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Subclinical depressive symptoms during pregnancy and birth outcome—a pilot study in a healthy German sample

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Abstract

There is a high prevalence of depression in Germany and all over the world. Maternal depressive symptoms during pregnancy have been shown in some studies to be associated with an increased risk of preterm birth and low birth weight. The influence of maternal depressive symptoms during pregnancy on preterm delivery and fetal birth weight was investigated in a prospective single-centre study. A sample of 273 healthy pregnant women was assessed for symptoms of antepartum depression. Symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ). Symptoms of anxiety were assessed using the State/Trait Anxiety Inventory. Patients who scored above the cutoff were contacted by phone for a Structured Clinical Diagnostic interview. Neonatal measurements were obtained from the birth registry of the Department of Obstetrics. Baseline data were assessed with a self-styled data sheet. Prevalence of elevated depressive symptoms was 13.2 % when measured with the EPDS and 8.4 % with the PHQ. According to DSM-IV criteria, only four (EPDS) respective two (PHQ-D) of these patients could be diagnosed with a depressive disorder and ten (EPDS) respective seven (PHQ) with an anxiety disorder. There was no significant influence on preterm birth or birth weight. Maternal depressive symptoms are self-reported. Elevated subclinical symptoms of depression and anxiety during pregnancy are common. However, this study showed no evidence that these symptoms are associated with adverse pregnancy outcome.

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References

  • Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W (2007) 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 20(3):189–209, Review

    Article  PubMed  Google Scholar 

  • Andersson L, Sundström-Poromaa I, Wulff M, Aström M, Bixo M (2004) Neonatal outcome following maternal antenatal depression and anxiety: a population-based study. Am J Epidemiol 159(9):872–881

    Article  PubMed  Google Scholar 

  • Beeckman K, Louckx F, Putman K (2010) Determinants of the number of antenatal visits in a metropolitan region. BMC Publ Health 10:527

    Article  Google Scholar 

  • Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103(4):698–709, Review. Erratum in: Obstet Gynecol. 2004 Jun;103(6):1344

    Article  PubMed  Google Scholar 

  • Bergant AM, Nguyen T, Heim K, Ulmer H, Dapunt O (1998) German language version and validation of the Edinburgh postnatal depression scale. Dtsch Med Wochenschr 123(3):35–40, German

    Article  PubMed  CAS  Google Scholar 

  • Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G (2004) Perinatal risks of untreated depression during pregnancy. Can J Psychiatry 49(11):726–735

    PubMed  Google Scholar 

  • Bortz J (2005) Statistik: Für Human- und Sozialwissenschaftler, 6th edn. Springer, Berlin

    Google Scholar 

  • Brouwers EP, van Baar AL, Pop VJ (2001) Does the Edinburgh postnatal depression scale measure anxiety? J Psychosom Res 51(5):659–663

    Article  PubMed  CAS  Google Scholar 

  • Chen CH, Lin HC (2011) Prenatal care and adverse pregnancy outcomes among women with depression: a nationwide population-based study. Can J Psychiatry 56(5):273–280

    PubMed  Google Scholar 

  • Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum, Hillsdale

    Google Scholar 

  • Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786

    Article  PubMed  CAS  Google Scholar 

  • Cox JL, Chapman G, Murray D, Jones P (1996) Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. J Affect Disord 39(3):185–189

    Article  PubMed  CAS  Google Scholar 

  • Davis EP, Glynn LM, Schetter CD, Hobel C, Chicz-Demet A, Sandman CA (2007) Prenatal exposure to maternal depression and cortisol influences infant temperament. J Am Acad Child Adolesc Psychiatry 46(6):737–746

    Article  PubMed  Google Scholar 

  • Dawson G, Ashman SB, Carver LJ (2000) The role of early experience in shaping behavioral and brain development and its implications for social policy. Dev Psychopathol 12(4):695–712

    Article  PubMed  CAS  Google Scholar 

  • Diego MA, Field T, Hernandez-Reif M, Schanberg S, Kuhn C, Gonzalez-Quintero VH (2009) Prenatal depression restricts fetal growth. Early Hum Dev 85(1):65–70

    Article  PubMed  Google Scholar 

  • Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S (2010) Gender differences in the developmental course of depression. J Affect Disord 127(1–3):185–190, Epub 2010 Jun 22

    Article  PubMed  Google Scholar 

  • Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191

    Article  PubMed  Google Scholar 

  • Faul F, Erdfelder E, Buchner A, Lang A-G (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160

    Article  PubMed  Google Scholar 

  • Field T, Diego M, Hernandez-Reif M, Figueiredo B, Deeds O, Ascencio A, Schanberg S, Kuhn C (2010) Comorbid depression and anxiety effects on pregnancy and neonatal outcome. Infant Behav Dev 33(1):23–29

    Article  PubMed  Google Scholar 

  • Fishell A (2010) Depression and anxiety in pregnancy. J Popul Ther Clin Pharmacol 17(3):e363–e369

    PubMed  Google Scholar 

  • Fransson E, Ortenstrand A, Hjelmstedt A (2011) Antenatal depressive symptoms and preterm birth: a prospective study of a Swedish national sample. Birth 38(1):10–16. doi:10.1111/j.1523-536X.2010.00441.x

    Google Scholar 

  • Giardinelli L, Innocenti A, Benni L, Stefanini MC, Lino G, Lunardi C, Svelto V, Afshar S, Bovani R, Castellini G, Faravelli C (2012) Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health 15(1):21–30

    Article  PubMed  CAS  Google Scholar 

  • Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R (2009) A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand 119(5):350–364

    Article  PubMed  CAS  Google Scholar 

  • Goedhart G, Snijders AC, Hesselink AE, van Poppel MN, Bonsel GJ, Vrijkotte TG (2010) Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a large multiethnic cohort study. Psychosom Med 72(8):769–776

    Article  PubMed  Google Scholar 

  • Goldenberg RL, Culhane JF, Iams JD, Romero R (2008) Epidemiology and causes of preterm birth. Lancet 371(9606):75–84

    Article  PubMed  Google Scholar 

  • Grigoriadis S, de Camps Meschino D, Barrons E, Bradley L, Eady A, Fishell A, Mamisachvili L, Cook GS, O’Keefe M, Romans S, Ross LE (2011) Mood and anxiety disorders in a sample of Canadian perinatal women referred for psychiatric care. Arch Womens Ment Health 14(4):325–333

    Article  PubMed  Google Scholar 

  • Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ (2010) A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 67(10):1012–1024

    Article  PubMed  Google Scholar 

  • Kaitz M, Maytal HR, Devor N, Bergman L, Mankuta D (2010) Maternal anxiety, mother–infant interactions, and infants’ response to challenge. Infant Behav Dev 33(2):136–148

    Article  PubMed  Google Scholar 

  • Kaplan LA, Evans L, Monk C (2008) Effects of mothers’ prenatal psychiatric status and postnatal caregiving on infant biobehavioral regulation: can prenatal programming be modified? Early Hum Dev 84(4):249–256

    Article  PubMed  Google Scholar 

  • Kelly RH, Russo J, Holt VL, Danielsen BH, Zatzick DF, Walker E, Katon W (2002) Psychiatric and substance use disorders as risk factors for low birth weight and preterm delivery. Obstet Gynecol 100(2):297–304

    Article  PubMed  Google Scholar 

  • Liu Y, Murphy SK, Murtha AP, Fuemmeler BF, Schildkraut J, Huang Z, Overcash F, Kurtzberg J, Jirtle R, Iversen ES, Forman MR, Hoyo C (2012) Depression in pregnancy, infant birth weight and DNA methylation of imprint regulatory elements. Epigenetics 7(7):735–746

    Article  PubMed  CAS  Google Scholar 

  • Löwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, Buchholz C, Witte S, Herzog W (2004) Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord 78(2):131–140

    Article  PubMed  Google Scholar 

  • Magnusson M, Lagerberg D, Sundelin C (2011) How can we identify vulnerable mothers who do not reach the cut off 12 points in EPDS? J Child Health Care 15(1):39–49

    Article  PubMed  Google Scholar 

  • Marcus SM (2009) Depression during pregnancy: rates, risks and consequences—Motherisk Update 2008. Can J Clin Pharmacol 16(1):e15–e22

    PubMed  Google Scholar 

  • Marcus S, Lopez JF, McDonough S, Mackenzie MJ, Flynn H, Neal CR Jr, Gahagan S, Volling B, Kaciroti N, Vazquez DM (2011) Depressive symptoms during pregnancy: impact on neuroendocrine and neonatal outcomes. Infant Behav Dev 34(1):26–34

    Article  PubMed  Google Scholar 

  • Matthey S, Ross-Hamid C (2012) Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress. J Affect Disord. doi:10.1016/j.jad.2012.02.037

  • Matthey S, Barnett B, Kavanagh DJ, Howie P (2001) Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. J Affect Disord 64(2–3):175–184

    Google Scholar 

  • Matthey S, Henshaw C, Elliott S, Barnett B (2006) Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale: implications for clinical and research practice. Arch Womens Ment Health 9(6):309–315

    Article  PubMed  CAS  Google Scholar 

  • Meades R, Ayers S (2011) Anxiety measures validated in perinatal populations: a systematic review. J Affect Disord 133(1–2):1–15

    Article  PubMed  Google Scholar 

  • Olkin E, Pratt JW (1958) Unbiased estimation of certain correlation coefficients. Ann Math Stat 29:201–211

    Article  Google Scholar 

  • Reck C, Hunt A, Fuchs T, Weiss R, Noon A, Moehler E, Downing G, Tronick EZ, Mundt C (2004) Interactive regulation of affect in postpartum depressed mothers and their infants: an overview. Psychopathology 37(6):272–280

    Article  PubMed  Google Scholar 

  • Saigal S, Doyle LW (2008) An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 371(9608):261–269

    Article  PubMed  Google Scholar 

  • Salomon A et al (2001) Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression. ResearchJ Nerv Ment Dis 189:498–506

    Article  Google Scholar 

  • Spielberger CD, Gorsuch RL, Lushene RE (1970) Manual for the state-trait anxiety inventory (self-evaluation questionnaire). Consulting Psychologists Press, Palo Alto

    Google Scholar 

  • Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA 282(18):1737–1744

    Article  PubMed  CAS  Google Scholar 

  • Stewart RC (2007) Maternal depression and infant growth: a review of recent evidence. Matern Child Nutr 3(2):94–107, Review

    Article  PubMed  Google Scholar 

  • Strohle A, Holsboer F (2003) Stress responsive neurohormones in depression and anxiety. Pharmacopsychiatry 36:207–214

    Google Scholar 

  • Tegethoff M, Greene N, Olsen J, Meyer AH, Meinlschmidt G (2010) Maternal psychosocial adversity during pregnancy is associated with length of gestation and offspring size at birth: evidence from a population-based cohort study. Psychosom Med 72(4):419–426

    Article  PubMed  Google Scholar 

  • Wittchen HU, Wunderlich U, Gruschwitz S, Zaudig M (1997) SCID. Structured clinical interview for DSM-IV, Axis I. Hogrefe, Goettingen

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Heidelberg, Vossstr. 9, 69115, Heidelberg, Germany

    S. Gawlik, A. Szabo & C. Sohn

  2. Department of General Psychiatry, University of Heidelberg, Vossstr. 2, 69115, Heidelberg, Germany

    L. Waldeier, M. Müller & C. Reck

  3. Universitätsfrauenklinik Heidelberg, Vossstr. 9, 69115, Heidelberg, Germany

    S. Gawlik

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  1. S. Gawlik
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  2. L. Waldeier
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  3. M. Müller
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  4. A. Szabo
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  5. C. Sohn
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  6. C. Reck
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Correspondence to S. Gawlik.

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Gawlik, S., Waldeier, L., Müller, M. et al. Subclinical depressive symptoms during pregnancy and birth outcome—a pilot study in a healthy German sample. Arch Womens Ment Health 16, 93–100 (2013). https://doi.org/10.1007/s00737-012-0320-0

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  • DOI: https://doi.org/10.1007/s00737-012-0320-0

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