The possible effects of depressive symptoms on risk of preterm birth are clouded by lack of control over confounding factors

Abstract

The possible effects of depressive symptoms on risk of preterm birth are clouded by lack of control over confounding factors Kimberly A Yonkers Commentary on: Straub H, Adams M, Kim JJ, et al. Antenatal depressive symptoms increase the likelihood of preterm birth. Am J Obstet Gynecol 2012;207:e1-4. ContextDepressive symptoms have been associated with risk of preterm birth (PTB). 1 Straub and colleagues sought to explore whether an elevated score on the Edinburgh Postnatal Depression Scale (EPDS) is associated with adverse birth outcomes, including PTB. MethodsThe authors present results from a 'universal' screening project that enrolled 14 175 women who received prenatal care through the NorthShore University Health System. Approximately 50% of women receiving prenatal care were screened. Barriers to inclusion were participant refusal and administrative issues, but PTB rates were similar in screened and non-screened subgroups. Screening occurred between 24 and 28 weeks gestation; the method (eg, self-report or clinician-administered) was not described. A screen was considered positive if the score was >12, or if the woman endorsed suicidal thoughts. Screening results were linked with electronic medical records, and birth outcome data were extracted. The authors used multivariable logistic regression to model risk of birth <37 weeks (PTB), <34 weeks, <32 weeks, <28 weeks or delivery of a small for gestational age (SGA) infant. The analytical approach included possible confounders of race, age, history of prior PTB and insurance status. The use of antidepressant medications, tobacco or other licit and illicit substances, was not included in models. FindingsThe rate of PTB was 13.9% in women with as compared to 10.3% in women without elevated depressive symptoms. The adjusted OR for PTB was 1.3 (95% CI 1.09 to 1.35). The risk was slightly higher when only singleton pregnancies were included (1.7, 95% CI 1.38 to 1.99). Exposure to depressive symptoms also increased the risk of earlier PTB and SGA (6.6% vs 5.1%; p<0.001). CommentaryThis study included a large and generalisable cohort of pregnant women. However, there are limitations. First, an elevated score on the EPDS does not necessarily indicate a depressive disorder but can indicate an anxiety disorder, a substance use disorder or any emotional condition of high stress. 2 The use of various licit and illicit

Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery

“…[57] However, other investigators have found no increased odds of PTB in relation to antepartum depression. Potential reasons posited for null findings in prior studies have been confounding by illicit substances and other psychosocial conditions such as exposure to trauma and violence [58] although these reasons are unlikely to explain our observed findings. Self-reported Illicit drug use in our study population is only 0.5%.…”

Practitioner Review: Maternal mood in pregnancy and child development – implications for child psychology and psychiatry

“…A second set of findings is that many of the obstetric factors that have long been associated with child health and development – birth weight, gestational age – are predicted from maternal mood and stress in pregnancy (Grote et al., , but see Littleton, Breitkopf, & Berenson, ; Yonkers, ). The lesson here is that presumed established risk factors for poor future child neurobehavioral development may themselves be proxies for prenatal events and exposures.…”