Depression During Pregnancy And Preterm Birth; A Prospective Cohort Study Carried Out Among Women Attending Antenatal Clinic At Pumwani Maternity Hospital.

Abstract

Background: Depression is a debilitating illness characterized by the presence of sad, irritable or empty mood. Prior studies have preempted that when it occurs during pregnancy, depression may lead to various adverse obstetric outcomes including preterm delivery. Objective: To determine whether antenatal depression is significantly associated with preterm delivery. Methods: 292 women attending the antenatal clinic at Pumwani Maternity Hospital in Nairobi, Kenya meeting the study criteria were recruited. The Edinburgh postnatal depression scale (EPDS) was administered to screen for depression. A clinical cutoff score of 10 and above was regarded as possible depression. Thereafter The Patient Health Questionnaire- 9 (PHQ-9) was administered to evaluate women on DSM-V criteria for major depressive disorder. Only 255 of the women were successfully followed up to delivery with an attrition rate of 12.7%. Records of gestation at delivery, birth weight and other related obstetric outcomes were collected. Data Analysis: Preterm delivery was associated with various demographic, psychosocial and medical variables using chi square tests. To determine whether depression was an independent risk factors for preterm delivery, relative risks were estimated via log binomial regression analysis with adjustment for potential confounding variables. Results: Of the 255 participants, 98(38.4%) had depression and 27(10.7%) delivered preterm. The risk of delivering preterm increased with severity of depression. Compared to pregnant women who scored low for depression, the relative risk of preterm delivery for women with mild depression (PHQ-9 score 5-9) was 3.43(95% C. I. =1.48-7.92) and for women with moderate depression (PHQ-9 score 10-19) was 4.45(C. I. =1.91-10.90). After controlling for potential confounders, depression (both mild and moderate) was still associated with preterm delivery with an aRR of 4.13(95% C. I. = 2.82-17.42). Conclusion: There is a positive association between antenatal depression and preterm delivery. This highlights the importance of screening for mental health challenges in the antenatal period as a means to reduce adverse obstetric outcomes. Keywords: antenatal depression, prospective cohort, preterm delivery, low-income country