What is the course and stability of maternal depressive symptoms throughout the perinatal period?

By Tarun Sai LomteReviewed by Lily Ramsey, LLMOct 31 2023

In a recent study published in JAMA Network Open, researchers examined maternal depressive symptoms in diverse observational cohorts.

Study: Perinatal Trajectories of Maternal Depressive Symptoms in Prospective, Community-Based Cohorts Across 3 Continents. Image Credit: Pormezz/Shutterstock.com

Background

Maternal mental health remains a risk factor for adverse outcomes in the offspring. Yet, the contradictory data on prepartum versus postpartum onset of depression complicate health policies regarding optimal intervention timings.

Studies indicate a higher incidence of maternal clinical depression post-childbirth. Nevertheless, these studies lacked prospective longitudinal analyses to delineate the onset time.

By contrast, extensive community-based prospective longitudinal studies report that depression levels remain slightly elevated in pregnancy and sustain after that. Therefore, it is necessary to determine the onset of depressive symptoms to ensure timely interventions, given the implications for the offspring.

About the study

In the present study, researchers examined maternal depression onset and stability. They analyzed data from the following cohorts:

1) mapping antenatal maternal stress (MAMS),

2) Singapore pre-conception study of long-term maternal and child outcomes (S-PRESTO),

3) growing up in Singapore toward healthy outcomes (GUSTO),

4) Montreal antenatal well-being study (MAWS),

5) maternal adversity, vulnerability, and neurodevelopment (MAVAN) study,

6) Alberta pregnancy outcomes and nutrition (APrON) study, and

7) Avon longitudinal study of parents and children (ALSPAC).

Participants were recruited during pregnancy or pre-conception. The team harmonized data on maternal depressive symptoms from pregnancy through two years after childbirth.

The 20-item Center for Epidemiological Studies-Depression (CES-D) scale was administered in the MAVAN cohort, whereas the 10-item Edinburgh Postnatal Depression Scale (EPDS) was issued in the remaining cohorts. EPDS and CES-D measured the frequency of depressive symptoms in the past week.

Data on maternal age, education level, marital status, and ethnicity were obtained. Individual responses to the CES-D and EPDS were analyzed using item response theory techniques.

The team derived a latent depression trait estimate per participant for each time point, providing a trajectory of depressive symptoms over time. Participant groups having similar trajectories were identified using K-means clustering.

Findings

The study included 11,563 pregnant individuals aged 29, on average. Most participants (87%) were White, followed by East Asian (5%) and South East Asian (2.6%) individuals. The ALSPAC, APrON, MAWS, GUSTO, MAVAN, S-PRESTO, and MAMS cohorts included 8,704, 953, 710, 329, 350, 86, and 431 participants, respectively.

All subjects in the S-PRESTO cohort, 97.4% in the MAMS cohort, 94.9% in the MAVAN cohort, 96.9% in the GUSTO cohort, 97.2% in the MAWS cohort, 97.4% in the APrON cohort, and 80.7% in the ALSPAC cohort had a partner or were married at recruitment.

The researchers observed three groups of mothers based on (high, mild, or low levels of) depressive symptoms in each cohort.

The average trajectory was stable during pregnancy through two years post-childbirth. Additionally, the team examined symptoms in a sub-group with probable depression, defined as having an EPDS score ≥ 15 in pregnancy and ≥ 13 after childbirth.

Consistently, this sub-group showed a stable trajectory of depressive symptoms throughout the perinatal period.

Conclusions

Together, the study illustrated three stable trajectory groups of participants with low, mild, or high levels of depressive symptoms, in agreement with previous studies.

The findings suggest that maternal depressive symptoms appear (early) during pregnancy and remain stable into the postnatal period. Notably, this pattern was also noted among mothers with clinical levels of depressive symptoms.

Thus, the early antenatal period may serve as the time point for identifying trajectories of depressive symptoms. The results underscore the approach by the American Psychiatric Association to rename postpartum depression as peripartum depression.

The study’s limitations include the lack of cohorts from the global south, as well as the exclusion of participants using psychotropic drugs in a few cohorts.

Overall, the study showed that inter-individual differences in maternal depressive symptoms appear early in pregnancy and stably persist for up to two years postpartum. Thus, public health initiatives and interventions should focus on ameliorating depressive symptoms during pregnancy in addition to after childbirth.