The Effects Of Antenatal Depression On Adverse Pregnancy Outcomes And Its Reversion

Background:Antenatal depression(AND)refers to the emotional depression occurred during any period of pregnancy.AND is the most common psychiatric disorder in women during pregnancy,and its high incidence has caused widespread concerns around the world.AND not only affects women’s physical and mental health,but also is associated with the occurrence of various adverse pregnancy outcomes.Without timely intervention,AND could further develop into postpartum depression(PPD),causing long-term harmful consequences to maternal and infant health.At present,the incidence of AND from different studies varies greatly in different regions,and there are conflicting conclusions regarding its effects on adverse pregnancy outcomes,which also requires further clarification.In addition,the risk and the path of continuous development of AND to PPD are not clear.Therefore,research on these aspects can provide valuable information for the prevention,intervention and management of AND in the field of perinatal health care,and have important public health significance for the health of women and children.Objective:Through this cohort study based on Hangzhou Women’s hospital,to determine the incidence of AND among pregnant women in Hangzhou;to clarify the effects of AND on adverse pregnancy outcomes;to explore the influence of AND on the continuous development of PPD.Methods:(1)The screening of AND and the follow-up of PPD assessment were conducted in a cohort established in Hangzhou Women’s Hospital.The pregnancy outcome data were collected through the hospital medical record system.(2)Based on the purpose of the study,descriptive studies were used to describe the prevalence of AND and adverse pregnancy outcomes in the cohort.The correlation between AND and adverse pregnancy outcomes was explored using the Cox regression model,and the association was further clarified by adjusting confounding factors.(3)For the continuous influence of AND on PPD,a nested case-control study,with AND-positive population as the research object and PPD as the outcome variable,was conducted.Non-conditional Logistic regression analysis was applied to identify the influencing factors.Finally,a path analysis model was constructed to explore the role of the influencing factors and their direct and indirect effects on PPD.Results:(1)There were 2243 women enrolled in this cohort.The incidence of AND in this study was 25.77%,and the mean score of EPDS in the AND group was 12.63 ±2.95,which was significantly higher than that in the non-AND group(5.07 ± 2.45).Compared with non-AND group,the AND group showed younger age,lower proportion of full-time work,lower annual family income,poor sleep status during pregnancy,shorter walking time,higher proportion of drinking before pregnancy,and less family care(P <0.05).Among the gestational complications,hypothyroidism was higher in the AND group(16.1% vs 12.7%).Among the characteristics of this pregnancy,the AND group showed a high proportion of unplanned pregnancy(34.8%vs 27.0%)and severe sickness(mild: 72.5% vs 67.6%,severe: 5.7% vs 2.9%).(2)In this study,the rates of preterm birth,low birth weight,macrosomia,fetal malformation,spontaneous abortion,stillbirth,fetal intrauterine distress and postpartum hemorrhage were 3.82%,2.46%,4.32%,0.64%,1.4%,0.12%,12.73%and 7.82%,respectively.The incidence of premature rupture of membranes was25.01%.However,the incidence of neonatal hospitalization and postpartum anemia was relatively high(28.10% and 32.88%,respectively).AND was only associated with preterm birth(P=0.035),and the risk of preterm birth in the AND group was1.626 times that of the non-AND group(HR=1.626,95%CI:1.035-2.554).(3)Among the 578 AND-positive women,333 continued to develop PPD(57.6%).In the nonconditional logistic regression model,age <35 years,high school level education,non-one-child family,less spouse support,higher antenatal EPDS score,fever during pregnancy,and poor postpartum sleep were risk factors for the continuous development of AND to PPD.The results of path analysis model showed that sleep quality after delivery(β=0.226,P=0.004)and one-child families(β=0.088,P=0.015)had a direct impact on the risk of PPD.Spousal support(β=0.036,P=0.002)and educational level had an indirect effect on the risk of PPD(β=-0.011,P=0.009).On the contrary,EPDS score during pregnancy has both direct(β=0.137,P=0.005)and indirect effect(β=0.037,P=0.004).In addition,pyrexia during pregnancy may also have direct(β=0.116,P=0.008)and indirect(β=0.017,P=0.051)impact on the risk of postpartum depression.Conclusions:(1)The incidence of AND in Hangzhou was 25.7%.(2)AND can significantly increase the risk of preterm birth,but there is no statistically significant association with other adverse pregnancy outcomes(3)AND is an important factor affecting the continuous development of PPD,and higher antenatal EPDS scores have both direct and indirect effect on the risk of developing PPD.(4)Attention should be paid to the harmful effect of AND on preterm birth and PPD.Universal depression screening for perinatal women should be included in routine medical clinics.Preventing the occurrence of perinatal depression has important practical significance for both maternal and child health care and public health fields.