Study Findings Challenge Previously Considered Maternal Depression Timeline


New study findings conflict with long-understood associations between maternal depression and the postpartum period and highlight the potential need for public health policy revisions.

Maternal depressive symptoms may present before conception, according to a recent study published in JAMA Network Open.1

There is an association between maternal mental health and developmental outcomes in offspring, but data on prepartum vs postpartum onset of depressive symptoms remains inconclusive. It is vital to define when depressive symptoms first emerge in order to provide timely interventions.

Investigators conducted a study to assess the timing of onset and stability of maternal depressive symptoms. Data was obtained from 7 different, prospective longitudinal community-based cross-continental cohorts including 11,563 pregnant women. Depressive symptoms were measured at multiple perinatal time points in all cohorts.

Data on self-reported maternal depressive symptoms was gathered from pregnancy up to 2 years postdelivery and evaluated using either the Edinburgh Postnatal Depression Scale (EPDS) or the Center for Epidemiological Studies-Depression (CES-D). There are 10 items in the EPDS and 20 items in the CES-D, which measure the frequency of common depressive symptoms.

Six of the 7 cohorts received the EPDS, while the final cohort received the CES-D. Covariates included maternal age, educational level, ethnicity, and marital status. Data analysis was completed in R Project for Statistical Computing version 4.1.1.

Participants were aged a mean 29 years, with 4.9% being East Asian, 2.6% Southeast Asian, and 87.6% White. Most women were married or had a partner at recruitment. Investigators found 3 consistent trajectory groups of maternal depressive symptoms after childbirth: low, mild, and high. The mean trajectory across all participants remained stable from pregnancy to 2 years after childbirth.

When examining the trajectory of maternal depressive symptoms with probably depression, indicated by an EPDS score of 15 or more during pregnancy or 13 or more after childbirth, investigators observed a stable trajectory of maternal depressive symptoms during the perinatal period.

These results indicated maternal depressive symptoms are apparent during pregnancy and remain stable into the perinatal period. Investigators concluded maternal depressive symptoms may often appear before conceptions, indicating a need to update public health policy.

This article originally appeared in Contemporary OB/GYN.

1. Kee MZL, Cremaschi A, De Iorio M, et al. Perinatal trajectories of maternal depressive symptoms in prospective, community-based cohorts across 3 continents. JAMA Netw Open. 2023;6(10):e2339942. doi:10.1001/jamanetworkopen.2023.39942
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