Neonatal Outcomes After Elective Cesarean Delivery

Abstract

P regnancy can trigger the first episode of depression in a women or a recurrence of depression in those women with a prior history of the disorder. The prevalence of depression during pregnancy is estimated at 8% to 51%. The wide range in cited prevalence can be due to variations in the criteria used to diagnose depression and the timing and types of assessments used for evaluation of the disorder. This study evaluated the time to onset, duration, and risk factors for major and minor depression in pregnant women.The women were recruited from the Centers for Prenatal Care of the Public Health Service District in Mantova, Italy from September 2005 to August 2006. At each monthly visit, the study participants completed the Primary Care Evaluation of Mental Disorders (PRIME-MD) for screening of depressive disorders and the Hospital Anxiety and Depression Scale (HADS) for evaluation of the severity of anxious and depressive symptoms. The patients also completed a brief questionnaire for sociodemographic data. The PRIME-MD evaluates the presence of 9 depressive symptoms occurring in the previous 2 weeks. The HADS is a 14-item self-administered test that evaluates anxiety and depression in a nonpsychiatric population; it generates 2 subscale scores, that is, an anxiety and a depression score. Comparisons were made among women with minor or major depression and those without depression.Of 193 women who visited the center during the study period, 154 completed the study; their mean age was 30.8 ± 4.4 years, and the mean number of assessments completed during pregnancy was 6.2 ± 0.5. Nineteen (12.3%) and 28 (18.1%) women had major and minor depression, respectively, and 107 had no depressive symptoms. Those without depressive symptoms served as the control group. The 3 groups of women were similar in age, education, and family status although a larger number of women in the depression groups (26.3% in major depression group and 32.1% in minor depression group) were housewives compared with the controls (6.5%). Women with major depression had more frequent conflict with a husband or partner than women in the control group [odds ratio (OR), 7.8; 95% confidence interval (CI), 1.0-62.7]. No differences were found among the groups in the rates of family and job problems, presence of family support, and unwanted pregnancy. Major depression had a later onset (5.6 ± 2.8 mo vs. 2.3 ± 1.7 mo, respectively; P = 0.09) and longer duration (3.5 ± 2.2 mo and 1.6 ± 0.7 mo, respectively; P = 0.03), compared with minor depression. Among those with depression, 6 mothers with major depression and 2 with minor depression were still depressed at the final evaluation before delivery. No depressed women were treated with antidepressants or other psychotropic drugs, and only 2 women with major depression received psychologic support. Compared with nondepressed women, predictive factors at the beginning of pregnancy for the development of major depression were a history of a previous depressive episode (OR, 9.5; CI,) and conflict with a husband or...

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