Elevated risk of adverse obstetric outcomes in pregnant women with depression

Department of Psychiatry and Penn Center for Women's Behavioral Wellness, Perelman School of Medicine of the University of Pennsylvania, Pennsylvania, USA, .
Archives of Women s Mental Health (Impact Factor: 2.16). 08/2013; 16(6). DOI: 10.1007/s00737-013-0371-x
Source: PubMed


In this study, we evaluated the association between prenatal depression symptoms adverse birth outcomes in African-American women. We conducted a retrospective cohort study of 261 pregnant African-American women who were screened with the Edinburgh Postnatal Depression Scale (EPDS) at their initial prenatal visit. Medical records were reviewed to assess pregnancy and neonatal outcomes, specifically preeclampsia, preterm birth, intrauterine growth retardation, and low birth weight. Using multivariable logistic regression models, an EPDS score ≥10 was associated with increased risk for preeclampsia, preterm birth, and low birth weight. An EPDS score ≥10 was associated with increased risk for intrauterine growth retardation, but after controlling for behavioral risk factors, this association was no longer significant. Patients who screen positive for depression symptoms during pregnancy are at increased risk for multiple adverse birth outcomes. In a positive, patient-rated depression screening at the initial obstetrics visit, depression is associated with increased risk for multiple adverse birth outcomes. Given the retrospective study design and small sample size, these findings should be confirmed in a prospective cohort study.

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Available from: Cynthia Neill Epperson, Apr 14, 2014
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    • "This lack of competence can result in undiagnosed problems, which, in turn, can have seriously negative consequences for women in their care, including relapse of existing mental health problem, development of new problems, and in the extreme case, maternal suicide (CMACE, 2011). PMHP during pregnancy can also impact negatively on the foetus and are associated with an increased risk of pre-term delivery and growth retardation (Ding et al, 2014; Kim et al, 2013). McCauley et al.'s (2011) study of midwives in Australia found that whilst the midwives recognised that they were indeed caring for women with, or at risk of developing, mental health problems, they reported having received little or no education in mental health and, more alarmingly, they did not perceive assessment of mental health needs as an important aspect of their role, perceiving it to be the role of other professionals (McCauley et al, 2011). "
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    ABSTRACT: Midwives are well-placed to address mental health issues with women by conducting assessments, providing information, and supporting them in making informed choices about care and treatment. Many midwives, however, feel they lack the competency and education to support women with mental health care, which can lead to these needs being ignored or brushed aside. Therefore, the first two named authors developed and delivered a module on perinatal mental health issues for the undergraduate direct entry midwifery programme within their university. The module aimed to enhance knowledge and skills in talking to women about mental health issues and to assist them in identifying and responding to mental health issues in an appropriate manner. In 2012, a post-survey evaluation of the module demonstrated positive findings while making suggestions for improvement (Higgins et al 2012). Following on from this evaluation, a number of revisions were made to the module content and assessment and a more robust pre/post evaluation of the impact of these changes on the knowledge, skills and attitudes of the midwifery students taking the module was undertaken. The aim of this paper is to report on findings from this evaluation.
    Nurse Education Today 10/2015; · 1.36 Impact Factor
    • "Psychiatric disorders during the prenatal and postpartum periods are of high clinical and public health significance because of their strong associations with adverse pregnancy, infant, and parenting outcomes. For instance, a mature and diverse literature has documented associations of maternal psychiatric symptoms and disorders with adverse outcomes including shortened gestational length or preterm delivery (Seng et al. 2011; Sanchez et al. 2013; Yonkers et al. 2014), placental abruption (de Paz et al. 2011), preeclampsia (Qiu et al. 2007; Kim et al. 2013), and maternal health risk behaviors such as suicidality (Farber et al. 1996), cigarette smoking (Lopez et al. 2011), and substance use (Massey et al. 2011). Furthermore, maternal postpartum depression has been linked to emotional and behavioral difficulties in offspring (Cicchetti et al. 1998; Verbeek et al. 2012; Walker et al. 2013). "
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    ABSTRACT: The objective of this review is to summarize the literature (and to the extent possible, report the magnitude and direction of the association) concerning history of childhood sexual abuse (CSA) and depression or depressive symptoms among pregnant and postpartum women. Publications were identified through literature searches of seven databases (PubMed, EMBASE, PyscINFO, CINAHL, Web of Science, BIOSIS, and Science Direct) using keywords including "child abuse," "depression," "pregnancy," "prenatal," "pregnancy," and "postpartum." The literature search yielded seven eligible studies on the prenatal period and another seven studies on the postpartum period. All but one prenatal study observed statistically significant positive associations of CSA with depression or depressive symptoms during pregnancy. Findings on the association of CSA with postpartum depression or depressive symptoms were inconsistent; pooled unadjusted and adjusted odds ratios were 1.82 (95 % confidence interval (CI) 0.92, 3.60) and 1.20 (95 % CI 0.81, 1.76). In sum, findings suggest a positive association of history of CSA with depression and depressive symptoms in the prenatal period. Findings on the postpartum period were inconsistent. Clinical and public health implications of evidence from the available literature are discussed, as are desirable study design characteristics of future research.
    Archives of Women s Mental Health 05/2015; 18(5). DOI:10.1007/s00737-015-0533-0 · 2.16 Impact Factor
    • "Perinatal mental illness is also associated with maternal and infant morbidity. For example, the infants of women who experience anxiety and depression during pregnancy have increased risk of intrauterine growth retardation (Kim et al, 2013) and pre-term delivery (Grote et al, 2010). Women who experience anxiety and depression are also more susceptible to developing hypertension and pre-eclampsia (Bansil et al, 2010) and have more operative deliveries than other women (Bansil et al, 2010). "
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    ABSTRACT: Background:Psychiatric illness is a leading indirect cause of maternal mortality. Earlier studies suggest serious discrepancies in the training and knowledge of midwives with regard to perinatal mental health. Aims:To explore the knowledge and experience of student midwives in the care of women with perinatal mental health problems. Methods:A modified questionnaire was distributed to student midwives near completion of 3-year and 78-week midwifery programmes. Results:Students often under-estimated the risk of women with existing mental health problems developing a serious mental health problem during pregnancy or in the postpartum period. Students felt ill-prepared and lacked confidence in caring for women with serious mental health problems. Conclusion:Recommendations from the findings of this study indicate (1) a review of undergraduate midwifery education in relation to perinatal mental health is needed; (2) a larger study, involving a more diverse sample of students, would enable generalisation to a wider population.
    British Journal of Midwifery 12/2014; 23(1):32. DOI:10.12968/bjom.2015.23.1.32
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