Women who are depressed during pregnancy have a higher chance of premature births according to findings from scientists at University of Washington (UW). The study, published in the Archives of General Psychiatry, also show that women who suffer from depression, combined with lower socioeconomic status are at even higher risk of delivering early or having an infant with low birth weight.
The findings are important for public health. Women commonly feel depressed during pregnancy. Infants born prematurely are at risk for respiratory and neurological problems in addition to chronic health problems that put them at risk for early mortality from disabilities.
"In the United States, the likelihood of experiencing premature birth is even greater for depressed pregnant women living in poverty than for depressed pregnant women from middle- to high-socioeconomic backgrounds," explains lead study author Dr. Nancy Grote, research associate professor of social work at UW. Additionally, "Poor women in America are twice as likely to experience depression, compared to other women in this country."
The statistical analysis was performed by Dr. Jeffrey Bridge of The Research Institute at Nationwide Children's Hospital and Department of Pediatrics of The Ohio State University that was a combined effort of UW, The Ohio State University, and the University of Pittsburgh. The multidisciplinary team included social work, psychiatry, statistics, obstetrics, and pediatrics. Included were United States and non-United States studies in the research, conducted rigorously to clarify inconsistencies found in past studies linking depression to preterm birth and low birth weight
Depression During Pregnancy has Lasting Effects
The research confirmed the link, but in addition to premature birth the scientist say depression during pregnancy can have lasting effects on mother and child. "Maternal depression affects the fetus, the newborn, the child and the adolescent," Grote said. "There are pernicious effects both before and after birth."
In addition to newborn health problems Grote says, "Maternal postpartum depression, in turn, has been found to interfere with mother-infant bonding and attachment. Insecure attachment to the mother is associated with a host of emotional, behavioral, and cognitive problems for the child. It can foster difficulties in the baby's emotional and social development, school and learning problems as the child grows, and adolescent mental health concerns."
The findings suggest women should be carefully screened during pregnancy for depression. From the perspective of health care reform, Grote says it is well worth the investment to maintain supportive social service staff whose positions are often eliminated by States during an economic downturn. An emphasis on screening women for depression, especially the socioeconomically disadvantaged, would offset the cost of neonatal intensive care, maternal education and the expense of ongoing medical care for infants born prematurely with chronic health problems.
Grote also discusses the role of anti-depressants during pregnancy that are often stopped, leaving women untreated. She says, "Many news reports exaggerate the perils of taking anti-depressant medication during pregnancy. They seldom mention that untreated depression during pregnancy has negative birth outcomes comparable to anti-depressant medication use...
"Depressed pregnant women and their health-care providers," she suggested, "should weigh the risks and benefits of antidepressant use in their particular situations. They should also discuss together whether other evidence-based, effective ways to treat depression, like interpersonal psychotherapy or cognitive-behavioral therapy, might be preferable or available."
When considering antidepressants during pregnancy, Grote says clinicians can find guidelines for prescribing from the American Congress of Obstetricians and Gynecologists (ACOG).
Signs of depression that include poor appetite or overeating, sleeping too much or too little, lack of interest in life and generally feeling down, should be reported. Grote explains, "Being depressed is a treatable, medical condition. It's not your fault. Depression can affect your health and your baby's health. If one person can't help you, he or she might know someone else who can."
The study highlights an unmet need that impacts public, personal and family health. The authors say pregnant women suffering from depression should 'speak up when you're down.". The analysis shows depressed women, especially those from low socioeconomic status are at increased risk for preterm birth that can have lasting effects on maternal and child health.
Arch Gen Psychiatry. 2010;67(10):1012-1024