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Timing of depression onset in pregnant women may determine severity

Recent findings suggest that the timing of depression onset among pregnant women is significant and may indicate risk for associated mood disorders.

“Mothers who develop postpartum depression often experience protective risk factors such as better access to resources, fewer children and are more mature, which helps them adapt to the stress of pregnancy,” Sheehan D. Fisher, PhD, of the Feinberg School of Medicine, Northwestern University, said in a press release. “Once their babies are born, they show more obsessive-compulsive symptoms — like over-worrying about their baby’s health — than mothers who developed depression before or during pregnancy.”

To determine risk factors that distinguish the onset of unipolar and bipolar depression and associations between depression onset by diagnosis, researchers assessed depression symptoms in an obstetrical sample of 727 women. Depression was evaluated at 4 to 6 weeks postpartum by the Structured Interview guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms.

Overall, 24.9% of participants developed depression prepregnancy, 36.7% developed depression during pregnancy and 38.4% developed depression after pregnancy.

Women with postpartum onset of depression were more likely to be older, white, educated, married or cohabitating, have one or no previous children and have private health insurance, compared with women with prepregnancy or postnatal depression.

Women with prepregnancy depression were more likely to experience hypersomnia or difficulty falling asleep.

Compared with women who developed depression during or after pregnancy, those with prepregnancy depression exhibited more symptoms of paranoia and had more severe postpartum depression.

Bipolar disorder was significantly more common among women with prepregnancy depression (38.7%), compared with those who developed depression during pregnancy (22.6%) or after (17.9%).

Agitation differentiated mothers with unipolar depression vs. those with bipolar depression. Women with bipolar disorder and developed depression during pregnancy exhibited the greatest amount of agitation.

“There’s a difference between postpartum depression and depression that started before or during the pregnancy. It’s not a homogenous disorder,” Fisher said in the release. “When clinicians see a mother during the postpartum period and diagnose her with depression, it’s important for them to ask how long this depression has been an issue so they can assess the longevity and severity.” – by Amanda Oldt

Disclosure: The research was supported by grant R01 MH071825 from the NIMH. Please see the full study for a list of all authors’ relevant financial disclosures.