Treating Prenatal Depression May Cut Adverse Birth Outcomes

Diana Swift

April 19, 2016

Women who suffer from prenatal depression run a greater risk for adverse pregnancy outcomes such as preterm or cesarean delivery and small-for-gestational-age babies, a large observation study confirms. The study, published online April 4 in Obstetrics & Gynecology, also suggests that treating depressed mothers-to-be with antidepressants may reduce the odds of these adverse events.

Kartik K. Venkatesh, MD, PhD, from the Department of Obstetrics and Gynecology at Brigham and Women's Hospital, Boston, Massachusetts, and colleagues studied 7267 women (median age, 33 years) giving birth at Massachusetts General Hospital, Boston, between July 2010 and October 2013 and delivering at 20 weeks' gestation or greater.

Within this cohort, 831 (11%) of the women screened positive for antenatal depression, having Edinburgh Postnatal Depression Scale scores of at least 10. Overall, 15% of mothers delivered at less than 37 weeks, 32% had a cesarean delivery, and 13% of newborns were classified as small for gestational age.

Even after controlling for multiple sociodemographic and clinical variables, depressed mothers-to-be were significantly more likely to give birth at less than 37 weeks (adjusted odds ratio [OR], 1.27, 95% confidence interval [CI], 1.04 - 1.55) or less than 32 weeks (adjusted OR, 1.82; 95% CI, 1.09 - 3.02) compared with nondepressed mothers-to-be. In addition, they were more likely to have babies weighing less than 2500 g (adjusted OR, 1.41; 95% CI, 1.10 - 1.81) and classified as small for gestational age (adjusted OR, 1.28; 95% CI, 1.04 - 1.58).

Women with positive depression scores were more often younger, overweight, or obese, and of minority race. They were also more likely to smoke and have other children (P < .05), and a greater proportion resided in lower-income areas and had government insurance coverage.

Of those with positive depression screens, 29.7% had a previous diagnosis of depression vs 11.5% of those with a negative depression screen (OR ratio, 3.24; 95% CI, 2.74 - 3.83). In all, 518 (7%) women received antidepressant medication, including 19% of positive screens and 5% of negative screens (OR, 4.04; 95% CI, 3.30 - 4.95).

Compared with nondepressed women, the women who were treated with antidepressants showed no significant increase in risk for preterm delivery (OR, 1.44; 95% CI, 0.86 - 2.43), very preterm delivery (OR, 1.08; 95% CI, 0.18 - 6.35), or small for gestational age (OR, 1.67; 95% CI, 0.95 - 2.94). In contrast, each of those measures remained significant for women who were depressed but did not receive antidepressants compared with the undepressed population.

The authors note, however, that because only 160 of 831 positive women received antidepressants, the study had limited power to directly compare outcomes with and without treatment.

These positive findings contrast with those from previous research suggesting prenatal antidepressant therapy pregnancy may increase the odds of worse neonatal outcomes. In addition, one study found that treatment in particular with selective serotonin reuptake inhibitors had no effect on the odds of having preterm birth.

"Our results extend prior reports that identified risk in smaller cohorts or without detailed consideration of confounding," write Dr Venkatesh and associates.

They write that their findings are notable because they clearly demonstrated an association with very preterm birth, identified depression via the Edinburgh Postnatal Depression Scale, and evaluated the effects of confounding factors and antidepressant treatment.

The study results are in line with national efforts to incorporate depression screening into routine prenatal care: "If additional studies support the finding of decreased risk among women being treated with antidepressants, this would suggest that early identification and treatment of women with depression in pregnancy may not only improve maternal well-being, but potentially affect obstetric outcome," the authors write.

This study was supported through funding from the National Institute of Mental Health. One coauthor disclosed receiving consulting fees and scientific advisory board work for private sector companies. The other authors have disclosed no relevant financial relationships.

Obstet Gynecol. Published online April 4, 2016. Abstract

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