WUNRN
Hum. Reprod. Advance Access published online
on October 23, 2008
Human
Reproduction, doi:10.1093/humrep/den342
"CONCLUSIONS: Our findings show that pregnant women with depressive symptoms are at increased risk of preterm delivery and, in addition, provide preliminary evidence that social and reproductive risk factors as well as obesity and stressful events may exacerbate the effect."
http://humrep.oxfordjournals.org/cgi/content/abstract/den342
Presence of
Depressive Symptoms During Early Pregnancy and the Risk of Preterm
Delivery: A Prospective Cohort Study
Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA
* Correspondence address. Tel: +1-510-891-3755; Fax: +1-510-891-3761;
E-mail: dkl@dor.kaiser.org
BACKGROUND: The impact of prenatal depression on pregnancy outcomes is largely unknown.
METHODS: We conducted a population-based prospective cohort study among
pregnant women of the Kaiser Permanente Medical Care Program to
examine the impact of prenatal depression on the risk of preterm
delivery. We interviewed pregnant women in their early pregnancy.
Women's depressive symptoms were ascertained using the standard
Center for Epidemiological Studies Depression Scale (CESD). The
presence of significant prenatal depressive symptoms and severe
depressive symptoms was determined by CESD scores 
16
and 22,
respectively.
RESULTS: Among the 791 participants who answered CESD questions and
delivered a live birth, after controlling for potential confounders
using the Cox proportional hazard regression, women with CESD scores
16
had almost twice the risk of preterm delivery compared with women
without depressive symptoms: adjusted hazard ratio (aHR) = 1.9, 95%
confidence interval (CI) 1.0–3.7. The risk of preterm delivery
increased with increasing severity of depression: aHR = 1.6 (CI
0.7–3.6) for CESD 16–21 and aHR = 2.2 (CI 1.1–4.7) for CESD 22.
The risk of preterm delivery associated with prenatal depression
appears to be exacerbated by low educational level, a history of
fertility problems and the presence of obesity and stressful events.
The observed associations were not confounded by the use of
antidepressants, although some of the associations did not reach
statistical significance.
CONCLUSIONS: Our findings show that pregnant women with depressive symptoms are at increased risk of preterm delivery and, in addition, provide preliminary evidence that social and reproductive risk factors as well as obesity and stressful events may exacerbate the effect.
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