Clinical Risk Factors May Predict Depression During Pregnancy

From Medscape Medical News

Laurie Barclay, MD

December 30, 2009 — Clinical risk factors that may be easily identified during routine obstetric examination may help predict depression during pregnancy, according to the results of a review of 57 studies reported in the January 2010 issue of the American Journal of Obstetrics & Gynecology.

"Prenatal care providers are uniquely suited to address antepartum depression," write Christie A. Lancaster, MD, MS, from the University of Michigan in Ann Arbor, and colleagues. "First of all, providers have already captured their target population, because most women will use obstetric services at some point during their pregnancies. Providers also have multiple opportunities to assess, treat, and follow-up with patients, as obstetric visits are recurring during a several-month span."

Based on an English-language search of the literature from 1980 through 2008, the reviewers aimed to examine risk factors for antepartum depressive symptoms that could be detected in routine obstetric care. Selection criteria were studies evaluating the association between antepartum depressive symptoms and 1 or more risk factors. Two masked, independent reviewers assessed the overall trend of evidence for each potential risk factor.

There were 57 studies identified that met selection criteria.
Factors associated with a greater likelihood of antepartum depressive symptoms in bivariate analyses were maternal anxiety, life stress, history of depression, lack of social support, unintended pregnancy, Medicaid insurance, domestic violence, lower income, lower education, smoking, single status, and poor relationship quality.

In multivariate analyses, factors that continued to show a significant association with depressive symptoms were life stress, lack of social support, and domestic violence.

"Our results demonstrate several correlates that are consistently related to an increased risk of depressive symptoms during pregnancy," the review authors write.

"Our results are important for practicing clinicians because they identify risk factors that can be assessed during routine obstetric care," they add.
"For current practice, providers should especially consider the likelihood of depressive symptoms in women with these risk factors, such as report of domestic violence or a lack of social support during pregnancy."

Limitations of the studies reviewed include significant heterogeneity among studies; lack of diagnostic assessments for depression; use of different cutoff points on screening tools; limited sample size; and observational, cross-sectional design in most studies. Limitations of the data analysis include possible publication bias, review of only studies published in English, and subjective assessment of quality.

"Future work should address how well our current obstetric screening forms capture these constructs and how we can use risk factor identification to improve screening efficiency and accuracy and to enhance our clinical assessments during pregnancy," the study authors conclude.

"For example, future research studies could evaluate the likelihood of major depressive disorder in women with positive depression screens that do or do not have these additional risk factors."

The Robert Wood Johnson Clinical Scholars Program supported this study.

Am J Obstet Gynecol. 2010;202:5-14.