And preterm birth is leading cause of infant mortality, study notes

Women who are depressed early in their pregnancy run a higher risk of preterm delivery, the leading cause of infant mortality, a new study suggests.For the study, researchers interviewed 791 San Francisco-area women near their 10th week of pregnancy. Forty-one percent reported "significant" symptoms of depression, and 22 percent reported "severe" symptoms.

Those women with severe symptoms had almost twice the risk of an early birth, defined as before 37 weeks' gestation. Those with significant symptoms had a 60 percent risk of early birth, the study found.

Women who were likelier to report depressive symptoms tended to be younger than 25, unmarried, less educated, poorer, black, and have a history of preterm delivery.

Discovering a possible cause of preterm birth, about which little is known, makes the findings significant, said study lead author Dr. De-Kun Li, a perinatal epidemiologist and senior research scientist at Kaiser Permanente's Division of Research in Oakland, Calif.

Scientists have been researching for the causes of high rates of infant mortality in the United States, Li said, but, "we don't know what is going on. If we can find something as obvious as depression that can be treated during pregnancy, that is very, very significant."

The findings were published online Oct. 23 in the journal Human Reproduction.

Dr. Shari I. Lusskin, director of reproductive psychiatry at New York University Medical Center, said she doesn't think the study establishes a link between depression in early pregnancy and preterm delivery. She said the women in the study weren't clinically diagnosed with depression but had scored high on a screening test.

"We don't know if the depression at 10 weeks is a marker for something that happens later in pregnancy, which is the real culprit," she said.

Li hopes the study's findings will make "ante-natal depression" as widely recognized as postpartum depression has become. Until now, depression during pregnancy has been "under-estimated and under-treated," he said, "not just by women, but also by their doctors."

One reason for this lack of attention is that there hasn't been strong evidence of a connection between depression in pregnant women and harm to the fetus, Li said.

Women may not readily report depressed feelings when they are pregnant because of the societal expectation that having a baby should be a joyous occasion, said Dr. Jennifer Wu, an obstetrician and gynecologist at Lenox Hill Hospital in New York City.

"I think many patients are very stressed about pregnancy and worried about the pregnancy and not sure about its impact on their lives," Wu said.

Lusskin tries to spread the word about the dangers of depression during pregnancy.

"The more we know about postpartum depression, the more we realize that half the cases started in pregnancy," Lusskin said. Ante-natal depression also carries the risk of noncompliance with prenatal care, poor nutrition, inadequate sleep, self-medication with drugs and alcohol, and suicide, she explained.

And, Lusskin added, "Ante-natal depression interferes with bonding with the baby both during pregnancy and post-partum."

The take-home lesson from the Kaiser study, Lusskin said, "is that ante-natal depression and ante-natal depression symptoms have some effect on pregnancy, and they should be treated, even though we don't know how that mood is translated into the biochemistry of that pregnancy."

She added that she is "a proponent of maintaining a good mood throughout pregnancy and breast-feeding, and doing what you have to do to do that. If a patient requires medication, she should do that. Then, it's a matter of finding the drugs that are best studied and most effective for the patient."

Carolyn Colwell 

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Coping With Depression During Pregnancy

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An expectant mother's depression can harm her baby, including raising the odds of preterm delivery

Christine Doherty Ashley, currently six months pregnant, realizes that her first trimester was fraught with depression. Now, with the perspective of an improved mood, Ashley recalls being particularly judgmental of her doldrums, questioning, "Am I allowed to say I'm sad or that I hate how I feel?" Nausea kept her on the couch and logistics kept her isolated: She was a high school teacher on summer break, had just moved to a new town, and she and her husband were not yet sharing the news because, at 41, she was at higher risk of early miscarriage. "It was a perfect storm," she explains.

Depression in pregnancy not only causes mom to suffer; it can also pose health risks to the baby. Research published today in the journal Human Reproduction found that women with symptoms of depression were more likely to experience a preterm birth. The greater the severity of depression symptoms, the greater the likelihood of early delivery. This research adds "strong evidence that depression during pregnancy is bad for the fetus," says lead study author De-Kun Li, reproductive and perinatal epidemiologist at Kaiser Permanente's Division of Research in Oakland, Calif., "This should not be dismissed anymore." Preterm birth, write the study authors, is the leading cause of infant mortality and medical expenditures for newborns.

Contrary to the belief that all expectant moms are buoyed by their own joyous anticipation, the reality is that pregnancy offers no protection against depression. A woman's overall risk of depression peaks during childbearing years, and "roughly 12 to 14 percent of mothers will experience depression during pregnancy," says Cindy-Lee Dennis, researcher at the University of Toronto and associate professor of nursing with an appointment in the psychiatry department. The biggest risk factor for symptoms while pregnant, Dennis explains, is a previous history of depression.

Such depression may also be linked to a baby being born at a lower birth weight with elevated levels of cortisol (a stress hormone) and changes in attention or alterations in electroencephalography (an infant brain test), says Diana Dell, assistant professor of psychiatry and obstetrics-gynecology at Duke University Medical Center. These issues can affect health even into adulthood. "Being anxious or depressed is not [going to have] a neutral impact on a developing fetus," says Dell.

But silence often accompanies such melancholy. Fear of being judged a less-than-capable mother or labeled mentally ill can lead to quiet suffering, says Dennis. It wasn't until Ashley's depression lifted that she broached the topic with her husband. To ward off postpartum depression, she's enlisted his help, telling him, "You need to ask me [because] sometimes I can't say it; I judge myself." In fact, depression during pregnancy is the top risk factor for developing postpartum depression.

But treatment options exist. To alleviate prenatal depression, lifestyle elements are quite significant, experts agree, including stress reduction, eating well, drinking enough of water, consistently getting good sleep, and exercising. Depending on the depression's severity and cause, physicians may recruit cognitive behavioral therapy, couples therapy, bright light therapy, or antidepressant medications. While some research suggests certain antidepressants may pose risks to the baby, some have been shown to be safer than others. Dell weighs such risks against the dangers of a fetus developing inside a mother who cannot function because she's depressed and not caring for herself well. An untreated depressed or anxious pregnant woman, says Dell, "generates some pretty noxious chemicals" that are not good for a fetus.

For those who feel motivated enough to get some exercise, a known mood enhancer, doing so is plenty safe. "Anything equivalent to brisk walking is fine," James Pivarnik, kinesiology professor at Michigan State University and coauthor of the section on activity in pregnancy and after delivery in the 2008 Physical Activity Guidelines released this month by the Department of Health and Human Services. The new recommendation for pregnant women and those who recently delivered is at least 150 minutes of moderate activity per week. Keeping this schedule may also reduce the risk of preeclampsia and gestational diabetes. Pivarnik notes that women should be careful not to overheat—like using a fan during indoor workouts—which can be problematic for the fetus.

But a woman's mood may be too low for physical activity. This is when the support of friends and family can have a significant impact, says Dennis. It is critical, she explains, that the mother, partner, and family are all aware of the risks and symptoms of depression in pregnancy, including feelings of emptiness, sadness, hopelessness, irritability, crying excessively; trouble sleeping, or sleeping all the time. Many women assume this is all part of being pregnant, but persistent symptoms are not. Both Dennis and Dell say the Edinburgh Postnatal Depression Scale, though designed for the postpartum period, can be a helpful tool for expectant mothers, too, and is widely available online and is also available here. Dennis also recommends the Motherisk program website, affiliated with the University of Toronto and intended to provide information on drug, chemical, and disease risks in pregnant women.

Mothers need not feel guilt about depression in pregnancy or about the chosen treatment—pharmacological or otherwise, experts emphasize. "This is a brain disease, it's not a character flaw, not a pull-yourself-up-by-the-bootstraps kind of thing," says Dell, "You don't have to tough it out."

Sarah Baldauf 

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Premature Birth Risk Doubles For Depressed Pregnant Women

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A new study published in the journal Human Reproduction has found that pregnant women who suffer from depression are twice as likely to have a premature birth.

Researchers have found a direct link between depression and the risk of premature birth. The more serious the depression, the higher the risk.

The study was led by De-Kun Li at Kaiser Permanente’s Division of Research in Oakland, California and interviewed 791 women between 6 weeks and 18 weeks of pregnancy.

A premature birth occurs when a woman gives birth within the first 37 weeks of pregnancy.

This is tied to developmental problems and other issues for the kids.

Researchers have been unable to explain why the link is there though.

Out of the 791 women who were interviewed, 41.2% were “significantly” depression, while 21.7% were in “severe” depression.

Those “significantly” depressed were 1.6 times more likely to have a preterm birth.

Women suffering from severe depression were 2.2 times more likely..

The study has been published in the journal Human Reproduction. >>>> 

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