Being born too soon and weighing too little at birth can jeopardize the immediate survival and long-term health of babies. Preterm birth and low birth weight are leading causes worldwide of infant and early childhood mortality, respiratory distress, neurological and developmental impairment, cerebral palsy, blindness, hearing loss and other disabilities.
Depression is common during pregnancy as well as during other times in a woman’s life. Between nine to 23 percent of women experience clinical depression while pregnant.
“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,” said lead author, Dr. Nancy Grote, University of Washington (UW), research associate professor of social work. Compounding the situation, she added, “Poor women in America are twice as likely to experience depression, compared to other women in this country.”
The study found that depressed, pregnant women living in European social democracies fared better than poor pregnant, depressed women in developing nations or in the U.S. European women had lower rates of premature births and low-birth weight infants. Social democracies offer universal health care and tend to have fewer socioeconomic disparities in birth outcomes. Living in a developing nation or in poverty in the U.S., where adequate prenatal, medical and mental health services may be lacking, could add to the harmful effects of depression during pregnancy on birth outcomes.
A multidisciplinary group of researchers at the UW, The Ohio State University and the University of Pittsburgh – representing social work, psychiatry, statistics, obstetrics and pediatrics – conducted this study.
Previous reports over the past decade on the association between depression during pregnancy and preterm birth and low-birth weight infants have provided an inconsistent and inconclusive picture. The researchers for this project performed a meta-analysis of all available U.S. and non-U.S. studies and used rigorous state-of-the-art guidelines to examine the data.
Dr. Jeffrey Bridge of Center for Innovation in Pediatric Practice in The Research Institute at Nationwide Children's Hospital and Department of Pediatrics of The Ohio State University conducted the statistical analyses for the study. The results affirmed the strength of the link between depression during pregnancy and negative birth outcomes.
Based on these findings and other research evidence on the lasting effects of maternal depression on mothers and their children, the authors suggest public health, as well as personal and family actions. Universal screening for depression and ready access to mental health care during pregnancy are critical initiatives.
“Ideally, pregnant women across the socioeconomic spectrum should be checked for clinical depression, and treated appropriately,” said Grote. In addition to this study showing depression during pregnancy might lead to serious newborn health issues, Grote explained that work by other researchers has shown that about 60 percent of postpartum depressions begin during pregnancy. 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.
“Maternal depression affects the fetus, the newborn, the child and the adolescent,” said Grote. “There are pernicious effects both before and after birth.”
The results of the study also address the debate over whether women should be prescribed anti-depressant medication during pregnancy. Depression in pregnant women often goes untreated – or treatment is stopped – because of safety concerns about medications.
“Many news reports exaggerate the perils of taking anti-depressant medication during pregnancy,” said Grote. “They seldom mention that untreated depression during pregnancy has negative birth outcomes comparable to anti-depressant medication use, such as those reported in this study. “Depressed pregnant women and their health-care providers should weigh the risks and benefits of anti-depressant use in their particular situations,” said Grote. “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.”
Grote noted that professional guidelines on the safety of anti-depressant use during pregnancy are available from the American Congress of Obstetricians and Gynecologists (ACOG) for obstetricians, nurse midwives, pharmacists, family physicians, psychiatrists, internal medicine physicians and others whose patients are depressed and might be pregnant or considering pregnancy.
Women who are trying to have a baby, who are already pregnant or who recently gave birth and find themselves feeling the blues should notify a health-care provider or a social services worker. Some features of depression are a low mood, lasting sadness, sleeping or eating too much or too little, mental anguish, difficulty concentrating, worrying, withdrawing from others or losing interest in life.
Additional researchers on this study were Dr. Amelia Gavis, UW School of Social Work; Dr. Jennifer L. Melville, Department of Obstetrics and Gynecology, UW School of Medicine; Dr. Satish Iyengar of the Department of Statistics at the University of Pittsburgh; and Dr. Wayne J. Katon, Department of Psychiatry and Behavioral Sciences, UW School of Medicine.
The study was supported by grants from the National Institute of Mental Health and from the National Center for Research Resources, which are both components of the National Institutes of Health (NIH) and from the NIH Roadmap for Medical Research.