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May 02, 2023
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Improved depressive symptoms may decrease odds of preterm birth

Fact checked byRichard Smith
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Key takeaways :

  • Mental health care referral improved depressive symptoms among 35% of pregnant people.
  • Improvement in antenatal depression symptoms was linked to significantly decreased odds of preterm birth.

BALTIMORE — Improved antenatal depression symptom trajectory was associated with decreased odds of preterm birth among pregnant people[JR1]  referred for mental health care, according to data presented at the ACOG Annual Clinical & Scientific Meeting.

Several studies have suggested associations between antenatal depression and preterm birth with plausible explanations for the links, according to study background.

Allie Sakowicz, MD, MS, quote
Data were derived from Sakowicz A, et al. Obstet Gynecol. 2023;doi:10.1097/AOG.0000000000005125.

“The main take-home message is the importance of incorporating mental health care into routine prenatal care,” Allie L. Sakowicz, MD, MS, an obstetrics and gynecology resident in the department of obstetrics and gynecology at Wake Forest University School of Medicine, Winston-Salem, North Carolina, told Healio. “Routine screening for depression during pregnancy is important in order to allow for the timely diagnosis and treatment of depressive symptoms, and it is possible that optimizing perinatal depression identification and treatment could represent a public health strategy to reduce preterm births.”

In a retrospective cohort study, researchers enrolled 732 pregnant people who were referred to a perinatal collaborative care program for mental health and gave birth between March 2016 and March 2021. All participants had access to subspecialty mental health treatment, such as psychiatric consultation, psychopharmacotherapy and psychotherapy.

Researchers monitored depressive symptoms with the self-reported Patient Health Questionnaire-9 and determined antenatal depression trajectories by comparing early prenatal depression scores after collaborative care referral with scores obtained closest to delivery date. Participants were then categorized as improved, stable or worsened depending on whether depression scores changed by at least 5 points.

Overall, 71.4% of participants had mild or more severe depressive symptoms with scores of 5 or higher at their baseline screening. Antenatal depressive symptoms improved among 35%, remained stable in 59.7% and worsened for 5.3% of participants. Preterm birth incidence was 12.5% among participants with improved antenatal depression symptoms, 14% among those with stable symptoms and 30.8% among those with worsened symptoms.

Participants with improved antenatal depression symptom trajectory had significantly decreased odds of preterm birth compared with those with worsened trajectory (adjusted OR = 0.37; 95% CI, 0.15-0.89).

“Even though preterm birth is the leading cause of perinatal mortality in the United States, risk factors that predispose individuals to preterm birth are not completely understood,” Sakowicz said. “There are currently few proven mechanisms to reduce the rate of preterm birth, and treating depressive symptoms during pregnancy could represent one potential mechanism.”

Further, “if causality could be established, optimizing perinatal depression identification and treatment could represent a public health strategy to reduce preterm births,” Sakowicz said during the ACOG presentation.

Future directions may focus on depression screening at more than one timepoint during pregnancy and pairing depression screening with adequate care planning and treatment of positive screen results, Sakowicz said here.

For more information:

Allie L. Sakowicz, MD, MS, can be reached at allison.sakowicz@northwestern.edu.