Elsevier

Journal of Affective Disorders

Volume 186, 1 November 2015, Pages 66-73
Journal of Affective Disorders

Research report
Depression symptoms during pregnancy: Evidence from Growing Up in New Zealand

https://doi.org/10.1016/j.jad.2015.06.009Get rights and content

Highlights

  • 11.9% of pregnant New Zealand women had probable depression (EPDS score >12).

  • Pacific and Asian women were more likely to exceed the EPDS cut-off.

  • Greater perceived stress during pregnancy was associated with probable depression.

  • Anxiety (before and during pregnancy) was associated with probable depression.

  • Further attention to supporting maternal mental health during pregnancy is needed

Abstract

Background

Depression during pregnancy has significant implications for pregnancy outcomes and maternal and child health. There is a need to identify which family, physical and mental health factors are associated with depression during pregnancy.

Methods

An ethnically and socioeconomically diverse sample of 5664 pregnant women living in New Zealand completed a face-to-face interview during the third trimester. Antenatal depression (AD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Maternal demographic, physical and mental health, and family and relationship characteristics were measured. The association between symptoms of AD and maternal characteristics was determined using multiple logistic regression.

Results

11.9% of the participating women had EPDS scores (13+) that indicated probable AD. When considering sociodemographic predictors of AD symptoms, we found that women from non-European ethnicities, specifically Pacific Islander, Asian and other, were more likely to suffer from AD symptoms. Greater perceived stress during pregnancy and a diagnosis of anxiety both before and during pregnancy were also associated with greater odds of having AD according to the EPDS.

Limitations

The women were in their third trimester of pregnancy at the interview. Therefore, we cannot discount the possibility of recall bias for questions relating to pre-pregnancy status or early-pregnancy behaviours.

Conclusions

AD is prevalent amongst New Zealand women. Ethnicity, perceived stress and anxiety are particularly associated with a greater likelihood of depression during pregnancy. Further attention to supporting maternal mental health status in the antenatal period is required.

Introduction

Depression during pregnancy has adverse effects on maternal health and pregnancy outcomes. Maternal complications of pregnancy associated with depression include inadequate weight gain, underutilisation of prenatal care, continuation of smoking, and premature delivery (Goedhart et al., 2010). Depression during pregnancy is a risk factor for postnatal depression (Cankorur et al., 2015, Evans et al., 2001, Mallikarjun and Oyebode, 2005).

Depression during the antenatal period is also an important determinant of child health. Poor mental health during pregnancy is associated with intrauterine growth retardation, lower Apgar scores, smaller head circumference, and increased risk of infant mortality (Goedhart et al., 2010). It decreases the likelihood of breastfeeding initiation (Grigoriadis et al., 2013).

The prevalence of depression during pregnancy has been estimated at 7%, 14%, and 12% for first, second, and third trimesters, respectively (systematic review by Bennett et al., 2004). Despite these high rates, depression during pregnancy has received much less attention than postnatal depression, in terms of research, media and health care community interest (Bowen and Muhajarine, 2006).

Recent interest in antenatal depression (AD) has been kindled by research into “foetal programming” (Ponder et al., 2011). Multidisciplinary studies show that a mother's psychological state while pregnant has a strong and long-lasting impact on her child's subsequent development and health. O'Donnell et al. (2009) concluded a review of the field by stating: “the evidence for an association between maternal stress, depression or anxiety in pregnancy and an adverse neurodevelopmental outcome for the child is now substantial” (p. 290).

Antenatal depression, anxiety and stress are frequently co-morbid (Lancaster et al., 2010, Poudevignel and O'Connor, 2006) and can negatively impact the intrauterine environment. For example, stress-induced activation of the sympathetic nervous system (de Bruijn et al., 2009) can increase uterine artery resistance, reducing blood flow to the foetus and altering brain structure and function (Teixeira et al., 1999, Welberg and Seckl, 2001). Antenatal depression has been linked to delayed infant motor development (Huizink et al., 2003) as well as childhood (e.g., Talge et al., 2007) and adolescent (Pawlby et al., 2009) behavioural and emotional problems. These effects are thought to be via the neuroendocrine effects of maternal depression, anxiety and stress (Field et al., 2003, O'Donnell et al., 2009).

In a systematic review of AD risk factors, Lancaster et al. (2010) found that women with a history of depression, who had experienced domestic violence, had an unintended pregnancy, lower income, or were unemployed, were more likely to experience AD. In contrast, women with more social support and positive health related behaviours, such as reducing alcohol consumption and cigarette smoking, and maintaining a reasonable level of physical exercise, were less likely to develop AD (e.g., Goedhart et al., 2009; Poudevignel and O'Connor, 2006; Odendaal et al., 2008). Intimate partner support also protects against AD (Lancaster et al., 2010).

Our aim in this study was to identify maternal characteristics associated with AD in a socioeconomically and ethnically diverse cohort. We anticipated that identification of such factors would increase the capacity for health care providers to identify and thus treat pregnant women with depression. By conducting this study within a cohort of pregnant women whose children would form a new longitudinal study, we also saw the careful description of maternal depression at baseline to be an essential element of any subsequent life-course assessment of the determinants of child health.

Section snippets

Participant and general procedure

We completed our study of AD symptoms, risk and protective factors in a socioeconomically and ethnically diverse cohort of 5664 pregnant women who were participating in the Growing Up in New Zealand longitudinal study (Morton et al., 2012).

The Growing Up in New Zealand cohort of pregnant women was recruited to provide information that is broadly generalisable to all current NZ births (Morton et al., 2012). The women had a due date between 25th April 2009 and 25th March 2010 and lived in the

Results

Of 5664 pregnant women, 672 (11.9%) had EPDS scores of 13 or above and were thus considered to have EPDS-AD.

The chi square test results indicating associations between EPDS-AD status and sociodemographc variables are presented in Table 1. All sociodemographic variables (age, ethnicity, education, workforce participation, household income and relationship status) except rurality were significantly associated with EPDS-AD (ps<.001). No significant association was found between EPDS-AD status and

Discussion

Almost 12 percent (11.9%) of this ethnically and socioeconomically diverse cohort of Growing Up in New Zealand women had depression during pregnancy (according to the EPDS). Use of a validated tool (EPDS) to assess the presence of depression avoided the underestimation of AD prevalence that occurs if the definition of AD is based upon physician diagnosis. As reviewed by Marcus (2009), only a small number of women who meet criteria for a major depressive disorder seek medical treatment. In New

Conclusions

The number and diversity of women recruited are strengths of Growing Up in New Zealand and provide adequate explanatory power to examine complex outcomes across the whole cohort. In the near future, we will report the prevalence of postnatal depression among our cohort of women, and eventually the longer term effects on developing offspring. This knowledge will inform the development of strategies likely to improve the health, wellbeing and equity of outcomes for all New Zealand children and

Acknowledgements

The Ministry of Social Development (MSD), supported by the Health Research Council (HRC), was the initial funder of the development phase of this study. We also acknowledge other agencies who have contributed to the funding and success of this study: Ministries of Health; Education; Justice; Research; Science and Technology; Women's Affairs and Pacific Island Affairs; the Families Commission; Departments of Corrections and Labour; Housing New Zealand; Te Puni Kokiri; Office of Ethnic Affairs;

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