Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-15T15:20:53.423Z Has data issue: false hasContentIssue false
  • English
  • Français

Relationship of prenatal depression and comorbidities to infant outcomes

Published online by Cambridge University Press:  19 December 2015

Heather A. Flynn ,
Nicole McBride ,
Aura Cely ,
Yuxia Wang  and
Julie DeCesare
Heather A. Flynn*
Affiliation:
Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
Nicole McBride
Affiliation:
Florida State University, Tallahassee, Florida, USA
Aura Cely
Affiliation:
Florida State University, Tallahassee, Florida, USA
Yuxia Wang
Affiliation:
Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
Julie DeCesare
Affiliation:
Obstetrics and Gynecology, Florida State University College of Medicine at Sacred Heart Hospital, Tallahassee, Florida, USA
*
*Address for correspondence: Heather A. Flynn, PhD, Florida State University, 1115 West Call Street, Tallahassee, FL 32306, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The purpose of this study was to provide information on the effect of prenatal depression and anxiety as assessed in the context of obstetrical care on key infant outcomes (gestational age at birth, birth weight, and APGAR scores), while simultaneously considering interactions with maternal medical conditions among primarily Medicaid enrollees.

Methods

Obstetrical medical records of 419 women presenting consecutively for prenatal care at a health system serving primarily Medicaid patients were examined. Information on maternal characteristics (age, race, education) and maternal medical health (BMI, high blood pressure, diabetes, and kidney problems), as well as mental health information, was extracted. Depression was assessed as part of routine care using the Patient Health Questionnaire-9 (PHQ-9), and any documentation of depression or anxiety by the obstetrics clinician was also used in the analyses.

Results

Approximately one-third of the sample showed some evidence of prenatal depression, either based on PHQ-9 score (≥10) or clinician documentation of depression, and close to 10% showed evidence of anxiety. Multivariate analyses showed significant interactions between depression and anxiety on gestational age and birth weight, between depression and high blood pressure on gestational age, and also between anxiety and kidney problems on gestational age.

Conclusion

Among this sample, the effect of maternal depression and anxiety on birth outcomes was more evident when considered along with maternal chronic medical conditions. This information may be used to assist prenatal care clinicians to develop risk assessment based on knowledge of multiple risk factors that may exert and additive influence on poor birth outcomes.

Keywords

Anxietyinfant outcomesmedical comorbidityprenatal depression
Type
Original Research
Information
CNS Spectrums , Volume 20 , Issue 1 , February 2015 , pp. 20 - 28
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This work was funded by a Seed Grant from the Florida State University College of Medicine. The authors wish to thank Dr. Myra Hurt and Gesnyr Ocean for their support of this work.

References

1. Gavin, NI, Gaynes, BN, Lohr, KN, Meltzer-Brody, S, Gartlehner, G, Swinson, T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005; 106(5 Pt 1): 1071–1083.Google Scholar
2. Marcus, SM, Flynn, HA, Blow, FC, Barry, KL. Depressive symptoms among pregnant women screened in obstetrics settings. J. Womens Health (Larchmt). 2003; 12(4): 373–380.Google Scholar
3. Cuijpers, P, De Graaf, R, Van Dorsselaer, S. Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. J Affect Disord. 2004; 79(1–3): 71–79.Google Scholar
4. Holzman, C, Eyster, J, Tiedje, LB, Roman, LA, Seagull, E, Rahber, MH. A life course perspective on depressive symptoms in mid-pregnancy. Matern Child Health J. 2006; 10(2): 127–138.Google Scholar
5. Gawlik, S, Waldeier, L, Muller, M, Szabo, A, Sohn, C, Reck, C. Subclinical depressive symptoms during pregnancy and birth outcome—a pilot study in a healthy German sample. Arch Womens Ment Health. 2013; 16(2): 93–100.Google Scholar
6. Lovejoy, MC, Graczyk, PA, O’Hare, E, Neuman, G. Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev. 2000; 20(5): 561–592.Google Scholar
7. Binaro, L, Pinto, N, Ahn, E, Einarson, A, Steiner, M, Koren, G. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004; 49(11): 726–735.Google Scholar
8. Davis, EP, Glynn, LM, Schetter, CD, Hobel, C, Chicz-Demet, A, Sandman, CA. Prenatal exposure to maternal depression and cortisol influences infant temperament. J Am Acad Child Adolesc Psychiatry. 2007; 46(6): 737–746.Google Scholar
9. Grigoriadis, S, VonderPorten, EH, Mamisashvili, L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013; 74(4): e321–e341.Google Scholar
10. Field, T, Diego, M, Hernandez-Reif, M. Prenatal depression effects on the fetus and newborn: a review. Infant Behav Dev. 2006; 29(3): 445–455.Google Scholar
11. Evans, J, Heron, J, Patel, RR, Wiles, N. Depressive symptoms during pregnancy and low birth weight at term: longitudinal study. Br J Psychiatry. 2007; 191(1): 84–85.Google Scholar
12. Reading, R. Educational and behavioural problems in babies of 32–35 weeks gestation. Child: Care, Health and Development. 2002; 28(1): 121–122.Google Scholar
13. Wang, ML, Dorer, DJ, Fleming, MP, Catlin, EA. Clinical outcomes of near-term infants. Pediatrics. 2004; 114(2): 372–376.Google Scholar
14. Capra, L, Tezza, G, Mazzei, F, Boner, AL. The origins of health and disease: the influence of maternal diseases and lifestyle during gestation. Ital J Pediatr. 2013; 39: 7.Google Scholar
15. Grote, NK, Bridge, JA, Gavin, AR, Melville, JL, Iyengar, S, Katon, WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010; 67(10): 1012–1024.Google Scholar
16. Alder, J, Fink, N, Bitzer, J, Hosli, I, Holzgreve, W. Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med. 2007; 20(3): 189–209.Google Scholar
17. Field, T, Diego, M, Hernandez-Reif, M, et al. Pregnancy anxiety and comorbid depression and anger: effects on the fetus and neonate. Depress Anxiety. 2003; 17(3): 140–151. doi:10.1002/da.10071 Google Scholar
18. Schetter, CD, Tanner, L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry. 2012; 25(2): 141–148.Google Scholar
19. Blumenshine, P, Egerter, S, Barclay, CJ, Cubbin, C, Braveman, PA. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med. 2010; 39(3): 263–272.Google Scholar
20. Shapiro-Mendoza, CK, Tomashek, KM, Kotelchuc, M, et al. Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics. 2008; 121(2): e223–e232.Google Scholar
21. Hromi-Fiedler, A, Bermúdez-Millán, A, Segura-Pérez, S, Pérez-Escamilla, R. Household food insecurity is associated with depressive symptoms among low-income pregnant Latinas. Matern Child Nutr. 2011; 7(4): 421–430.Google Scholar
22. Bennett, HA, Einarson, AR, Taddio, A, Koren, G, Einarson, TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004; 103(4): 698–709.Google Scholar
23. Rodrigues, T, Rocha, L, Barros, H. Physical abuse during pregnancy and preterm delivery. Am J Obstet Gynecol. 2008; 198(2): 171.e1–171.e6.Google Scholar
24. Kelly, RH, Russo, J, Holt, VL. Psychiatric and substance use disorders as risk factors for low birth weight and preterm delivery. Obstet Gynecol. 2002; 100(2): 297–304.Google Scholar
25. McFarlane, J, Parker, B, Soeken, K. Abuse during pregnancy: associations with maternal health and infant birth weight. Nurs Res. 1996; 45(1): 37–42.Google Scholar
26. Pinto, SM, Dodd, S, Walkinshaw, SA, Siney, C, Kakkar, P, Mousa, HA. Substance abuse during pregnancy: effect on pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol. 2010; 150(2): 137–141.Google Scholar
27. Ding, X-X, Wu, Y-L, Xu, S-J, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Disord. 2014; 159: 103–110.Google Scholar
28. George, A, Luz, RF, DeTychey, C, Thilly, N, Spitz, E. Anxiety symptoms and coping strategies in the perinatal period. BMC Pregnancy Childbirth. 2013; 13(1): 233.Google Scholar
29. Kroenke, K, Spitzer, RL, Williams, JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9): 606–613.Google Scholar
30. Kroenke, K, Spitzer, RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals. 2002; 32(9): 509–515.Google Scholar
31. Boulet, S, Schieve, L, Boyle, C. Birth weight and health and developmental outcomes in US children, 1997–2005. Matern Child Health J. 2011; 15(7): 836–844.Google Scholar
32. World Health Organization, UNICEF. Low Birthweight: Country, Regional and Global Estimates. Geneva: World Health Organization; 2004.Google Scholar
33. Casey, BM, McIntire, DD, Leveno, KJ. The continuing value of the APGAR score for the assessment of newborn infants. N Engl J Med. 2001; 344(7): 467–471.Google Scholar
34. Li, F, Wu, T, Lei, X, Zhang, H, Mao, M, Zhang, J. The APGAR score and infant mortality. PloS One. 2013; 8(7): 1–8.Google Scholar
35. Haddad, GG, Green, TP. Diagnostic approach to respiratory disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders Elsevier; 2011: chap 366, p. 1421.Google Scholar
36. Field, T, Diego, M, Hernandez-Reif, M, et al. Comorbid depression and anxiety effects on pregnancy and neonatal outcome. Infant Behav Dev. 2010; 33(1): 1–14.Google Scholar
37. Gaynes, BN, Gavin, N, Meltzer-Brody, S, et al. Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes. Rockville, MD: Agency for Healthcare Research and Quality; 2005.Google Scholar