Effect of perinatal depression on risk of adverse infant health outcomes in mother-infant dyads in Gondar town: a causal analysis

Abstract

Background Approximately one-third of pregnant and postnatal women in Ethiopia experience depression posing a substantial health burden for these women and their families. Although associations between postnatal depression and worse infant health have been observed, there have been no studies to date assessing the causal effects of perinatal depression on infant health in Ethiopia. We applied longitudinal data and recently developed causal inference methods that reduce the risk of bias to estimate associations between perinatal depression and infant diarrhea, Acute Respiratory Infection (ARI), and malnutrition in Gondar Town, Ethiopia. Methods A cohort of 866 mother-infant dyads were followed from infant birth for 6 months and the cumulative incidence of ARI, diarrhea, and malnutrition were assessed. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the presence of maternal depression, the Integrated Management of Newborn and Childhood Illnesses (IMNCI) guidelines were used to identify infant ARI and diarrhea, and the mid upper arm circumference (MUAC) was used to identify infant malnutrition. The risk difference (RD) due to maternal depression for each outcome was estimated using targeted maximum likelihood estimation (TMLE), a doubly robust causal inference method used to reduce bias in observational studies. Results The cumulative incidence of diarrhea, ARI and malnutrition during 6-month follow-up was 17.0% (95%CI: 14.5, 19.6), 21.6% (95%CI: 18.89, 24.49), and 14.4% (95%CI: 12.2, 16.9), respectively. There was no association between antenatal depression and ARI (RD = − 1.3%; 95%CI: − 21.0, 18.5), diarrhea (RD = 0.8%; 95%CI: − 9.2, 10.9), or malnutrition (RD = -7.3%; 95%CI: − 22.0, 21.8). Similarly, postnatal depression was not associated with diarrhea (RD = -2.4%; 95%CI: − 9.6, 4.9), ARI (RD = − 3.2%; 95%CI: − 12.4, 5.9), or malnutrition (RD = 0.9%; 95%CI: − 7.6, 9.5). Conclusion There was no evidence for an association between perinatal depression and the risk of infant diarrhea, ARI, and malnutrition amongst women in Gondar Town. Previous reports suggesting increased risks resulting from maternal depression may be due to unobserved confounding.

Maternal mental health and nutritional status of infants aged under 6 months: a secondary analysis of a cross-sectional survey

“…The lack of associations between higher maternal depressive symptoms with infant nutritional status is consistent with previous studies where maternal common mental problems were not associated with nutritional status of under five years children in Ethiopia (14,28,29), but contrasts with several other studies from LMICs (16)(17)(18)(19)(30)(31)(32)(33)(34)(35) including findings from Ethiopia (36,37). Our finding is consistent with findings of high income settings (European cohort study (38) and the generation R study (39)) and upper middle income countries (e.g.…”

Assessment of The Burden of, and Women’s Experience With Screening For, Maternal Perinatal Depression in Kuwait

“…Perinatal depression can have damaging effect on the wellbeing of the newborn, and that maternal emotional distress can even affect the fetus and impair the cognitive and behavioral development. Perinatal depression is attributed to inadequate prenatal care which can lead to poor nutritional health for the mothers and the infants, and a higher risk of infections in children (13,15,16). In some cases, it can also lead to negative maternal-infant interaction, behavioral problems in children, and in severe cases suicide and infanticide have also been reported (17).…”

Supporting routine cognitive reactivity assessment during the perinatal period: psychometric testing of the Chinese version of the Leiden Index of Depression Sensitivity

“…In 2020, a systematic review in mainland China, which examined the prevalence of PND and its determinants, reported a 16.3%, 19.7%, and 14.8% pooled prevalence of PND, antenatal depression, and PPD, respectively [ 3 ]. PND entails various adverse health outcomes for both mothers and babies [ 1 , 4 , 5 ]. These include increased risk of preeclampsia, pregnancy, labor complications, infanticide or suicide for mothers and preterm births, low birth weight, and poor cognitive and emotional development for infants and newborns [ 1 , 4 , 5 ].…”

“…PND entails various adverse health outcomes for both mothers and babies [ 1 , 4 , 5 ]. These include increased risk of preeclampsia, pregnancy, labor complications, infanticide or suicide for mothers and preterm births, low birth weight, and poor cognitive and emotional development for infants and newborns [ 1 , 4 , 5 ].…”