Trajectories of antenatal depression and adverse pregnancy outcomes.

BACKGROUND: Antenatal depression affects approximately one in seven pregnancies, with an increasing prevalence across gestation. Data regarding the associations between antenatal depression and adverse pregnancy outcomes yield conflicting results. However, previous studies evaluated the cross-sectional prevalence of depression at various time points, and not the trajectory of depressive symptoms across gestation.

OBJECTIVE: To identify whether the trajectory of antenatal depressive symptoms is associated with different risks of adverse pregnancy outcomes.

STUDY DESIGN: This is a secondary analysis of a large multi-site prospective cohort of nulliparous women across the United States. Edinburgh Postpartum Depression Scales (EPDS) were administered at two study visits: between 6-14 weeks and again between 22-30 weeks of gestation. The EPDS score trajectories were categorized as improved, stable, or worsened based on whether the scores changed by at least one standard deviation between the two visits. The frequencies of adverse pregnancy outcomes [hypertensive disorders of pregnancy, abruption, cesarean delivery, preterm birth (i.e., < 37 weeks gestation), small for gestational age neonates, NICU admission, and maternal readmission] were compared according to depression trajectories across gestation in bivariable and multivariable analyses. Secondary analyses evaluated the frequencies of spontaneous and medically-indicated preterm birth, as well as the frequencies of spontaneous and medically-indicated preterm birth before 35, 32, and 28 weeks gestation.

RESULTS: Of the 8,784 women who completed both antenatal EPDS, 1,141 (13.0%) had improved, 6,663 (75.9%) had stable, and 980 (11.2%) had worsened depressive symptom trajectories across gestation. Compared to women with improved or stable depressive symptoms, those with worsened symptoms were more likely to experience preterm birth (8.3% vs 7.4% vs 9.9%, respectively, p=0.018). After controlling for potential confounders, worsened depressive symptoms remained associated with more frequent preterm birth (aOR 1.68, 95% CI 1.10-2.57).

CONCLUSIONS: Women with depression symptoms that worsen as pregnancy progresses have increased odds of preterm birth. Future research is warranted to optimize and implement effective prevention, screening, and treatment protocols for antenatal depressive symptoms as a strategy to prevent preterm birth.