BackgroundPregnancy is a time of increased vulnerability for the development of anxiety and depression. This systematic review aims to identify the main risk factors involved in the onset of antenatal anxiety and depression.MethodsA systematic literature analysis was conducted, using PubMed, PsychINFO, and the Cochrane Library. Original papers were included if they were written in English and published between 1st January 2003 and 31st August 2015, while literature reviews and meta-analyses were consulted regardless of publication date. A final number of 97 papers were selected.ResultsThe most relevant factors associated with antenatal depression or anxiety were: lack of partner or of social support; history of abuse or of domestic violence; personal history of mental illness; unplanned or unwanted pregnancy; adverse events in life and high perceived stress; present/past pregnancy complications; and pregnancy loss.LimitationsThe review does not include a meta-analysis, which may have added additional information about the differential impact of each risk factor. Moreover, it does not specifically examine factors that may influence different types of anxiety disorders, or the recurrence or persistence of depression or anxiety from pregnancy to the postpartum period.ConclusionsThe results show the complex aetiology of antenatal depression and anxiety. The administration of a screening tool to identify women at risk of anxiety and depression during pregnancy should be universal practice in order to promote the long-term wellbeing of mothers and babies, and the knowledge of specific risk factors may help creating such screening tool targeting women at higher risk.

Studies ignoring genetic transmission overestimate social transmission effects because both genetic and environmental processes are involved in creating risk for ASB in children of depressed mothers. Interventions for depressed mothers aiming to reduce conduct problems in their children should address parents' antisocial personality, as well as mothers' depression.

The aim of the study was to examine long-term sequelae in the children of mothers who were depressed at 3 months postpartum. In a community sample from two general practices in South London. 149 women were given psychiatric interviews at 3 months postpartum and 132 of their children (89 %) were tested at 11 years of age. The children of women who were depressed at 3 months postpartum had significantly lower IQ scores. They also had attentional problems and difficulties in mathematical reasoning. and were more likely than other children to have special educational needs. Boys were more severely affected than girls, with the sex difference most pronounced on Performance IQ. The links between postnatal depression and the children's intellectual problems were not mediated by parental IQ and were not accounted for by measures of social disadvantage nor by the mother's later mental health problems. Breastfeeding did not remove the effect of the mother's illness on Full Scale IQ, but exerted its own influence on Verbal IQ and appeared to mediate the link with mathematical ability. The findings show that adverse experiences in infancy predict cognitive ability and academic performance a decade later.

A follow-up study was carried out to investigate the children of 204 mothers who had previously participated in a study of their mental health during pregnancy and the first postnatal year. One hundred and seventy two children, 170 mothers, and 99 fathers were assessed when the children were 3 years 10 months. Boys of mothers depressed in the first year postpartum scored approximately 1 standard deviation lower on standardised tests of intellectual attainment than boys whose mothers were well that year. The difference was reliable even when behaviour during the test was controlled for, and general behavioural problems, birth weight, parental IQ measures of the family climate and home environment, mother-child interaction, and breast-feeding during infancy were taken into account.

Some effects attributed to mothers' mental health problems in pregnancy or post partum may be mediated by cumulative exposure to maternal illness, probably reflecting genetic influence and gene-environment correlation. However, PPD has a direct effect on cognition. Clinicians should endeavour to identify women with depression in pregnancy (31% of this sample) and help them to manage their lifelong illness.