Burden and risk factors for antenatal depression and its effect on preterm birth in South Asia: A population-based cohort study

Abstract

Introduction Women experience high rates of depression, particularly during pregnancy and the postpartum periods. Using population-based data from Bangladesh and Pakistan, we estimated the burden of antenatal depression, its risk factors, and its effect on preterm birth. Methods The study uses the following data: maternal depression measured between 24 and 28 weeks of gestation using the 9–question Patient Health Questionnaire (PHQ-9); data on pregnancy including an ultrasound before 19 weeks of gestation; data on pregnancy outcomes; and data on woman’s age, education, parity, weight, height, history of previous illness, prior miscarriage, stillbirth, husband’s education, and household socioeconomic data collected during early pregnancy. Using PHQ-9 cutoff score of ≥12, women were categorized into none to mild depression or moderate to moderately severe depression. Using ultrasound data, preterm birth was defined as babies born <37 weeks of gestation. To identify risk ratios (RR) for antenatal depression, unadjusted and adjusted RR and 95% confidence intervals (CI) were calculated using log- binomial model. Log-binomial models were also used for determining the effect of antenatal depression on preterm birth adjusting for potential confounders. Data were analyzed using Stata version 16 (StataCorp LP). Results About 6% of the women reported moderate to moderately severe depressive symptoms during the antenatal period. A parity of ≥2 and the highest household wealth status were associated with an increased risk of depression. The overall incidence of preterm birth was 13.4%. Maternal antenatal depression was significantly associated with the risk of preterm birth (ARR, 95% CI: 1.34, 1.02–1.74). Conclusion The increased risk of preterm birth in women with antenatal depression in conjunction with other significant risk factors suggests that depression likely occurs within a constellation of other risk factors. Thus, to effectively address the burden of preterm birth, programs require developing and providing integrated care addressing multiple risk factors.

Traversing mental health disorders during pregnancy: Lebanese women’s experiences of antepartum depression and anxiety

“…Undeniably, looking into the factors that may be connected to an increased propensity for prenatal depression and anxiety is of crucial interest, owing to the fact that mental disorders during pregnancy may impact maternal/infant health adversely, by generating substantial mortality rates and serious morbidities (e.g., increased risk of addictions in pregnancy, obstetrical complications, preterm birth, compromised postpartum bonding, psychological and neurodevelopmental disturbances in children, as well as malnutrition, growth impairment, and infectious/diarrheal diseases; as infants are highly dependent on their mothers for physical care and social interaction) [ 9 , 33 – 39 ]. A thorough comprehension of the underlying risk factors may enlighten the path towards further refining the identification of maternal mental disorders and enhancing prevention programs in Lebanon.…”

Association of Pregnant Women’s Perinatal Depression with Sociodemographic, Anthropometric and Lifestyle Factors and Perinatal and Postnatal Outcomes: A Cross-Sectional Study

“…High levels of depressive and anxiety symptomatology during pregnancy have been associated with obstetric problems and adverse pregnancy consequences, such as preterm birth [98]. A recent population-based, cohort survey indicated that women's antenatal depression was related to an increased risk of pregnant women's perinatal depressive symptoms [99]. A meta-analysis further confirmed a significant risk of preterm birth in women with perinatal depression [56].…”

Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women

“…When examining preterm birth from an evolutionary perspective, it is suggested that adverse maternal contextual factors (e.g., socio-economic status, chronic stress) may initiate adaptive responses that, in conjunction with psychosocial distress, may determine the trajectory of preterm birth [ 75 ]. The risk of preterm birth has been reported to increase when depression occurs in combination with other etiological contributing factors (e.g., parity, household socio-economic status) [ 76 ]. Our study identified four potential effect modifiers: income, food availability, social support from family, and current planned pregnancy.…”