Depression during Pregnancy: Rates, Risks and Consequences

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Sheila M. Marcus


Depression, Pregnancy, Rates, Risks, Consequences


Affective  illness  is common  in women,  and the puerperium  is a time  of particular  vulnerability. Gender  differences  in the expression  of affective disorders have been attributed to the impact of hormonal influence, socialization, and genetics. Dramatic fluctuations in gonadal hormones that occur following childbirth, influences the increased incidence of mood disorders during this time. Numerous tools including the Edinburgh Postpartum   Depression   Scale  can  be  used  to screen for depression during pregnancy and postpartum. While screening tools may assist with appropriately  identifying  women  who should  be further assessed, their use alone does not significantly  increase  treatment  seeking  in women, even when their providers are notified about risk. Many studies demonstrate  that only a small number  (18%)  of  women  who  meet  criteria  for major depressive disorder seek treatment during pregnancy  and postpartum.  Additionally,  common symptoms of depression (sleep, energy and appetite change) may be misinterpreted as normative experiences of pregnancy. Treatment  engagement  is important  as untreated depression   during  pregnancy  may  have unfavorable   outcomes   for   both   women   and children.  Complications  of  pregnancy  associated with depression include: inadequate weight gain, under utilization of prenatal care, increased substance   use,   and   premature   birth.   Human studies   demonstrate   that   perceived   life-event stress, as well as depression and anxiety predicted lower birth weight,  decreased Apgar scores,  and smaller head circumference, and small for gestational age babies. Postpartum  depression  (PPD)  is a common clinical  disorder  occurring  in 15% of deliveries, making it one of the most frequent conditions to complicate pregnancy. Risk factors include past personal or family history of depression, sing marital status, poor health functioning, lower SES, and alcohol use. Women who have a prior history of  postpartum  depression,  particularly  with features of bipolarity or psychosis may be at particularly high risk

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