Maternal and Child Health Journal

, Volume 15, Issue 3, pp 401–409

Perinatal Depression and Birth Outcomes in a Healthy Start Project

  • Megan V. Smith
  • Lin Shao
  • Heather Howell
  • Haiqun Lin
  • Kimberly A. Yonkers
Article

Abstract

Given the risk of adverse perinatal outcomes associated with a depressive disorder, the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) from 2001–2005 devoted resources through the Federal Healthy Start Initiative to screen pregnant women for depression and link them with services. In this report, we present the evaluation of a program that screened for depression and provided services for women with depressive symptoms or psychiatric distress in pregnancy to assess whether the program was associated with a reduction in babies born low birth weight, small for gestational age, or preterm. The program impact was examined among 1,100 women in three cohorts enrolled from 2001–2005 that included: (1) subjects recruited prior to the inception of the Healthy Start Initiative; (2) subjects enrolled in the Healthy Start Initiative; and (3) a comparison group recruited during the project period but not enrolled in the Healthy Start Initiative. After adjustment for covariates, women with probable depression were over one and a half times more likely to give birth to a preterm baby than non depressed women. Neither adjusted nor unadjusted risks for delivery of preterm, low birth weight or small for gestational age infants were significantly lower for women enrolled in Healthy Start as compared to women not enrolled in Healthy Start. However, regardless of enrollment in Healthy Start, women who delivered babies after the Healthy Start program began were 85% less likely to deliver preterm babies than women giving birth before the program began. Depression status conferred increased risk of adverse birth outcomes, results that were not altered by participation in the Healthy Start program. We cannot exclude the possibility that the community activities of the Healthy Start program promoted increased attention to health issues among depressed women and hence enhance birth outcomes.

Keywords

Perinatal depression Birth outcomes Healthy start Evaluation 

References

  1. 1.
    Gavin, N., Gaynes, B., Lohr, K., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106(5, part 1), 1071–1083.PubMedCrossRefGoogle Scholar
  2. 2.
    Gaynes, B., Gavin, N., Meltzer-Brody, S., Lohr, K., Swinson, T., & Gartlehner, G., et al. (2005). Perinatal depression: Prevalence, screening accuracy and screening outcomes. Evidence Report/Technology Assessment No. 119. In: Quality AfHRa (ed.). Rockville, MD: AHRQ Publication No. -5-E006-2: AHRQ Publication No. 05-E006-2.Google Scholar
  3. 3.
    Neggers, Y., Goldenberg, R., Cliver, S., & Hauth, J. (2004). Effects of domestic violence on preterm birth and low birth weight. Acta Obstetricia et Gynecologica Scandinavica, 83, 455–460.PubMedGoogle Scholar
  4. 4.
    Rahman, A., Iqbal, Z., Bunn, J., Lovel, H., & Harrington, R. (2004). Impact of maternal depression on infant nutritional status and illness. Archives of General Psychiatry, 61, 946–952.PubMedCrossRefGoogle Scholar
  5. 5.
    Field, T., Diego, M., Hernandez-Reif, M., Deeds, O., Holder, V., Schanberg, S., et al. (2009). Depressed pregnant black women have a greater incidence of prematurity and low birthweight outcomes. Infant Behavior and Development, 32(1), 10–16.PubMedCrossRefGoogle Scholar
  6. 6.
    Dayan, J., Creveuil, C., Marks, M. N., Conroy, S., Herlicoviez, M., Dreyfus, M., et al. (2006). Prenatal depression, prenatal anxiety, and spontaneous preterm birth: A prospective cohort study among women with early and regular care. Psychosomatic Medicine, 68(6), 938–946.PubMedCrossRefGoogle Scholar
  7. 7.
    Orr, S., James, S., & Prince, C. B. (2002). Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, MD. American Journal of Epidemiology, 156(9), 797–802.PubMedCrossRefGoogle Scholar
  8. 8.
    Brooke, O., Anderson, H. R., Bland, M. J., Peacock, J., Stewart, C. M. (1989). Effects on birth weight if smoking, alcohol, caffeine, socioeconomic factors, and psychosocial stress. British Medical Journal 298.Google Scholar
  9. 9.
    Chung, T., Franzcog, L., Yip, A., Chiu, H., & Lee, D. (2001). Antepartum depressive symptomology is associated with adverse obstetric and neonatal outcomes. Psychosomatic Medicine, 63, 830–834.PubMedGoogle Scholar
  10. 10.
    McCormick, M., Brooks-Gunn, J., Shorter, T., Holmes, J., Wallace, C., & Heagarty, M. (1990). Factors associated with smoking in low income pregnant women: Relationship to birth weight, stressful life events, social support, health behaviors and mental distress. Journal of Clinical Epidemiology, 43(5), 441–448.PubMedCrossRefGoogle Scholar
  11. 11.
    Misri, S., Oberlander, T. F., Fairbrother, N., Carter, D., Ryan, D., Kuan, A. J., et al. (2004). Relation between prenatal maternal mood and anxiety and neonatal health. Canadian Journal of Psychiatry—Revue Canadienne de Psychiatrie, 49(10), 684–689.PubMedGoogle Scholar
  12. 12.
    Berle, J. O., Mykletun, A., Daltveit, A. K., Rasmussen, S., Holsten, F., & Dahl, A. A. (2005). Neonatal outcomes in offspring of women with anxiety and depression during pregnancy. A linkage study from The Nord-Trondelag Health Study (HUNT) and Medical Birth Registry of Norway. Archives of Women’s Mental Health, 8(3), 181–189.PubMedCrossRefGoogle Scholar
  13. 13.
    Andersson, L., Sundstrom-Poromaa, I., Wulff, M., Astrom, M., & Bixo, M. (2004). Neonatal outcome following maternal antenatal depression and anxiety: A population-based study. American Journal of Epidemiology, 159(9), 872–881.PubMedCrossRefGoogle Scholar
  14. 14.
    Nordentoft, M., Lou, H., Hansen, D., Nim, J., Pryds, O., Rubin, P., et al. (1996). Intrauterine growth retardation and premature delivery: The influence of maternal smoking and psychosocial factors. American Journal of Public Health, 86(3), 347–354.PubMedCrossRefGoogle Scholar
  15. 15.
    Spitzer, R., Williams, J., Kroenke, K., Hornyak, R., & McMurray, J. (2000). Validity and utility of the Patient Health Questionnaire (PHQ) in assessing 3000 obstetric gynecology patients: The Prime-MD PHQ obstetric gynecology study. American Journal of Obstetrics and Gynecology, 183(3), 759–769.PubMedCrossRefGoogle Scholar
  16. 16.
    Yonkers, K. A., Smith, M. V., Lin, H., Howell, H. B., Shao, L., Rosenheck, R. A., et al. (2009). Depression screening of perinatal women: an evaluation of the healthy start depression initiative. Psychiatric Services, 60(3), 322–328.PubMedCrossRefGoogle Scholar
  17. 17.
    Bracken, M., Triche, E., Belanger, K., Hellenbrand, K., Saftlas, A., Beckett, W., et al. (2003). Effects of asthma severity and drug therapy on preterm delivery and fetal growth: A prospective study of 2,205 pregnancies. Obstetrics and Gynecology, 102, 739–752.PubMedCrossRefGoogle Scholar
  18. 18.
    Salihu, H., Mbah, A., Jeffers, D., Alio, A., & Berry, L. (2009). Healthy start program and feto-infant morbidity outcomes: Evaluation of program effectiveness. Maternal and Child Health Journal, 13(1), 56–65.PubMedCrossRefGoogle Scholar
  19. 19.
    Devaney, B., Howell, E., McCormick, M., & Lorenzo, M. (2000). Reducing infant mortality: Lessons learned from healthy start. Mathematica Policy Research Inc.Google Scholar
  20. 20.
    Meschke, L. L., Holl, J. A., & Messelt, S. (2003). Assessing the risk of fetal alcohol syndrome: Understanding substance use among pregnant women. Neurotoxicology and Teratology, 25, 667–674.PubMedCrossRefGoogle Scholar
  21. 21.
    Azadi, A., & Dildy Iii, G. A. (2008). Universal screening for substance abuse at the time of parturition. American Journal of Obstetrics and Gynecology, 198(5), e30–e32.PubMedCrossRefGoogle Scholar
  22. 22.
    Frick, K., & Lantz, P. (1999). How well do we understand the relationship between prenatal care and birth weight? Health Services Research, 34(5), 1063–1070.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Megan V. Smith
    • 1
  • Lin Shao
    • 2
  • Heather Howell
    • 2
  • Haiqun Lin
    • 3
  • Kimberly A. Yonkers
    • 2
    • 4
  1. 1.Departments of Psychiatry and Child StudyYale University School of MedicineNew HavenUSA
  2. 2.Department of PsychiatryYale University School of MedicineNew HavenUSA
  3. 3.Department of BiostatisticsYale University School of Public HealthNew HavenUSA
  4. 4.Department of Obstetrics, Gynecology, and Reproductive SciencesYale University School of Public HealthNew HavenUSA

Personalised recommendations