Educating clinicians about how to identify and treat serious illness in expectant mothers is crucial to minimizing complications, researchers say
ANN ARBOR, Mich. — Some pregnant women are more likely to be depressed than others.
A new U-M study published in this month’s American Journal of Obstetrics and Gynecology, finds that factors such as stress, mental health history, social support, and whether a pregnancy was intended, contribute to a woman being more at risk of experiencing depression than others.
Depression, experienced by as many as 12.7 percent of pregnant women, is a serious complication that, if identified, can be treated during pregnancy.
"Depression has been associated with adverse outcomes for both mom and baby, including pre-term delivery, pre-eclampsia, sleep disturbances for both mom and baby, maternal-infant attachment effects, in addition to its impact on the mother's daily quality of life," says Christie A. Lancaster, M.D., M.S., a U-M clinical lecturer in the department of Obstetrics and Gynecology and lead author in the study.
Lancaster and a team of researchers set out to study risk factors that could help doctors evaluate a patient’s risk for depression while pregnant.
The study consisted of a literature review that evaluated 159 English-language articles published between 1980 and 2008 conducted in the U.S., Europe, Canada, New Zealand and Australia.
Those studies looked at risk factors such as maternal anxiety, life stress, history of depression, a lack of social support, unintended pregnancy, type of medical insurance, domestic violence, lower income, lower education, smoking, relationship status and poor relationship quality.
Numerous studies have been conducted regarding postpartum depression, but few have looked at risk factors for depression while a woman is pregnant.
U-M researchers felt that studies that concentrate on post-partum depression are not adequate in evaluating depression risks in pregnant women because factors such as pregnancy intention and social support may vary before and after the arrival of the baby. Therefore, those factors could potentially be related to depression at one time point but not another.
Because more organizations are now promoting screening women for depression during each trimester of pregnancy, researchers deemed it important to identify the risk factors.
Study results showed that maternal anxiety, life stress, prior depression, lack of social support, domestic violence, unintended pregnancy, relationship factors and public insurance have a high correlation with depressive symptoms in pregnant women.
Authors of this study say it’s imperative for practicing clinicians to be educated in identifying depression in pregnant women.
At U-M all pregnant patients are screened for depression during pregnancy. But not all women with a positive screening test will have or develop clinical depression.
“We are hoping that providers can use the presence or absence of risk factors such as those identified in our study to enhance their assessments for depression in addition to the information that they obtain from the screening test,” Lancaster says.
Additional authors: Christie A. Lancaster, MD, MS; Katherine J. Gold, MD, MSW, MS; Heather A. Flynn, PhD; Harim Yoo; Sheila M. Marcus, MD; Matthew M. Davis, MD, MAPP; all of the University of Michigan Health System
Funding: This study was supported by Robert Wood Johnson Clinical Scholars Program
Journal reference: doi: 10.1016/j.ajog.2009.09.007