Impact of antenatal common mental disorders upon perinatal outcomes in Ethiopia: the P‐MaMiE population‐based cohort study

Abstract

Summaryobjectives To examine the impact of antenatal psychosocial stressors, including maternal common mental disorders (CMD), upon low birth weight, stillbirth and neonatal mortality, and other perinatal outcomes in rural Ethiopia.methods A population-based sample of 1065 pregnant women was assessed for symptoms of antenatal CMD (Self-Reporting Questionnaire-20: SRQ-20), stressful life events during pregnancy (List of Threatening Experiences: LTE) and worry about the forthcoming delivery. In a sub-sample of 654 women from six rural sub-districts, neonatal birth weight was measured on 521 (79.7%) singleton babies within 48 h of delivery. Information about other perinatal outcomes was obtained shortly after birth from the mother's verbal report and via the Demographic Surveillance System.results After adjusting for potential confounders, none of the psychosocial stressors were associated with lower mean birth weight, stillbirth or neonatal mortality. Increasing levels of antenatal CMD symptoms were associated both with prolonged labour (>24 h) (SRQ 1-5: RR 1.4; 95% CI 1.0-1.9, SRQ ‡ 6: RR 1.6; 95% CI 1.0-2.6) and delaying initiation of breast-feeding more than eight hours (SRQ 1-5: RR 1.4; 95% CI 0.8 to 2.4, SRQ ‡ 6: RR 2.8; 95% CI 1.3-6

Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review

“…In Pakistan, Rahman et al 45 recruited women via household visits by female community health workers and thereby included pregnant women unlikely to attend antenatal services. Gausia et al 27 in Bangladesh and Hanlon et al 30 in Ethiopia used sites covered by Demographic Surveillance Systems to identify eligible pregnant women who were then assessed during household visits by a health worker or surveillance site enumerator. Box 1.…”

“…The most representative ones, on the other hand, are those that recruited systematically in health services, including those located in rural areas, in low-and lower-middleincome countries where most women (> 90%) make at least one antenatal visit, 25,38 or those that recruited women who would not usually attend antenatal care, systematically 27,30,45 (Fig. 2 and Table 4).…”

“…increased risk 10,16,18,25,30,37,39,40,45,49 . Relative rather than absolute disadvantage also appears to be relevant: Wan et al 48 found that not owning a car in Beijing was associated with a higher risk of suffering a CPMD (odds ratio, OR: 1.9; 95% CI: 1.0-3.6).…”

“…8,27,28,31,38,39,45,48 Higher average symptom scores among women in polygamous rather than monogamous marriages were found in Nigeria 53 and Nepal, 31 but not in Ethiopia. 30 Only seven 24,25,28,[30][31][32]40 studies investigated an association with intimate partner violence. However, in 6 of them women who had experienced physical abuse during pregnancy or in the previous year had a higher prevalence …”

“…8,9,11,13,23,30,[37][38][39][40]49,53 A higher risk was associated with adverse reproductive events including unwanted or unintended pregnancy, past pregnancy losses, coincidental illness and operative birth. However, other studies found no significant association between CPMDs and unwanted pregnancy, 16,28 gravidity, 22,36,48 parity 13,16,20,22,34,37,47,57 prior stillbirth, 18,20,34,39 coincidental medical problems 48 or caesarean birth.…”