigrant women living in Canada present with higher rates of prenatal depressive symptomatology than Canadian-born women; however, the associated psychosocial correlates remain understudied. Antenatal depression and stress negatively affect maternal health and infant development, in part through changes in maternal hypothalamic-pituitary-adrenal (HPA) axis activity. We aimed to examine the factors associated with prenatal depressive symptoms, including altered HPA axis function, in an ethnically diverse community sample of Canadian immigrant women. Seventy-eight pregnant immigrant women were recruited from the community at 19 weeks' gestation and provided information on health, mood, stressful life events (SLEs), and social support. Fifty-seven of these women also provided saliva samples for measurement of the cortisol awakening response and nighttime cortisol levels. Seventeen per cent of the sample had a high level of prenatal depressive symptoms, and these women reported more perceived stress, more somatic symptoms, lower social support, and were less often working or attending school during pregnancy. Controlling for wake time, parity, and region of origin, high levels of prenatal depressive symptoms were associated with elevated nighttime cortisol levels, whereas SLEs were not associated with any measures of HPA axis activity. High levels of prenatal depressive symptoms are common in immigrant women living in Canada, and are associated with identifiable factors. Preliminary evidence suggests a similar pattern of HPA axis activity characterizing depressive symptomatology in this subpopulation as previously seen in clinically depressed patients.

Household food insecurity is associated with depressive symptoms among low-income pregnant Latinas

Latinas experience high rates of poverty, household food insecurity and prenatal depression. To date, only one USA study has examined the relationship between household food insecurity and prenatal depression, yet it focused primarily on non-Latina white and non-Latina black populations. Therefore, this study examined the independent association of household food insecurity with depressive symptoms among low-income pregnant Latinas. This cross-sectional study included 135 low income pregnant Latinas living in Hartford, Connecticut. Women were assessed at enrolment for household food security during pregnancy using an adapted and validated version of the US Household Food Security Survey Module. Prenatal depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. A cut-off of ≥21 was used to indicate elevated levels of prenatal depressive symptoms (EPDS). Multivariate backwards stepwise logistic regression was used to identify risk factors for EPDS. Almost one third of participants had EPDS. Women who were food insecure were more likely to experience EPDS compared to food secure women (OR = 2.59; 95% CI = 1.03-6.52). Being primiparous, experiencing heartburn and reporting poor/fair health during pregnancy, as well as having a history of depression were also independent risk factors for experiencing EPDS. Findings from this study suggest the importance of assessing household food insecurity when evaluating depression risk among pregnant Latinas.

How Much Does Low Socioeconomic Status Increase the Risk of Prenatal and Postpartum Depressive Symptoms in First-Time Mothers?

To examine socioeconomic status (SES) as a risk factor for depressive symptoms in late pregnancy and the early postpartum period. A secondary objective was to determine whether SES was a specific risk factor for elevated postpartum depressive symptoms beyond its contribution to prenatal depressive symptoms. Quantitative, secondary analysis, repeated measures, descriptive design. Participants were recruited from paid childbirth classes serving upper middle class women and Medicaid-funded hospitals serving low-income clients in Northern California. A sample of 198 first-time mothers was assessed for depressive symptoms in their third trimester of pregnancy and at 1, 2, and 3 months postpartum. Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) Scale. Low SES was associated with increased depressive symptoms in late pregnancy and at 2 and 3 months, but not at 1 month postpartum. Women with four SES risk factors (low monthly income, less than a college education, unmarried, unemployed) were 11 times more likely than women with no SES risk factors to have clinically elevated depression scores at 3 months postpartum, even after controlling for the level of prenatal depressive symptoms. Although new mothers from all SES strata are at risk for postpartum depression, SES factors including low education, low income, being unmarried, and being unemployed increased the risk of developing postpartum depressive symptoms in this sample.

Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.

This study addressed two aims: (1) to assess the level of depressive symptoms among pregnant, HIV-infected racial and ethnic minority women and (2) to identify potentially modifiable factors associated with prenatal depression in order to foster proactive clinical screening and intervention for these women. Baseline interview data collected from HIV-infected women participating in the Perinatal Guidelines Evaluation Project were analyzed. Participants were from prenatal clinics in four areas representative of the U. S. HIV/AIDS epidemic among women. Of the final sample (n = 307), 280 were minorities (218 blacks [African American and Caribbean], 62 Hispanic). Standardized interviews assessed potential psychosocial factors associated with pregnancy-related depression and psychological distress (life stressors, inadequate social support, and ineffective coping skills) in a population for whom little work has been done. Depressive symptomatology was considerable, despite excluding somatic items in order to avoid confounding from prenatal or HIV-related physical symptoms. The psychosocial factors significantly predicted the level of prenatal depressive symptoms beyond the effects of demographic and health-related factors. Perceived stress, social isolation, and disengagement coping were associated with greater depression, positive partner support with lower depression. These findings demonstrate that psychosocial and behavioral factors amenable to clinical intervention are associated with prenatal depression among women of color with HIV. Routine screening to identify those currently depressed or at risk for depression should be integrated into prenatal HIV-care settings to target issues most needing intervention.

Prenatal Correlates of Indigent Mothers?? Attitudes about Spoiling Their Young Infants

The purpose of this study was to investigate factors associated with indigent mothers' attitudes about spoiling their young infants. Mothers who believe that young infants can be spoiled may be more likely to misperceive their infants' basic needs for nurturing and thus undermine their infants' sense of security and trust. One hundred twenty-nine consecutive pregnant women who were at approximately 15 weeks' gestation completed measures to assess depressive symptoms (Center for Epidemiologic Studies Depression Scale) and social support (Maternal Social Support Index). One hundred seventeen mothers (91%) completed a simple three-question Spoiling Index when their infants were about 1 month old. Fifty-eight percent were single, never married, 73% multiparous, 66% Euro-American, 28% African-American, and 84% at least 20 years old. Fifty-eight percent of mothers believed infants younger than 5 months old could be spoiled. After including maternal age, race, marital status, prenatal social support, and number of prenatal clinic visits in the hierarchical logistic regression model, "spoilers" were more likely to be primigravida mothers (odds ratio = 2.71; 95% confidence interval, 1.05 to 7.06) and more likely to be depressed during pregnancy (odds ratio = 2.83; 95% confidence interval, 1.29 to 6.19). Primigravida indigent mothers and mothers with higher levels of prenatal depressive symptoms are more likely to believe they can spoil their young infants.