To promote prompt identification and treatment of perinatal depression and enhance preventive care for women at risk.
Methods:
Using MEDLINE and PubMed searches, we reviewed the recent research on the origins, course, and consequences of pregnancy-related depression.
Results:
Depressive disorders are more common in pregnancy and postpartum than widely assumed, and there is no predictable protective effect of pregnancy. Relapse rates are high, and the postpartum period represents a time of increased vulnerability to depression.
Conclusion:
Early identification and treatment of perinatal depression will minimize morbidity and mortality for the woman, the child, and the family.
CoxJLMurrayDChapmanG.A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry. 1993;163:27–31.
7.
Munk-OlsenTLaursenTPedersenC, New parents and mental disorders: A population based register study. JAMA. 2006;296(21):2582–2589.
8.
CohenLSAltshulerLLHarlowBL, Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499–507.
9.
YonkersKAWisnerKLStoweZ, Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry. 2004;161(4):608–620.
10.
GhaemiSNHsuDJKoJY, Bipolar spectrum disorder: A pilot study. Psychopathology. 2004;37(5):222–226.
11.
GhaemiSNKoJYGoodwinFK, “Cade's disease” and beyond: Misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder. Can J Psychiatry. 2002;47(2):125–134. See comment.
12.
WeissmanNOlfsonM.Depression in woman: Implications for health care research. Science. 1995;269:799.
13.
GaynesBNGavinNMeltzer-BrodyS, Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ). 2005;119:1–8. Full report [Internet]. [cited 2006 Dec 12]. Available from: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1a.chapter.86039.
14.
FinerLBHenshawSK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38(2):90–96.
15.
MarcusSFlynnHBlowF, Depressive symptoms among pregnant women screened in obstetrics settings. Journal of Women's Health. 2003;12(4):373–379.
16.
LlewellynAStoweZNNemeroffCB. Depression during pregnancy and the puerperium. J Clin Psychiatry. 1997;58(Suppl 15):26.
17.
WatsonJElliottSARuggAJ, Psychiatric disorders in pregnancy and the first postnatal year. Br J Psychiatry. 1984;144:453.
18.
O'HaraM.Social support, life events, and depression during pregnancy and the puerperium. Arch Gen Psychiatry1986;43:569.
19.
KumarRRobsonKM. A prospective study of emotional disorders in childbearing women. Br J Psychiatry. 1984;144:35.
20.
EvansJHeronJFrancombH, Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323(7307):257–260.
21.
BennettHAEinarsonATaddioA, Prevalence of depression during pregnancy: Systematic review. Obstet Gynecol. 2004;103(4):698–709.
22.
CooperPJTomlinsonMSwartzL, Post-partum depression and the mother-infant relationship in a South African peri-urban settlement. Br J Psychiatry. 1999;175:554–558.
23.
GlasserSBarellVShohamA, Prospective study of postpartum depression in an Israeli cohort: Prevalence, incidence and demographic risk factors. J Psychosom Obstet Gynecol. 1998;19(3):155–164.
24.
OmarHAMartinCMcElderryD.Screening for depression in adolescents: Association with teen pregnancy. J Pediatr Adolesc Gynecol. 2001;14(3):129–133.
25.
CoxJLHoldenJMSagovskyR, Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–786. See comment.
26.
MattheySHenshawCElliottS, Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale—implications for clinical and research practice. Arch Womens Ment Health. 2006;9(6):309–315.
27.
BeckCTGableRKBeckCT, Comparative analysis of the performance of the Postpartum Depression Screening Scale with two other depression instruments. Nurs Res. 2001;50(4):242–250.
28.
YonkersKARaminSMRushAJ, Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry. 2001;158(11):1856–1863.
29.
RyanDMilisLMisriN.Depression during pregnancy. Can Fam Physician. 2005;51:1087–93.
30.
BuistACondonJBrooksJ, Acceptability of routine screening for perinatal depression. J Affect Disord. 2006;93(1–3):233–237.
31.
GordonTECardoneIAKimJJ, Universal perinatal depression screening in an Academic Medical Center. Obstet Gynecol. 2006;107(2 Part 1):342–347.
32.
StoweZNHostetterALNewportDJ. The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care. Am J Obstet Gynecol. 2005;192(2):522–526.
33.
CutlerCLusskinSRothM, An evaluation of screening for maternal depression during well-child visits. Poster presented at American Psychiatric Association 58th Institute for Psychiatric Services;2006; New York (NY).
34.
DennisCLRossLE. Depressive symptomatology in the immediate postnatal period: Identifying maternal characteristics related to true- and false-positive screening scores. Can J Psychiatry. 2006;51(5):265–273.
35.
MarcusSMFlynnHABlowF, A screening study of antidepressant treatment rates and mood symptoms in pregnancy. Arch Womens Ment Health. 2005;8(1):25–27.
36.
SmithMVRosenheckRACavaleriMA, Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics. Psychiatr Serv. 2004;55(4):407–414.
37.
American Psychiatric Association Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington (DC): American Psychiatric Association; 2000.
38.
O'HaraMWSchlechteJALewisDA, Prospective study of postpartum blues. Biologic and psychosocial factors. Arch Gen Psychiatry. 1991;48(9):801–806.
39.
SteinerMSteinerM.Postpartum psychiatric disorders. Can J Psychiatry. 1990;35(1):89–95.
40.
VigueraACCohenLSBaldessariniRJ, Managing bipolar disorder during pregnancy: Weighing the risks and benefits. Can J Psychiatry. 2002;47:426–436.
41.
SpinelliM.Infanticide: Psychosocial and legal perspectives on mothers who kill. Washington (DC): American Psychiatric Publishing, Inc; 2003.
42.
MisriSMilisL.Obsessive-compulsive disorder in the postpartum: Open-label trial of quetiapine augmentation. J Clin Psychopharmacol. 2004;24(6):624–627.
43.
SteinerMDunnEBornL.Hormones and mood: From menarche to menopause and beyond. J Affect Disord. 2003;74(1):67–83.
44.
TreloarSAMartinNGBucholzKK, Genetic influences on post-natal depressive symptoms: Findings from an Australian twin sample. Psycholog Med. 1999;29(3):645–654.
45.
JosefssonASydsjoGBergG, CYP2D6 genotypes and depressive symptoms during late pregnancy and postpartum. Nord J Psychiatry. 2004;58(1):61–64.
46.
BlochMSchmidtPJDanaceauM, Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry. 2000;157(6):924–930.
47.
WilsonLMReidAJMidmerDK, Antenatal psychosocial risk factors associated with adverse postpartum family outcomes. CMAJ. 1996;154(6):785–799.
48.
HarrisBLovettLNewcombeRG, Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II. BMJ. 1994;308(6934):949–953.
49.
NappiREPetragliaFLuisiS, Serum allopregnanolone in women with postpartum “blues.”Obstet Gynecol. 2001;97(1):77–80.
50.
HeidrichASchleyerMSpinglerH, Postpartum blues: Relationship between not-protein bound steroid hormones in plasma and postpartum mood changes. J Affect Disord. 1994;30(2):93–98.
51.
HendrickVAltshulerLLSuriR.Hormonal changes in the postpartum and implications for postpartum depression. Psychosomatics. 1998;39(2):93–101.
52.
GregoireAKumarREverittB, Transdermal oestrogen for treatment of severe postnatal depression. Lancet. 1996;347:930–933.
53.
LawrieTAHerxheimerADaltonK.Oestrogens and progestogens for preventing and treating postnatal depression. Cochrane Database of Systematic Reviews [computer file]. 2000(2):CD001690.
54.
HarrisBLovettLSmithJ, Cardiff Puerpreral Mood and Hormone Study: III. Postnatal depression at 5 to 6 weeks postpartum, and its hormonal correlates across the peripartum period. Br J Psychiatry. 1996;168(6):739–744.
55.
PedersenCASternRAPateJ, Thyroid and adrenal measures during late pregnancy and the puerperium in women who have been major depressed or who become dysphoric postpartum. J Affect Disord. 1993;29(2–3):201–211.
56.
KentGNStuckeyBGAllenJR, Postpartum thyroid dysfunction: Clinical assessment and relationship to psychiatric affective morbidity. Clin Endocrinol. 1999;51(4):429–438.
57.
HarrisBOthmanSDaviesJA, Association between postpartum thyroid dysfunction and thyroid antibodies and depression. BMJ. 1992;305(6846):152–156.
58.
HohlagschwandtnerMHussleinPKlierC, Correlation between serum testosterone levels and peripartal mood states. Acta Obstet Gynecol Scand. 2001;80(4):326–330.
59.
SchmeelkKHGrangerDASusmanEJ, Maternal depression and risk for postpartum complications: Role of prenatal corticotropin-releasing hormone and interleukin-1 receptor antagonist. Behav Med. 1999;25(2):88–94.
60.
van DamRMSchuitAJSchoutenEG, Serum cholesterol decline and depression in the postpartum period. J Psychosom Res. 1999;46(4):385–390.
61.
McCoySJBealJMWatsonGH. Endocrine factors and postpartum depression. A selected review. J Reprod Med. 2003;48(6):402–408.
62.
RossLEMurrayBJSteinerM.Sleep and perinatal mood disorders: A critical review. J Psychiatry Neurosci. 2005;30(4):247–256.
63.
McGuffinPMarusicAFarmerA, What can psychiatric genetics offer suicidology?Crisis. 2001;22(2):61–65.
64.
BeckC.A meta-analysis of predictors of postpartum depression. Nurs Res. 1996;45:297.
65.
FortyLJonesLMacgregorS, Familiality of postpartum depression in unipolar disorder: Results of a family study. Am J Psychiatry. 2006;163(9):1549–1553.
66.
O'HaraMSwaomAM. Rates and risks of postpartum depression—a meta-analysis. Int Rev Psychiatry. 1996;8:37.
67.
CohenLAltshulerLLHarlowBL, Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499–507.
68.
BrughaTSSharpHMCooperSA, The Leicester 500 Project. Social support systems and the development of postnatal depressive symptoms, a prospective cohort survey. Psychol Med. 1998;28(1):63–79.
69.
DennisCLRossLE. The clinical utility of maternal self-reported personal and familial psychiatric history in identifying women at risk for postpartum depression. Acta Obstet Gynecol Scand. 2006;85(10):1179–1185.
70.
JosefssonABergGNordinC, Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand. 2001;80(3):251–255.
71.
KitamuraTYoshidaKOkanoT, Multicentre prospective study of perinatal depression in Japan: Incidence and correlates of antenatal and postnatal depression. Arch Womens Ment Health. 2006;9(3):121–130.
72.
HenshawC.Mood disturbance in the early puerperium: A review. Arch Womens Ment Health. 2003;6(Suppl 2):S33–S42.
73.
AdewuyaAO. Early postpartum mood as a risk factor for postnatal depression in Nigerian women. Am J Psychiatry. 2006;163(8):1435–1437.
74.
BlochMRotenbergNKorenD, Risk factors for early postpartum depressive symptoms. Gen Hosp Psychiatry. 2006;28(1):3–8. See comment.
75.
WarnerRApplebyLWhittonA, Demographic and obstetric risk factors for postnatal psychiatric morbidity. Br J Psychiatry. 1996;168(5):607–611.
76.
RobertsonEGraceSWallingtonT, Antenatal risk factors for postpartum depression: A synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289–295. See comment.
77.
SeguinLPotvinLSt DenisM, Socio-environmental factors and postnatal depressive symptomatology: A longitudinal study. Women Health. 1999;29(1):57–72.
78.
O'HaraMW. Social support, life events, and depression during pregnancy and the puerperium. Arch Gen Psychiatry. 1986;43(6):569–573.
79.
BuistAJansonH.Childhood sexual abuse, parenting and postpartum depression—a 3-year follow-up study. Child Abuse Negl. 2001;25(7):909–921.
80.
MajorBCozzarelliCCooperML, Psychological responses of women after first-trimester abortion. Arch Gen Psychiatry. 2000;57(8):777–784. See comments.
81.
NeugebauerRKlineJShroutP, Major depressive disorder in the 6 months after miscarriage. JAMA. 1997;277:383–388.
82.
NeugebauerR.Depressive symptoms at two months after miscarriage: Interpreting study findings from an epidemiological versu clinical perspective. Depress Anxiety. 2003;17:152–161.
83.
HughesPMTurtonPEvansCD. Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: Cohort study. BMJ. 1999;318(7200):1721–1724.
84.
HalbreichU.The association between pregnancy processes, preterm delivery, low birth weight, and postpartum depressions—the need for interdisciplinary integration. Am J Obstet Gynecol. 2005;193(4):1312–1322.
85.
BonariLPintoNAhnE, Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004;49(11):726–735.
86.
LarssonCSydsjoGJosefssonA.Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms. Obstet Gynecol. 2004;104(3):459–466.
87.
KurkiTHiilesmaaVRaitasaloR, Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol. 2000;95(4):487–490.
88.
OatesM.Suicide: The leading cause of maternal death. Br J Psychiatry. 2003;183:279–281.
89.
ApplebyL.Suicide during pregnancy and in the first postnatal year. BMJ. 1991;302(6769):137–140. See comment.
90.
MarzukPMTardiffKLeonAC, Lower risk of suicide during pregnancy. Am J Psychiatry. 1997;154(1):122–123.
91.
GandhiSGGilbertWMMcElvySS, Maternal and neonatal outcomes after attempted suicide. Obstet Gynecol. 2006;107(5):984–990.
92.
JablenskyAVMorganVZubrickSR, Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. Am J Psychiatry. 2005;162(1):79–91.
93.
WeissmanMMWickramaratnePNomuraY, Offspring of depressed parents: 20 years later. Am J Psychiatry. 2006;163(6):1001–1008. See comment.
94.
FieldTDiegoMHernandez-ReifM, Pregnancy anxiety and comorbid depression and anger: Effects on the fetus and neonate. Depress Anxiety. 2003;17(3):140–151.
95.
Van den BerghBRHMennesMOosterlaanJ, High antenatal maternal anxiety is related to impulsivity during performance on cognitive tasks in 14-and 15-year-olds. Neurosci Biobehav Rev. 2005;29(2):259–269.
96.
O'ConnorTGHeronJGoldingJ, Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children. Br J Psychiatry. 2002;180:502–508.
97.
O'ConnorTGHeronJGoldingJ, Maternal antenatal anxiety and behavioural/emotional problems in children: A test of a programming hypothesis. J Child Psychol Psychiatry. 2003;44(7):1025–1036.
98.
Van Den BerghBRMarcoenA.High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds. Child Dev. 2004;75(4):1085–1097.
99.
Moses-KolkoELBogenDPerelJ, Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: Literature review and implications for clinical applications. JAMA. 2005;293(19):2372–2383.
100.
WadhwaPDSandmanCAPortoM, The association between prenatal stress and infant birth weight and gestational age at birth: A prospective investigation. Am J Obstet Gynecol. 1993;169(4):858–865.
101.
ChungTKLauTKYipAS, Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med. 2001;63(5):830–834.
102.
Van den BerghBRHMulderEJHMennesM, Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: Links and possible mechanisms. A review. Neurosci Biobehav Rev. 2005;29(2):237–258.
103.
van den BerghBRHMennesMStevensV, ADHD deficit as measured in adolescent boys with a continuous performance task is related to antenatal maternal anxiety. Pediatr Res. 2006;59(1):78–82.
104.
WadhwaPD. Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology. 2005;30(8):724–743.
105.
TeixeiraJMFiskNMGloverV.Association between maternal anxiety in pregnancy and increased uterine artery resistance index: Cohort based study. BMJ. 1999;318(7177):153–157.
106.
FederenkoISWadhwaPD. Women's mental health during pregnancy influences fetal and infant developmental and health outcomes. CNS Spectrums. 2004;9(3):198–206.
107.
Conde-AgudeloARosas-BermudezAKafury-GoetaAC. Birth spacing and risk of adverse perinatal outcomes: A meta-analysis. JAMA. 2006;295(15):1809–1823.
108.
BeckCT. The effects of postpartum depression on child development: A meta-analysis. Arch Psychiatr Nurs. 1998;12(1):12–20.
109.
WhitakerRCOrzolSMKahnRS, Maternal mental health, substance use, and domestic violence in the year after delivery and subsequent behavior problems in children at age 3 years. Arch Gen Psychiatry. 2006;63(5):551–560.
110.
WhitakerRCPhillipsSMOrzolSM, Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children. Pediatrics. 2006;118(3):e859–e868.
111.
RamchandaniPSteinAEvansJ, Paternal depression in the postnatal period and child development: A prospective population study. Lancet. 2005;365:2201–2205.
112.
BrockingtonIFAucampHMFraserC, Severe disorders of the mother-infant relationship: Definitions and frequency. Arch Womens Ment Health. 2006;9(5):243–251. See comment.
113.
BrockingtonIFFraserCWilsonD, The Postpartum Bonding Questionnaire: A validation. Arch Womens Ment Health. 2006;9(5):233–242. See comment.
114.
RossLEMcLeanLM. Anxiety disorders during pregnancy and the postpartum period: A systematic review. J Clin Psychiatry. 2006;67(8):1285–1298.
115.
MisriSKostarasXFoxD, The impact of partner support in the treatment of postpartum depression. Can J Psychiatry. 2000; 5(6):554–558.
