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Depressive Symptoms Prior to Pregnancy and Infant Low Birth Weight in South Africa

Maternal and Child Health Journal volume 19, pages 2179–2186 (2015)Cite this article

Abstract

Despite improvements in service delivery and patient management, low birth weight among infants has been a persistent challenge in South Africa. The study aimed to explore the relationship between depression before pregnancy and the low birth weight (LBW) of infants in post-apartheid South Africa. This study utilized data from Waves 1 and 2 of the South African National Income Dynamics Study, the main outcome being a dichotomous measure of child LBW (<2500 g) drawn from the Wave 2 child questionnaire. Depressive symptoms of non-pregnant women was the main predictor drawn from the Wave 1 adult questionnaire. Depressive symptoms were screened using the 10-item four-point Likert version of the Center for Epidemiologic Studies Depression Scale (CES-D) instrument. A total score of 10 or greater on the CES-D indicates a positive screen for depressive symptoms. An adjusted logistic regression model was used to examine the relationship between women’s depression before pregnancy and infant LBW. A sample size of 651 women in Wave 1 was linked to 672 newborns in Wave 2. The results of the adjusted logistic regression model indicated depressive symptoms (CES-D ≥ 10) prior to pregnancy were associated with infant LBW (adjusted OR 2.84, 95 % CI 1.08–7.46). Another significant covariate in the model was multiple childbirths. Our finding indicates that women’s depressive symptoms prior to pregnancy are associated with the low birth weight of newborns and suggests that this association may not be limited to depression present during the ante-natal phase.

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References

  1. Goldenberg, R. L., & Culhane, J. F. (2007). Low birth weight in the United States. American Journal of Clinical Nutrition, 85(2), 584S–590S.

    CAS  PubMed  Google Scholar 

  2. Vigod, S. N., Villegas, L., Dennis, C. L., et al. (2010). Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: A systematic review. BJOG, 117(5), 540–550.

    CAS  Article  PubMed  Google Scholar 

  3. Chopra, M., Daviaud, E., Pattinson, R., et al. (2009). Saving the lives of South Africa’s mothers, babies, and children: Can the health system deliver? Lancet, 374(9692), 835–846.

    Article  PubMed  Google Scholar 

  4. Organisation for Economic Cooperation and Development. (2011). Infant health: Low birth weight. http://dx.doi.org/10.1787/health_glance-2011-11-en

  5. Zimmer-Gembeck, M. J., & Helfand, M. (1996). Low birthweight in a public prenatal care program: Behavioral and psychosocial risk factors and psychosocial intervention. Social Science and Medicine, 43(2), 187–197.

    CAS  Article  PubMed  Google Scholar 

  6. Teitler, J. O., Reichman, N. E., Nepomnyaschy, L., et al. (2007). A cross-national comparison of racial and ethnic disparities in low birth weight in the United States and England. Pediatrics, 120(5), e1182–e1189.

    Article  Google Scholar 

  7. Khoshnood, B., Wall, S., & Lee, K. S. (2005). Risk of low birth weight associated with advanced maternal age among four ethnic groups in the United States. Maternal Child Health Journal, 9(1), 3–9.

    Article  PubMed  Google Scholar 

  8. Blondel, B., Kogan, M. D., Alexander, G. R., et al. (2002). The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: An international study. American Journal of Public Health, 92(8), 1323–1330.

    PubMed Central  Article  PubMed  Google Scholar 

  9. Odell, C. D., Kotelchuck, M., Chetty, V. K., et al. (2006). Maternal hypertension as a risk factor for low birth weight infants: Comparison of Haitian and African-American women. Maternal Child Health Journal, 10(1), 39–46.

    Article  PubMed  Google Scholar 

  10. Abu-Ghanem, S., Sheiner, E., Sherf, M., et al. (2012). Lack of prenatal care in a traditional community: Trends and perinatal outcomes. Archives of Gynecology and Obstetrics, 285(5), 1237–1242.

    Article  PubMed  Google Scholar 

  11. Manikkam, L., & Burns, J. K. (2012). Antenatal depression and its risk factors: An urban prevalence study in KwaZulu-Natal. South African Medical Journal, 102(12), 940–944.

    PubMed  Google Scholar 

  12. Grote, N. K., Bridge, J. A., Gavin, A. R., et al. (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(10), 1012–1024.

    PubMed Central  Article  PubMed  Google Scholar 

  13. Brennan, P. A., Hammen, C., Andersen, M. J., et al. (2000). Chronicity, severity, and timing of maternal depressive symptoms: Relationships with child outcomes at age 5. Developmental Psychology, 36(6), 759–766.

    CAS  Article  PubMed  Google Scholar 

  14. Marcus, S. M., Flynn, H. A., Blow, F. C., et al. (2003). Depressive symptoms among pregnant women screened in obstetrics settings. Journal of Women’s Health, 12(4), 373–380.

    Article  PubMed  Google Scholar 

  15. Dietz, P. M., Williams, S. B., Callaghan, W. M., et al. (2007). Clinically identified maternal depression before, during, and after pregnancies ending in live births. American Journal of Psychiatry, 164(10), 1515–1520.

    Article  PubMed  Google Scholar 

  16. Petersen, I., & Lund, C. (2011). Mental health service delivery in South Africa from 2000 to 2010: One step forward, one step back. South African Medical Journal, 101(10), 751–757.

    PubMed  Google Scholar 

  17. Class, Q. A., Khashan, A. S., Lichtenstein, P., et al. (2013). Maternal stress and infant mortality: The importance of the preconception period. Psychological Science, 24(7), 1309–1316.

    PubMed Central  Article  PubMed  Google Scholar 

  18. Witt, W. P., Wisk, L. E., Cheng, E. R., et al. (2012). Preconception mental health predicts pregnancy complications and adverse birth outcomes: A national population-based study. Maternal and Child Health Journal, 16(7), 1525–1541.

    PubMed Central  Article  PubMed  Google Scholar 

  19. Radloff, L. S. (1977). The CES-D scale. Applied Psychological Measurement, 1(3), 385–401.

    Article  Google Scholar 

  20. Bjorgvinsson, T., Kertz, S. J., Bigda-Peyton, J. S., et al. (2013). Psychometric properties of the CES-D-10 in a psychiatric sample. Assessment, 20(4), 429–436.

    Article  PubMed  Google Scholar 

  21. Andresen, E. M., Malmgren, J. A., Carter, W. B., et al. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10(2), 77–84.

    CAS  PubMed  Google Scholar 

  22. Rao, J. N. K., & Scott, A. J. (1984). On Chi-squared tests for multiway contingency tables with cell proportions estimated from survey data. Annals of Statistics, 12(1), 46–60.

    Article  Google Scholar 

  23. Joyce, K., Diffenbacher, G., Greene, J., & Sorokin, Y. (1984). Internal and external barriers to obtaining prenatal care. Social Work in Health Care, 9(2), 89–96.

    Article  Google Scholar 

  24. Kopelman, R. C., Moel, J., Mertens, C., et al. (2008). Barriers to care for antenatal depression. Psychiatric Services, 59(4), 429–432.

    PubMed Central  Article  PubMed  Google Scholar 

  25. Myer, L., & Harrison, A. (2003). Why do women seek antenatal care late? Perspectives from rural South Africa. Journal of Midwifery & Women’s Health, 48(4), 268–272.

    Article  Google Scholar 

  26. Jesse, D. E., Dolbier, C. L., & Blanchard, A. (2008). Barriers to seeking help and treatment suggestions for prenatal depressive symptoms: Focus groups with rural low-income women. Issues in Mental Health Nursing, 29(1), 3–19.

    Article  PubMed  Google Scholar 

  27. Kramer, M. S., Séguin, L., Lydon, J., et al. (2000). Socio-economic disparities in pregnancy outcome: Why do the poor fare so poorly? Paediatric and Perinatal Epidemiology, 14(3), 194–210.

    CAS  Article  PubMed  Google Scholar 

  28. Institute of Medicine. (1985). Preventing low birthweight. http://www.ncbi.nlm.nih.gov/books/NBK214468/pdf/TOC.pdf

  29. Krans, E. E., & Davis, M. M. (2012). Preventing low birthweight: 25 years, prenatal risk, and the failure to reinvent prenatal care. American Journal of Obstetrics and Gynecology, 206(5), 398–403.

    Article  PubMed  Google Scholar 

  30. Statistics South Africa. (2004). Concept and definitions. Pretoria: Statistics South Africa.

    Google Scholar 

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Acknowledgments

Dr. Tomita was supported by NIH Research Training Grant (R25 TW009337) funded by the Fogarty International Center and the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The data was accessed through Southern Africa Labour and Development Research Unit. National Income Dynamics Study 2008 and 2010–2011, Wave 1 and 2 (dataset). Version 4.1 for Wave 1 and version 1.0 for Wave 2. Cape Town: Southern Africa Labour and Development Research Unit (producer), 2013. Cape Town: Data First (distributor), 2013.

Conflict of interest

All authors have approved the manuscript as submitted and none of the authors have a conflict of interest to declare.

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Authors and Affiliations

  1. Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa

    Andrew Tomita, Charlotte A. Labys & Jonathan K. Burns

  2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Andrew Tomita

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  1. Andrew Tomita
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  2. Charlotte A. Labys
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Correspondence to Andrew Tomita.

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Tomita, A., Labys, C.A. & Burns, J.K. Depressive Symptoms Prior to Pregnancy and Infant Low Birth Weight in South Africa. Matern Child Health J 19, 2179–2186 (2015). https://doi.org/10.1007/s10995-015-1732-z

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  • DOI: https://doi.org/10.1007/s10995-015-1732-z

Keywords

  • Depression prior to pregnancy
  • Low birth weight
  • South Africa