A Meta-analysis of Depression During Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Intrauterine Growth Restriction

Abstract

Context Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR). Objective To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression. Data Sources and Study Selection We searched for English-language and non–English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks’ gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non–US-published studies met the selection criteria. Data Extraction Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error. Data Synthesis Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval]=1.39 [1.19–1.61], 1.49 [1.25–1.77], and 1.45 [1.05–2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00–1.06], 1.04 [0.99–1.09], and 1.02 [1.00–1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR=2.05; 95% confidence interval, 1.43–2.93) compared with the United States (RR=1.10; 95% confidence interval, 1.01–1.21) or European social democracies (RR=1.16; 95% confidence interval, 0.92–1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States. Conclusions Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.

Association between reported venlafaxine use in early pregnancy and birth defects, national birth defects prevention study, 1997–2007

“…Depression itself has been shown to be associated with a number of adverse pregnancy outcomes, such as spontaneous abortion, fetal death, low birth weight, and preterm birth (Bonari et al, 2004;Grote et al, 2010). In our study, over 50% of venlafaxineexposed mothers reported using the medication during the entire early pregnancy period, which suggests longterm treatment.…”

Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy – A Review

“…Other perinatal complications arising from mild to clinically relevant symptoms of prenatal maternal stress, depression or anxiety can include premature delivery and low birth weight of the child [118][119][120]. There were also indications that depression in the mother can predispose to intrauterine growth retardation [121][122]. If maternal mental health problems remain untreated, there is a risk that these symptoms will continue even after the birth of the child [123][124], which can seriously limit the maternal care given to the infant and the interaction between mother and infant [125][126][127].…”

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

“…[1][2][3] Although treatment is essential, the use of antidepressant medication during pregnancy has been found to be lower than other times of the life cycle. 4 One of the contributing factors for poor uptake of pharmacologic interventions appears to be concerns regarding the safety of antidepressant exposure for the fetus.…”

“…However, the warnings suggested a direct conflict between safety of the fetus and a mother's need for antidepressant medication, perhaps without regard to the documented negative effects of untreated depression on pregnancy outcomes. 3,7 The results of prior meta-analyses have been conflicting. Several have found no evidence of increased risk of major congenital malformations above the baseline [8][9][10] rate, which has been widely cited as 1%-3% for any pregnancy in North America [11][12][13][14] and less than 4% for minor congenital malformations.…”