BackgroundIn Australia, there is limited evidence on the impact of antenatal depression on perinatal outcomes. This study investigates the association between maternal depressive symptoms during pregnancy and key perinatal outcomes, including birth weight, gestational age at birth, breastfeeding indicators and postnatal depressive symptoms.MethodA retrospective cohort of mothers (N = 17,564) of all infants born in public health facilities within South Western Sydney Local Health District and Sydney Local Health District in 2014, in the state of New South Wales (NSW), Australia, was enumerated from routinely collected antenatal data to investigate the risk of adverse perinatal outcomes associated with maternal depressive symptoms during pregnancy. Antenatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression models that adjusted for confounders were conducted to determine associations between antenatal depressive symptoms and low birth weight, early gestational age at birth (<37 weeks), breast feeding indicators and postnatal depressive symptoms.ResultsThe prevalence of maternal depressive symptoms during pregnancy was 7.0% in the cohort, and was significantly associated with postnatal depressive symptoms [Adjusted Odd Ratios (AOR) = 6.4, 95% CI: 4.8–8.7, P<0.001]. Antenatal depressive symptoms was associated with a higher odds of low birth weight [AOR = 1.7, 95% CI: 1.2–2.3, P = 0.003] and a gestational age at birth of <37 weeks [AOR = 1.3, 95% CI: 1.1–1.7, P = 0.018] compared to women who reported lower EPDS scores in antenatal period. Antenatal depressive symptoms were not strongly associated with non-exclusive breast feeding in the early postnatal period.ConclusionMaternal depressive symptoms in the antenatal period are strongly associated with postnatal depressive symptoms and adverse perinatal outcomes in Australian infants. Early identification of antenatal and postnatal depressive symptoms, and referral for appropriate management could benefit not only the mother’s mental health, but also the infant’s health and development.

Key Points Question Is prenatal opioid exposure associated with differences in childhood cognitive and motor development? Findings In this systematic review and meta-analysis of 26 studies including 1455 children exposed to prenatal opioids compared with unexposed children, prenatal opioid exposure was associated with lower cognitive scores. The largest difference was seen between ages 6 months and 6 years. Meaning The negative consequences of prenatal opioid exposure on neurocognitive and physical development appear to be present from 6 months and persist beyond school age.

BACKGROUND AND OBJECTIVES:Little is known of the long-term, including school,

BackgroundDepression is a leading source of morbidity and health loss in Australian women. This study investigates the determinants of antenatal depressive symptoms and postnatal depressive symptoms in an Australian population, including people from culturally and linguistically diverse (CALD) backgrounds.MethodThe study used a retrospective cohort of mothers of all live births in public health facilities in 2014 (N = 17,564) within South Western Sydney Local Health District and Sydney Local Health District in New South Wales, Australia. Prevalence of antenatal and postnatal depressive symptoms were estimated for the cohort. Multivariate logistic regression models were conducted to investigate the sociodemographic, psychological and health service determinants of antenatal and postnatal depressive symptoms, measured using the Edinburgh Postnatal Depression Scale (EPDS).ResultsThe prevalence of antenatal and postnatal depressive symptoms was 6.2% and 3.3% of the cohort, respectively. Significant risk factors for maternal depressive symptoms during pregnancy were, a lack of partner support, history of intimate partner violence, being from the CALD population and low socioeconomic status. Self-reported antenatal depressive symptoms were strongly associated with postnatal depressive symptoms. Risk factors for postnatal depressive symptoms were similar to those for antenatal depressive symptoms, as well as assisted delivery.ConclusionFactors relating to demographic and psychosocial disadvantage were associated with subsequent antenatal and postnatal depressive symptoms in New South Wales, Australia. Our study suggests that screening for probable depression and timely referral for expert assessment of at-risk mothers may be an effective strategy to improve maternal mental health outcomes.

BackgroundThe impacts of optimal infant feeding practices on diarrhoea have been documented in some developing countries, but not in countries with high diarrhoea mortality as reported by the World Health Organisation/United Nations Children’s Fund. We aimed to investigate the association between infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality.MethodThe study used the most recent Demographic and Health Survey datasets collected in nine sub-Saharan African countries with high diarrhoea mortality, namely: Burkina Faso (2010, N = 9,733); Demographic Republic of Congo (2013; N = 10,458); Ethiopia (2013, N = 7,251); Kenya (2014, N = 14,034); Mali (2013, N = 6,365); Niger (2013, N = 7,235); Nigeria (2013, N = 18,539); Tanzania (2010, N = 5,013); and Uganda (2010, N = 4,472). Multilevel logistic regression models that adjusted for cluster and sampling weights were used to investigate the association between infant feeding practices and diarrhoea in these nine African countries.ResultsDiarrhoea prevalence was lower among children whose mothers practiced early initiation of breastfeeding, exclusive and predominant breastfeeding. Early initiation of breastfeeding and exclusive breastfeeding were significantly associated with lower risk of diarrhoea (OR = 0.81; 95% confidence interval (CI): 0.77–0.85, P<0.001 and OR = 0.50; 95%CI: 0.43–0.57, respectively). In contrast, introduction of complementary foods (OR = 1.31; 95%CI: 1.14–1.50) and continued breastfeeding at one year (OR = 1.27; 95%CI: 1.05–1.55) were significantly associated with a higher risk of diarrhoea.ConclusionEarly initiation of breastfeeding and exclusive breastfeeding are protective of diarrhoea in sub-Saharan African countries with high diarrhoea mortality. To reduce diarrhoea mortality and also achieve the health-related sustainable development goals in sub-Saharan African, an integrated, multi-agency strategic partnership within each country is needed to improve optimal infant feeding practices.

BackgroundFrom 2000 a routine survey of mothers with newborn infants was commenced in South Western Sydney. The survey included the Edinburgh Postnatal Depression Scale (EPDS). The aim of the study was to determine the prevalence and risk factors for postnatal depressive symptoms in women living in metropolitan Sydney, Australia.MethodsMothers (n=15,389) delivering in 2002 and 2003 were assessed at 2–3 weeks after delivery for risk factors for depressive symptoms. The binary outcome variables were EPDS >9 and >12. Logistic regression was used for the multivariate analysis.ResultsThe prevalence of EPDS >9 was 16.93 per 100 (95% CI: 16.34 to 17.52) and EPDS >12 was 7.73 per 100 (95% CI: 6.96 to 7.78). The final parsimonious logistic regression models included measures of infant behaviour, financial stress, mother’s expectation of motherhood, emotional support, sole parenthood, social support and mother’s country of birth.ConclusionsInfant temperament and unmet maternal expectations have a strong association with depressive symptoms with implications for the design of both preventative and treatment strategies. The findings also support the proposition that social exclusion and social isolation are important determinants of maternal depression.

A recent criticism of social epidemiological studies, and multi-level studies in particular has been a paucity of theory. We will present here the protocol for a study that aims to build a theory of the social epidemiology of maternal depression. We use a critical realist approach which is trans-disciplinary, encompassing both quantitative and qualitative traditions, and that assumes both ontological and hierarchical stratification of reality. We describe a critical realist Explanatory Theory Building Method comprising of an: 1) emergent phase, 2) construction phase, and 3) confirmatory phase. A concurrent triangulated mixed method multilevel cross-sectional study design is described. The Emergent Phase uses: interviews, focus groups, exploratory data analysis, exploratory factor analysis, regression, and multilevel Bayesian spatial data analysis to detect and describe phenomena. Abductive and retroductive reasoning will be applied to: categorical principal component analysis, exploratory factor analysis, regression, coding of concepts and categories, constant comparative analysis, drawing of conceptual networks, and situational analysis to generate theoretical concepts. The Theory Construction Phase will include: 1) defining stratified levels; 2) analytic resolution; 3) abductive reasoning; 4) comparative analysis (triangulation); 5) retroduction; 6) postulate and proposition development; 7) comparison and assessment of theories; and 8) conceptual frameworks and model development. The strength of the critical realist methodology described is the extent to which this paradigm is able to support the epistemological, ontological, axiological, methodological and rhetorical positions of both quantitative and qualitative research in the field of social epidemiology. The extensive multilevel Bayesian studies, intensive qualitative studies, latent variable theory, abductive triangulation, and Inference to Best Explanation provide a strong foundation for Theory Construction. The study will contribute to defining the role that realism and mixed methods can play in explaining the social determinants and developmental origins of health and disease.

The results confirm prevalence rates and maternal individual-level risk factors from previous studies. The study contributes to the limited number of studies of postnatal depression and socio-demographic factors. Neighbourhood and community group-level factors may be important and should be studied further.