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Depression During Pregnancy Is a Risk Factor for Postpartum Depression, Does Timing Matter?

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Depression During Pregnancy Is a Risk Factor for Postpartum Depression, Does Timing Matter?

About 10% to fifteen% of girls experience depression through the first 12 months of childbirth. A few of the earliest studies identified depression while pregnant as a sturdy predictor of postpartum depression. Other studies have indicated that for many ladies with postpartum depression, depressive symptoms actually begin to emerge while pregnant and worsen after childbirth.

A more nuanced understanding of the continuum of depressive symptoms across pregnancy and the postpartum period has essential clinical implications and will inform the timing of screening for perinatal mood and anxiety disorders.

A recent study conducted a scientific review and meta-analysis estimates the prevalence of postpartum depression (PPD) at different timepoints in women who experienced antenatal depression at different times while pregnant.

The researchers identified cohort studies examining the prevalence of PPD in women who had depression while pregnant (antenatal depression or AD) and studies examining the association between AD and PPD. The evaluation included 88 cohort studies with a complete of 1,042,448 perinatal women. 

  • About 37% of the pregnant women who had AD later experienced PPD. Women with antenatal depression had a 4.58-fold greater risk of developing PPD (OR: 4.58; 95% CI = 3.52-5.96). 
  • The likelihood of getting PPD were higher when antenatal depression was observed through the first or the third trimester in comparison with the second trimester. About 12.8% of PPD cases were attributable to AD.
  • Amongst women with PPD, 16.3% also had depression while pregnant.

On this meta-analysis including over a million perinatal women, women who experienced depression while pregnant were about 4 times as more likely to experience PPD in comparison with women with no depression while pregnant, a finding that is analogous to previous studies. As well as, depressive symptoms noted through the first trimester were as strongly related to PPD as depressive symptoms through the third trimester. 

What Are the Clinical Implications?

This study indicates that girls who experienced depression while pregnant had a greater than fourfold greater risk of developing PPD than women without antenatal depression. The chances of getting PPD were higher when antenatal depression was observed in the primary or third trimester in comparison with the second trimester. The findings of the present study are consistent with previous studies indicating that depression while pregnant is probably the most robust predictors of PPD.

While this study and lots of others have identified depression while pregnant as a risk factor for PPD, we don’t know exactly the way it confers risk. Some have hypothesized that a dysfunction within the neuroendocrine system and vulnerability to shifts within the hormonal milieu may explain the association between antenatal depression and PPD. One other hypothesis is that depressive episodes while pregnant could also be related to inflammation that increases vulnerability to stressors after childbirth and subsequent depressive episodes. One other explanation is the “scar hypothesis”; it is believed that a depressive episode results in lasting changes in personality, behavior and self-concept that render an individual more vulnerable to depression in the long run.

Questions remain; nonetheless, this study underscores the importance of screening for depression while pregnant. Screening using standardized questionnaires represents a simple, low-cost technique of identifying women in danger for PPD. Moreover, the study indicates that screening through the first trimester is as essential as screening during subsequent trimesters. Furthermore, if we discover women with depressive symptoms through the first trimester, we have now time to institute nonpharmacologic and pharmacologic interventions to treat the present episode of depression and to scale back risk for PPD.

Ruta Nonacs, MD PhD

References

Dlamini LP, Amelia VL, Shongwe MC, Chang PC, Chung MH. Antenatal depression across trimesters as a risk for postpartum depression and estimation of the fraction of postpartum depression attributable to antenatal depression: A scientific review and meta-analysis of cohort studies. Gen Hosp Psychiatry. 2023 Nov-Dec; 85:35-42.

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