Reduction of prenatal depression associated with higher full-term birth rates

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In a recent study published in eClinicalMedicine, researchers examined randomized clinical trial (RCT) data to investigate the effect of lowering prenatal mother depression on gestational duration.

They investigated whether faster-decreasing depressive symptoms during pregnancy would lead to a longer gestation and mediate the intervention impact on gestational length.

​​​​​​​Study: Impact of prenatal maternal depression on gestational length: post hoc analysis of a randomized clinical trial. Image Credit: HenadziPechan/Shutterstock.com​​​​​​​Study: Impact of prenatal maternal depression on gestational length: post hoc analysis of a randomized clinical trial. Image Credit: HenadziPechan/Shutterstock.com

Background

The shortened gestational period is a primary cause of pediatric illness and death, with long-term health effects. Infants born in the 37th week had more respiratory distress and neonatal intensive care unit (NICU) hospitalizations than those born after the 39th week.

Children born sooner, especially those in the late preterm and early term periods, are more likely to have developmental issues throughout their lives. Public health measures should aim to increase gestational weeks at birth.

Maternal depression during pregnancy, a common health condition associated with shorter gestational duration, may enhance birth outcomes by lowering the chance of premature delivery. 

About the study

In the present post-hoc study, researchers investigated whether slowing the progression of depression during pregnancy increases the gestational duration and the frequency of infants delivered beyond 39 gestational weeks.

They used the 39-week cut-off following The Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists recommendations.

The researchers randomly assigned 226 pregnant women 1:1 to interpersonal psychotherapy intervention (IPT, eight weekly 50-minute individual sessions) and enhanced usual care (EUC) study groups.

They enrolled individuals for the study between 10 August 2017 and 8 September 2021. Eligible participants were aged 18 to 45 years, experienced depression symptoms, spoke English, were single, pregnant, and had Edinburgh Postnatal Depression Scale (EPDS) scores of ≥10.

Exclusions included ongoing illicit drug use, significant health issues requiring invasive treatments, and cognitive behavioral therapy or IPT.

The researchers used the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5), to diagnose depression and the Symptom Checklist (SCL-20) with EPDS to detect depressive symptoms and define depression trajectories.

They also collected obstetric data (spontaneous labor vs. induced/cesarean-section without labor) and sociodemographic data [birthdate, household income, number of people in the household, cohabitation with a partner, marital status, educational attainment, race, ethnicity, and income-to-needs ratio (INR)].

The researchers gathered gestational date information from medical records using current procedures. The primary endpoint was a dichotomous measurement of gestational weeks at delivery (≥39 weeks of gestation), whereas the secondary endpoint was a continuous measurement.

They conducted post-hoc studies to determine the impact of lowering prenatal depression on the duration of gestation.

They performed exploratory analyses to investigate whether maternal major depressive disorder (MDD) diagnosis, psychotropic medication usage, gestational age, income-to-needs ratio, labor present, and infant sex at delivery attenuated the predicted principal mediation impact.

Results

The participants had a mean age of 30 years; 19% were Latino, 43% were non-Hispanic/Latine white, 8.8% were black, 4.4% were Asian, 0.4% were Native Hawaiian/Pacific Islander, and 24% were multiracial/multiethnic.

Lower depression trajectories during pregnancy were associated with a higher proportion of complete-term infants delivered after 39 weeks [odds ratio (OR), 1.5 for EPDS and 1.7 for SCL-20].

The likelihood of having a term delivery at 39 weeks gestational age or later rose by 54% and 67% with each standard deviation drop in the depression trajectory, as indicated by the EPDS and SCL-20. Similarly, the secondary endpoint of continuous gestational age at delivery was robustly associated with reduced depressive trajectories.

Causal mediation studies confirmed the notion that patients allocated to IPT had higher decreases in depressive symptom trajectories, contributing to longer gestational periods.

The intervention's lowered depression trajectories were linked to delivery at ≥39 weeks of gestation (OR for EPDS, 1.7; OR for SCL-20, 1.9), indicating mediation. Exploratory findings revealed no significant moderated mediation effects. 

The intervention group showed significant decreases in depression, with a five-fold reduction in MDD status and a 48% (SCL20) to 52% (EPDS) decrease in symptoms.

Pregnant people in the EUC condition also had a reduction in MDD status from 36% to 14% (SCL20) and symptoms by 33% (EPDS). Participants in IPT had higher MDD remission and depression symptom reduction compared to EUC.

Conclusions

The study findings showed that lowering maternal depression during pregnancy results in a longer gestation. Depression-treated moms exhibited a faster reduction in depression, implying a relationship between depression therapy and gestational duration.

The study's findings suggest that offering mental health care to pregnant women to minimize depression is a viable way to prolong gestation. 

Psychosocial therapies can help the mother and the offspring. Prenatal depression reduction may boost gestational length by improving sleep, physical activity, food, social interactions, communication, self-advocacy skills, and physiological processes such as stress physiology, which controls parturition time, sleep, and inflammatory mechanisms.

Journal reference:
Pooja Toshniwal Paharia

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Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.

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