Journal of Behavioral Medicine

, Volume 36, Issue 4, pp 427–440 | Cite as

Perceived social support interacts with prenatal depression to predict birth outcomes

  • Kimberly J. NylenEmail author
  • Michael W. O’Hara
  • Jane Engeldinger


Prenatal depression has been linked to adverse reproductive outcomes including preterm labor and delivery, and low birth weight. Social support also has been linked to birth outcomes, and may buffer infants from the adverse impact of maternal depression. In this prospective study, 235 pregnant women completed questionnaires about depression and social support. Clinical interviews were administered to assess for DSM-IV axis I disorders. Following delivery, birth outcomes were obtained from medical records. Babies of depressed mothers weighed less, were born earlier and had lower Apgar scores than babies of nondepressed mothers. Depressed women had smaller social support networks and were less satisfied with support from social networks. We found no direct associations between perceived social support and birth weight. However, depressed women who rated their partners as less supportive had babies who were born earlier and had lower Apgar scores than depressed mothers with higher perceived partner support. Women’s perception of partner support appears to buffer infants of depressed mothers from potential adverse outcomes. These results are notable in light of the low-risk nature of our sample and point to the need for continued depression screening in pregnant women and a broader view of risk for adverse birth outcomes. The results also suggest a possible means of intervention that may ultimately lead to reductions in adverse birth outcomes.


Depression Social support Pregnancy Birth outcomes 



This study was supported in part by a grant from the G.W. Stairs Memorial Fund of McGill University, awarded to Dr. Suzanne King, Dr. O’Hara, and others (McGill ref. no. 216908), The University of Iowa Department of Psychology, College of Liberal Arts and Sciences, and the Office of the Vice President for Research, and a $1000 grant from the University of Iowa Student Government, awarded to Dr. Kimberly Nylen. We thank Maddie Adams, Melissa Buttner, Lilian Dindo, Kilee Evans, Jenny Gringer-Richards, Jessica Leeper, Sarah Mott, and Erin Springer, for their assistance with data collection and tracking. We thank Suzanne King (McGill University) and David Laplante (Douglas Hospital Research Institute) in Montreal, Quebec, Canada, for their assistance in reviewing and editing this manuscript.


  1. Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.Google Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, Text Revision (4th ed.). Washington, DC.Google Scholar
  3. Arias, E., MacDorman, M. F., Strobino, D. M., & Guyer, B. (2003). Annual summary of vital statistics—2002. Pediatrics, 112, 1215–1230.PubMedCrossRefGoogle Scholar
  4. Barry, R. A., Bunde, M., Lawrence, E., & Brock, R. (2009). Validity and utility of a multidimensional model of received support in intimate relationships. Journal of Family Psychology, 23, 48–57.PubMedCrossRefGoogle Scholar
  5. Berle, J. Ø., 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. Archives of Women’s Mental Health, 8, 181–189.PubMedCrossRefGoogle Scholar
  6. Blanchard, A., Hodgson, J., Gunn, W., Jesse, E., & White, M. (2009). Understanding social support and the couple’s relationship among women with depressive symptoms in pregnancy. Issues in Mental Health Nursing, 30, 764–776.PubMedCrossRefGoogle Scholar
  7. Bryce, R. L., Stanley, F. J., & Garner, J. B. (1991). Randomized controlled trial of antenatal social support to prevent preterm birth. British Journal of Obstetrics and Gynaecology, 98, 1001–1008.PubMedCrossRefGoogle Scholar
  8. Caitlin, E. A., Carpenter, M. W., Brann, B. S. 4th., Mayfield, S. R., Shaul, P. W., Goldstein, M. et al. (1986). The Apgar score revisited: Influence of gestational age. Journal of Pediatrics, 109, 865–868.CrossRefGoogle Scholar
  9. Campos, B., Dunkel Schetter, C., Abdou, C. M., Hobel, C. J., Glynn, L. A., & Sandman, C. A. (2008). Familialism, social support, and stress: Positive implications for pregnant Latinas. Cultural Diversity and Ethnic Minority Psychology, 14, 155–162.PubMedCrossRefGoogle Scholar
  10. Chung, T. K. H., Lau, T. K., Yip, A. S. K., Chiu, H. F. K., & Lee, D. T. S. (2001). Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosomatic Medicine, 63, 830–834.PubMedGoogle Scholar
  11. Collins, N. L., Dunkel-Schetter, C., Lobel, M., & Schrimshaw, S. C. M. (1993). Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65, 1243–1258.PubMedCrossRefGoogle Scholar
  12. Coussons-Read, M. E., Okun, M. L., & Nettles, C. D. (2007). Psychosocial stress increases inflammatory markers and alters cytokine production across pregnancy. Brain, Behavior, and Immunity, 21, 343–350.PubMedCrossRefGoogle Scholar
  13. Crippa, J. A. S., de Lima Orsorio, F., Del-Ben, C. M., Filho, A. S., da Silva Freitas, M. C., & Loureiro, S. R. (2008). Comparability between telephone and face-to-face structured clinical interview for DSM-IV in assessing social anxiety disorder. Perspectives in Psychiatric Care, 44, 241–247.PubMedCrossRefGoogle Scholar
  14. Cutrona, C. E., & Suhr, J. A. (1994). An analysis of couples’ supportive interactions. In B. R. Burleson, T. L. Albrecht, D. J. Goldsmith, & I. G. Sarason (Eds.), Communication of social support: Messages, interactions, and community (pp. 113–135). Thousand Oaks, CA: Sage.Google Scholar
  15. Dayan, J., Creveuil, C., Herlicoviez, M., Herbel, C., Baranger, E., Savoye, C., et al. (2002). Role of anxiety and depression in the onset of spontaneous preterm labor. American Journal of Epidemiology, 155, 293–301.PubMedCrossRefGoogle Scholar
  16. Dehle, C., Larsen, D., & Landers, J. E. (2001). Social support in marriage. American Journal of Family Therapy, 29, 307–324.Google Scholar
  17. Dole, N., Savitz, D. A., Hertz-Picciotto, I., Siega-Riz, A. M., McMahon, M. J., & Buekens, P. (2003). Maternal stress and preterm birth. American Journal of Epidemiology, 157, 14–24.PubMedCrossRefGoogle Scholar
  18. Feldman, P. J., Dunkel-Schetter, C., Sandman, C. A., & Wadhwa, P. D. (2000). Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosomatic Medicine, 62, 715–725.PubMedGoogle Scholar
  19. Field, T., Diego, M., Hernandez-Reif, M., Figueiredo, B., Deeds, O., Ascencio, A., et al. (2010). Comorbid depression and anxiety effects on pregnancy and neonatal outcome. Infant Behavior and Development, 33, 23–29.PubMedCrossRefGoogle Scholar
  20. Field, T., Hernandez-Reif, M., & Diego, M. (2006). Risk factors and stress variables that differentiate depressed from nondepressed pregnant women. Infant Behavior and Development, 29, 169–174.PubMedCrossRefGoogle Scholar
  21. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured clinical interview for DSM-IV Axis I disorders: Research version, non-patient edition. New York: New York State Psychiatric Institute.Google Scholar
  22. Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics & Gynecology, 106, 1071–1083.CrossRefGoogle Scholar
  23. Ghosh, J. K. C., Wilhelm, M. H., Dunkel-Schetter, C., Lombardi, C. A., & Ritz, B. R. (2010). Paternal support and preterm birth, and the moderation of effects of chronic stress: A study in Los Angeles County mothers. Archives of Women’s Mental Health, 13, 327–338.PubMedCrossRefGoogle Scholar
  24. Glazier, R. H., Elgar, F. J., Goel, V., & Holzapfel, S. (2004). Stress, social support, and emotional distress in a community sample of pregnant women. Journal of Psychosomatic Obstetrics and Gynecology, 25, 247–255.PubMedCrossRefGoogle Scholar
  25. Goodman, S. H., & Tully, E. C. (2009). Recurrence of depression during pregnancy: Psychosocial and personal functioning correlates. Depression and anxiety, 26, 557–567.PubMedGoogle Scholar
  26. Grote, N. K., Bridge, J. A., Gavin, A. R., Melville, J. L., Iyengar, S., & Katon, W. L. (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry, 67, 1012–1024.PubMedCrossRefGoogle Scholar
  27. Hoffman, S., & Hatch, M. C. (2000). Depressive symptomatology during pregnancy: Evidence for an association with decreased fetal growth in pregnancies of lower social class women. Health Psychology, 19, 535–543.PubMedCrossRefGoogle Scholar
  28. Hedegaard, M., Henriksen, T. B., Secher, N. J., Hatch, M. C., & Sabroe, S. (1996). Do stressful life events affect duration of gestation and risk of preterm delivery? Epidemiology, 7, 339–345.PubMedCrossRefGoogle Scholar
  29. Hegyi, T., Carbone, T., Anwar, M., Ostfeld, B., Hiatt, M., & Koons, A. (1998). The Apgar score and its components in the preterm infant. Pediatrics, 101, 77–81.PubMedCrossRefGoogle Scholar
  30. Heinrichs, M., Baumgartner, T., Kirschbaum, C., & Ehlert, U. (2003). Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry, 54, 1389–1398.PubMedCrossRefGoogle Scholar
  31. Hodnett, E. D., Fredericks, S., & Weston, J. (2003). Support during pregnancy for women at increased risk of low birthweight babies. Cochrane Database of Systematic Reviews, CD000198.Google Scholar
  32. Jose, P. E. (2008). Modgraph-I: A programme to compute cell means for the graphical display of moderational analyses: The internet version, Version 2.0. Victoria University of Wellington: Wellington, New Zealand.Google Scholar
  33. Kiecolt-Glaser, J. K., Gouin, J. P., & Hantsoo, L. V. (2010). Close relationships, inflammation, and health. Neuroscience and Biobehavioral Reviews, 35, 33–38.PubMedCrossRefGoogle Scholar
  34. Kurki, T., Hiilesmaa, V., Raitasalo, R., Mattila, H., & Ylikorkala, O. (2000). Depression and anxiety in early pregnancy and risk for preeclampsia. Obstetrics & Gynecology, 95, 487–490.CrossRefGoogle Scholar
  35. Lawrence, E., Bunde, M., Barry, R. A., Brock, R. L., Sullivan, K. T., Pasch, L. A., et al. (2008). Partner support and marital satisfaction: Support amount, adequacy, provision, and solicitation. Personal Relationships, 15, 445–463.CrossRefGoogle Scholar
  36. Lobel, M., DeVincent, C. J., Kaminer, A., & Meyer, B. A. (2000). The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women. Health Psychology, 19, 544–553.PubMedCrossRefGoogle Scholar
  37. Lowe, S. R., Chan, C. S., & Rhodes, J. E. (2010). Pre-hurricane perceived social support protects against psychological distress: A longitudinal analysis of low-income mothers. Journal of Consulting and Clinical Psychology, 4, 551–560.CrossRefGoogle Scholar
  38. Mancuso, R. A., Schetter, C. D., Rini, C. M., Roesch, S. C., & Hobel, C. J. (2004). Maternal prenatal anxiety and corticotrophin-releasing hormone associated with timing of delivery. Psychosomatic Medicine, 66, 762–769.PubMedCrossRefGoogle Scholar
  39. Mathews, T. J., Menacker, F., & MacDorman, M. F. (2003). Infant mortality statistics from the 2001 period linked birth/infant death data set. National Vital Statistics Reports, 52, 1–27.PubMedGoogle Scholar
  40. Neggers, Y., Goldenberg, R., Cliver, S., & Hauth, J. (2006). The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta Obstetricia et Gynecologica, 85, 277–285.CrossRefGoogle Scholar
  41. Nkansah-Amankra, S., Dhawain, A., Hussey, J. R., & Luchok, K. J. (2010). Maternal social support and neighborhood income inequality as predictors of low birth weight and preterm birth outcome disparities: Analysis of South Carolina pregnancy risk assessment and monitoring system survey, 2000–2003. Maternal and Child Health Journal, 14, 774–785.PubMedCrossRefGoogle Scholar
  42. Norbeck, J. S., & Tilden, V. P. (1983). Life stress, social support, and emotional disequilibrium in complications of pregnancy: A prospective, multivariate study. Journal of Health and Social Behavior, 24, 30–46.PubMedCrossRefGoogle Scholar
  43. O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression—A meta-analysis. International Review of Psychiatry, 8, 37–54.CrossRefGoogle Scholar
  44. O’Hara, M. W., Varner, M. W., & Johnson, S. R. (1986). Assessing stressful life events associated with childbearing: The Peripartum Events Scale. Journal of Reproductive and Infant Psychology, 4, 85–98.CrossRefGoogle Scholar
  45. Olsen, I. E., Groveman, S. A., Lawson, M. L., Clark, R. H., & Zemel, B. S. (2010). New intrauterine growth curves based on United States Data. Pediatrics, 125, e214–e224.PubMedCrossRefGoogle Scholar
  46. Rini, C., Dunkel Schetter, C., Hobel, C., Glynn, L. M., & Sandman, C. A. (2006). Effective social support: Antecedents and consequences of partner support during pregnancy. Personal Relationships, 13, 207–229.CrossRefGoogle Scholar
  47. Sarason, I. G., Sarason, B. R., Shearin, E. H., & Pierce, G. R. (1987). A brief measure of social support: Practical and theoretical implications. Journal of Social and Personal Relationships, 4, 497–510.CrossRefGoogle Scholar
  48. Sobin, C., Sobin, C., Weissmam, M. M., Goldstein, R. B., Adams, P., Wickramaratne, P., et al. (1993). Diagnostic interviewing for family studies: Comparing telephone and face-to-face methods for the diagnosis of lifetime psychiatric disorders. Psychiatric Genetics, 3, 233.CrossRefGoogle Scholar
  49. SPSS for Windows, Release 17.0.1. (2008). Chicago: SPSS Inc.Google Scholar
  50. Sugiura-Ogasawara, M., Furukawa, T. A., Nakano, Y., Hori, S., Aoki, K., & Kitamura, T. (2002). Depression as a potential casual factor in subsequent miscarriage in recurrent spontaneous aborters. Human Reproduction, 17, 2580–2584.PubMedCrossRefGoogle Scholar
  51. Wadhwa, P. D. (2005). Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology, 30, 724–743.PubMedCrossRefGoogle Scholar
  52. Wadhwa, P. D., Culhane, J. F., Rauh, V., Barve, S. S., Hogan, V., Sandman, C. A., et al. (2001). Stress, infection, and preterm birth: A biobehavioral perspective. Pediatric and Perinatal Epidemiology, 15, 17–29.PubMedCrossRefGoogle Scholar
  53. Zachariah, R. (2009). Social support, life stress, and anxiety as predictors of pregnancy complications in low-income women. Research in Nursing & Health, 32, 391–404.CrossRefGoogle Scholar
  54. Zelkowitz, P., Saucier, J., Wang, T., Katofsky, L., Valenzuela, M., & Westreich, R. (2008). Stability and change in depressive symptoms from pregnancy to two months postpartum in childbearing immigrant women. Archives of Women’s Mental Health, 11, 1–11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Kimberly J. Nylen
    • 1
    Email author
  • Michael W. O’Hara
    • 2
  • Jane Engeldinger
    • 3
  1. 1.Department of PsychologyIdaho State UniversityPocatelloUSA
  2. 2.Department of PsychologyUniversity of IowaIowa CityUSA
  3. 3.Department of Obstetrics and Gynecology, Carver College of MedicineUniversity of IowaIowa CityUSA

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