Maternal and Fetal Outcomes Among Women with Depression

CONRAD, Atlanta, Georgia, USA.
Journal of Women's Health (Impact Factor: 2.05). 02/2010; 19(2):329-34. DOI: 10.1089/jwh.2009.1387
Source: PubMed


To compare maternal and fetal outcomes among women with and without diagnosed depression at the time of delivery.
Hospital discharge data from the 1998-2005 Nationwide Inpatient Sample (NIS) were used to examine delivery-related hospitalizations for select maternal and fetal outcomes by depression diagnosis.
The rate of depression per 1000 deliveries increased significantly from 2.73 in 1998 to 14.1 in 2005 (p < 0.001). Women diagnosed with depression were significantly more likely to have cesarean delivery, preterm labor, anemia, diabetes, and preeclampsia or hypertension compared with women without depression. Fetal outcomes significantly associated with maternal depression were fetal growth restriction, fetal abnormalities, fetal distress, and fetal death.
These findings suggest that depression is associated with adverse maternal and fetal outcomes. Our results provide additional impetus to screen for depression among women of reproductive age, especially those who plan to become pregnant.

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    • "Depressed women are more likely to experience preterm labor, preeclampsia, diabetes, Cesarean section, anemia, and infections during labor (Dunkel Schetter & Tanner, 2012; Nylen, O'Hara, & Engeldinger, 2012). Infants born to depressed women are also at greater risk for fetal growth restriction, abnormalities, distress, and death (Bansil et al., 2010). High levels of proinflammatory cytokines have been positively associated with depressive symptoms and psychosocial stress in many studies of nonpregnant individuals (Raison, Capuron, & Miller, 2006). "
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    ABSTRACT: A secondary pilot study was carried out as part of a larger parent study of thyroid function in pregnancy and postpartum. All women in the parent study (N = 631) had blood samples, demographic data, and measures of perceived stress and dysphoric moods collected between 16 and 26 weeks' gestation. The current study was completed with a subset of 105 pregnant women to examine the relationships among perceived stress, depression, plasma cortisol, and cytokines during the second trimester of pregnancy. Stress was measured using Cohen's Perceived Stress Scale and dysphoric moods using the Profile of Mood States Depression/Dejection Scale. Cytokines were measured by a 12-plex analysis on a Luminex-200, and cortisol was measured by enzyme-linked immunosorbent assay on stored plasma samples. Stress and depression scores were highly correlated, and depressive symptoms were inversely correlated with 3 of the 12 cytokines: interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and IL-7. Cortisol was inversely correlated with proinflammatory cytokines (IL-1β and TNF-α) and anti-inflammatory cytokines (IL-4, IL-5, IL-10, and IL-13). These data support the new conceptualizations of normal pregnancy as an inflammatory state that is carefully regulated, as both excessive and inadequate inflammation are potentially hazardous to the health of the pregnancy and fetus.
    Biological Research for Nursing 09/2014; 17(3). DOI:10.1177/1099800414543821 · 1.43 Impact Factor
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    • "There is a correlation of pregnancy-associated depression with poorer obstetric outcome measures, with fetal and neonatal complications [7, 8], with the length of the mother's hospital stay at the time of delivery [9], and with a negative impact on the child's development [10–13]. Information about the pathogenesis for pregnancy-associated depression may therefore be helpful for planning early interventions and understanding the pathogenesis of this disease, as it is not a part of the early intervention program in Germany yet [14]. "
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    ABSTRACT: Purpose: The aim of this study was to investigate whether single nucleotide polymorphisms (SNPs) in genes of the stress hormone signaling pathway, specifically FKBP5, NR3C1, and CRHR1, are associated with depressive symptoms during and after pregnancy. Methods: The Franconian Maternal Health Evaluation Study (FRAMES) recruited healthy pregnant women prospectively for the assessment of maternal and fetal health including the assessment of depressiveness. The German version of the 10-item Edinburgh Postnatal Depression Scale (EPDS) was completed at three time points in this prospective cohort study. Visit 1 was at study entry in the third trimester of the pregnancy, visit 2 was shortly after birth, and visit 3 was 6-8 months after birth. Germline DNA was collected from 361 pregnant women. Nine SNPs in the above mentioned genes were genotyped. After construction of haplotypes for each gene, a multifactorial linear mixed model was performed to analyse the depression values over time. Results: EPDS values were within expected ranges and comparable to previously published studies. Neither did the depression scores differ for comparisons among haplotypes at fixed time points nor did the change over time differ among haplotypes for the examined genes. No haplotype showed significant associations with depressive symptoms severity during pregnancy or the postpartum period. Conclusion: The analysed candidate haplotypes in FKBP5, NR3C1, and CRHR1 did not show an association with depression scores as assessed by EPDS in this cohort of healthy unselected pregnant women.
    03/2014; 2014:469278. DOI:10.1155/2014/469278
    • "weight, to failure to thrive and longer-term neurobehavioral problems (Bansil et al 2010; Van den Bergh et al. 2005). Thus, mental illness, during and after pregnancy, is a significant public health concern, and addressing this is key to improving maternal and child health outcomes. "
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    ABSTRACT: In low-resource settings, a stepped care approach is necessary to screen and provide care for pregnant women with mental health problems. This study sought to identify screening items that were most robust at differentiating women experiencing psychological distress and requiring counselling [assessed by screening with the Edinburgh Postnatal Depression Scale (EPDS) and a Risk Factor Assessment (RFA)] from those with a psychiatric disorder as diagnosed by a psychiatrist. Case records of women in an antenatal mental health service in Cape Town were reviewed. Composite scores and individual items on screening scales (EPDS, RFA) of participants who qualified for counselling (n = 308) were compared to those of participants who were diagnosed with a psychiatric disorder (n = 58). All participants with a psychiatric disorder were diagnosed with either depression or anxiety disorders. These participants had higher mean scores on the EPDS and RFA than those who qualified for counselling (p < 0.01). Logistic regression and ROC analyses suggested that the best items to distinguish women with depression or anxiety from those qualifying for counselling were 'I have felt sad and miserable', 'I am not pleased about being pregnant' and 'I have had serious depression, panic attacks or problems with anxiety before' (sensitivity 0.655, specificity 0.750 for this combination of three items). A small number of items may be useful in screening for mental illness in pregnancy which requires higher levels of care. Such screening may contribute to a more efficient stepped care approach.
    Archives of Women s Mental Health 04/2013; 16(5). DOI:10.1007/s00737-013-0343-1 · 2.16 Impact Factor
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