The British epidemiologist Dr. David J. Barker documented the relationship between infant birth weight and later onset of hypertension, coronary heart disease, insulin resistance, and type II diabetes. A stressful in utero environment can cause long-term consequences for offspring through prenatal programming. Prenatal programming most commonly occurs through epigenetic mechanisms and can be dependent on the type and timing of exposure as well as the sex of the fetus. In this review, we highlight the most recent evidence that prenatal programming is implicated in the development of psychiatric disorders in offspring exposed to maternal stress during pregnancy. Methodological differences between studies contribute to unavoidable heterogeneity in study findings. Current data suggest that fetal exposure to maternal hypothalamic-pituitary-adrenal axis dysregulation, excessive glucocorticoids, and inflammation with resulting epigenetic changes at both the placental and fetal levels are important areas of continued investigation.

Potentially important gender differences in certain illness characteristics were found in our study; however, in contrast to other reports, we did not find higher rates of lifetime depressive episodes or rapid cycling in women. Although our study is limited by its retrospective study design, its results are strengthened by our large sample size and use of structured interviews.

Objective In this study, we evaluated the association between patient depression ratings at an initial obstetrics visit and adverse birth outcomes in African-American women. Study Design We conducted a retrospective cohort study of 261 pregnant, African American women who were screened with the Edinburgh Postnatal Depression Scale (EPDS) at their initial prenatal visit. Medical records were reviewed to assess pregnancy and neonatal outcomes, specifically pre-eclampsia, preterm birth, intrauterine growth retardation and low birth weight. Results Using multivariable logistic regression models, an EPDS score ≥ 10 was associated with increased risk for preeclampsia, preterm birth and low birth weight. An EPDS score ≥ 10 was associated with increased risk for intrauterine growth retardation but after controlling for behavioral risk factors this association was no longer significant. Conclusion A positive, patient-rated depression screening at the initial obstetrics visit depression is associated with increased risk for multiple adverse birth outcomes. Given the retrospective study design and small sample size, this finding should be confirmed in a prospective cohort study.

TMS appears to be a promising treatment option for pregnant women who do not wish to take antidepressant medications.