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Antenatal depression: Pregnancy and neonatal outcomes

Antenatal depression: Pregnancy and neonatal outcomes
Literature review current through: Jan 2024.
This topic last updated: Apr 07, 2023.

INTRODUCTION — Antenatal maternal depression is associated with adverse effects upon pregnancy and neonatal outcomes [1-3]. In addition, antenatal depression is associated with abnormal infant and child development, as well as cognitive problems and psychopathology in the offspring.

This topic reviews the association between antenatal depression and pregnancy and neonatal outcomes. The association of antenatal depression with abnormal child development, as well as cognitive impairment and psychopathology in the offspring, is discussed separately, as are the risks of antenatal antidepressants and the clinical features, assessment, diagnosis, and treatment of antenatal depression:

(See "Antenatal depression: Risks of abnormal infant and child development".)

(See "Antenatal depression: Risks of cognitive impairment and psychopathology in the offspring".)

(See "Antenatal use of antidepressants and the potential risk of teratogenicity and adverse pregnancy outcomes: Selective serotonin reuptake inhibitors".)

(See "Antenatal use of antidepressants and risks of teratogenicity and adverse pregnancy outcomes: Drugs other than selective serotonin reuptake inhibitors".)

(See "Antenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs): Neonatal outcomes".)

(See "Unipolar major depression during pregnancy: Epidemiology, clinical features, assessment, and diagnosis".)

(See "Mild to moderate episodes of antenatal unipolar major depression: Choosing treatment".)

(See "Severe antenatal unipolar major depression: Choosing treatment".)

QUALITY OF EVIDENCE — Information about the association between antenatal depression and adverse pregnancy outcomes and adverse outcomes in the offspring comes from low to moderate quality studies. (See "Antenatal depression: Risks of abnormal infant and child development", section on 'Quality of evidence'.)

POTENTIAL MECHANISMS — There are several possible direct and indirect mechanisms by which antenatal maternal depression may adversely affect pregnancy outcomes as well as offspring. (See "Antenatal depression: Risks of abnormal infant and child development", section on 'Potential mechanisms'.)

PREGNANCY AND NEONATAL OUTCOMES — Antenatal depression is associated with an increased risk of multiple poor obstetric outcomes, including spontaneous abortion, bleeding, operative deliveries, and preterm birth [4,5]. However, the observed effects are small.

Teratogenicity — It is not clear if antenatal depression is associated with a small risk of teratogenicity, because the studies that have investigated the association between depression and teratogenicity may be confounded by the use of antidepressants and the severity of the depressive syndrome (antidepressants may be more likely to be used during pregnancy for severe depressive episodes than for mild to moderate syndromes):

A national registry study of women who delivered babies included patients with antenatal major depression (n >4000) and controls without depression (n >500,000) [6]. Major congenital anomalies were more likely in the offspring of depressed mothers than controls (odds ratio 1.4, 95% CI 1.3-1.6).

Another registry study of deliveries included women with major depression (n >3000) and women with no mental illness (n >430,000) and found that congenital anomalies were more likely in offspring of depressed women than controls (odds ratio 1.4, 95% CI 1.2-1.6) [7].

However, in a nationally representative database of primary care records that included live births of women with depression who were not treated with antidepressants (n >13,000) and women without depression who were not exposed to antidepressants (n >325,000) [8], the prevalence of major congenital anomalies for the two groups was comparable.

General information about teratogenicity is discussed separately. (See "Congenital anomalies: Causes".)

Pregnancy loss — Antenatal depression appears to be associated with a small increased risk of pregnancy loss (spontaneous abortion):

A registry study identified pregnant women with a diagnosis of depression in the four years before pregnancy (n >7000) and a control group of pregnant women who were not diagnosed with depression (n >19,000); neither group received antidepressants [9]. After controlling for potential confounding factors (eg, maternal age; socioeconomic status; and use of antipsychotics, anticonvulsants, and benzodiazepines in the first trimester), the analyses found that the risk of spontaneous abortion was slightly greater in the women with depression than in the controls (relative risk 1.1, 95% CI 1.0-1.2) [9].

A national registry study included pregnant women who were diagnosed with depression or anxiety in the year prior to pregnancy (n >3000) and pregnant women who did not receive a diagnosis of depression or anxiety in the prior year (controls; n >1,000,000); neither group used selective serotonin reuptake inhibitors [10]. After controlling for potential confounding factors (eg, maternal age, socioeconomic status, and prior miscarriages), the analyses found that the risk of spontaneous abortion was greater in the depressed/anxious group than in the controls (hazard ratio 1.3, 95% CI 1.1-1.4).

General information about pregnancy loss is discussed separately. (See "Pregnancy loss (miscarriage): Terminology, risk factors, and etiology".)

Late fetal death — It is not known whether antenatal depression is associated with late fetal death or stillbirth (delivery of a fetus ≥20 weeks of gestation with no signs of life), due to inconsistent results across retrospective studies:

A national registry study of women who delivered babies included patients with major depression during pregnancy (n >4000) and controls without depression (n >500,000) [6]. Late fetal death was more likely in depressed mothers than controls (odds ratio 1.8, 95% CI 1.2-2.6).

A study of administrative claims data included pregnant women who were depressed (n >5000) or not depressed (n >20,000) [11]. After adjusting for potential confounding factors (eg, age, comorbidity such as chronic hypertension, and medication), the analyses found that late fetal death occurred more often in depressed women than nondepressed women (odds ratio 1.7, 95% CI 1.1-2.6).

However, another registry study of deliveries included women with major depression (n >3000) and women with no mental illness (n >430,000) and found that the rate of late fetal death was comparable in depressed women and controls (0.4 and 0.5 percent) [7].

General information about late fetal death is discussed separately. (See "Stillbirth: Incidence, risk factors, etiology, and prevention".)

Preeclampsia — Most of the evidence suggests that antenatal depression is not associated with preeclampsia (hypertensive disorders of pregnancy) [12]:

A meta-analysis of four prospective observational studies (sample size not reported) compared pregnant women who were depressed with pregnant women who were not depressed and found that the probability of preeclampsia was comparable for the two groups [1].

In addition, several studies not included in the meta-analysis have also found that depression was not associated with hypertensive disorders of pregnancy [7,13-15]. As examples:

In a registry study that included pregnant women with depression who were not treated with antidepressant drugs (n >65,000) and pregnant women without depression (n >230,000), the prevalence of preeclampsia was 2 percent in both groups [16].

A retrospective study of an administrative claims database examined pregnant women with depression who were not exposed to antidepressants (nearly 60,000 patients) and women without depression (n >1,000,000); the prevalence of preeclampsia in both groups was 5 percent [17].

A study of administrative claims data included pregnant women who were depressed (n >5000) or not depressed (n >20,000) [11]. After adjusting for potential confounding factors (eg, age, comorbidity such as chronic hypertension, and medication), the analyses found that the frequency of preeclampsia/eclampsia was identical for each group (2 percent).

Nevertheless, a meta-analysis of five studies (nearly 4000 pregnant patients) found that the risk of preeclampsia was greater in patients with depression than in nondepressed patients (odds ratio 1.7, 95% CI 1.3-2.1) [18].

General information about preeclampsia is discussed separately. (See "Preeclampsia: Clinical features and diagnosis".)

Gestational diabetes — Antenatal depression is not associated with gestational diabetes:

A national registry study of live births found that, among women who were depressed (n >15,000) and women who were not depressed (n >340,000), the prevalence of gestational diabetes was 1 percent in both groups [14].

Another registry study of deliveries included women with major depression (n >3000) and women with no mental illness (n >430,000) and found that gestational diabetes in depressed women and controls was 3.4 and 4.7 percent (statistical significance was not reported) [7].

A study of administrative claims data included pregnant women who were depressed (n >5000) or not depressed (n >20,000) [11]. After adjusting for potential confounding factors (eg, age, comorbidity such as chronic hypertension, and medication), the analyses found that the frequency of gestational diabetes was identical for each group (12 percent).

General information about gestational diabetes is discussed separately. (See "Gestational diabetes mellitus: Obstetric issues and management".)

Placental abruption — Antenatal depression is not associated with placental abruption (partial or complete placental detachment prior to delivery of the fetus):

A national registry study of live births included infants born to women who were depressed (n >15,000) and women who were not depressed (n >340,000); the prevalence of placental abruption was 0.3 percent in both groups [14].

Another registry study of deliveries included women with major depression (n >3000) and women with no mental illness (n >430,000), and found that the frequency of placental abruption in both depressed women and controls was 1 percent [7].

A study of administrative claims data included pregnant women who were depressed (n >5000) or not depressed (n >20,000) [11]. After adjusting for potential confounding factors (eg, age, comorbidity such as chronic hypertension, and medication), the analyses found that the frequency of placental abruption was identical for each group (1 percent).

General information about placental abruption is discussed separately. (See "Acute placental abruption: Pathophysiology, clinical features, diagnosis, and consequences".)

Bleeding — It is not clear if antenatal depression is associated with hemorrhage during pregnancy and/or the postpartum period. Two retrospective studies found that antenatal depression was associated with hemorrhage, but the observed effect was clinically small, and a third retrospective found that antenatal depression was not associated with bleeding:

A national registry study identified pregnant women who were depressed but not treated with antidepressant drugs (n >1000) and pregnant women who were neither depressed nor exposed to antidepressants (n >55,000) [5]. Bleeding occurred in more depressed women than controls during the first trimester (23 versus 20 percent) and the second trimester (12 versus 9 percent).

A national registry study of live births included women with psychiatric diagnoses who were not treated with antidepressants or antipsychotics (n = 9652, 42 percent of whom had a depressive disorder) and women with no psychiatric diagnoses and no exposure to antidepressants or antipsychotics (n >31,000) [12]. In analyses adjusted for potential confounding factors (eg, maternal age, socioeconomic status, and smoking), the likelihood of bleeding during or after delivery was greater in depressed women than in controls (odds ratio 1.3, 95% CI 1.1-1.5).

A study of administrative claims data included pregnant women who were depressed (n >5000) or not depressed (n >20,000) [11]. After adjusting for potential confounding factors (eg, age, comorbidity such as chronic hypertension, and medication), the analyses found that the frequency of antepartum hemorrhage was similar for each group (approximately 9.0 percent), as was the frequency of postpartum hemorrhage (approximately 3.5 percent).

General information about antenatal and postpartum hemorrhage is discussed separately. (See "Evaluation and differential diagnosis of vaginal bleeding before 20 weeks of gestation" and "Overview of postpartum hemorrhage".)

Operative delivery — Antenatal depression is often associated with operative deliveries (eg, cesarean delivery or instrumentally assisted delivery) [12,19], but the clinical effect is small. As examples:

A meta-analysis of seven observational studies (n >4000 pregnant women) found that the risk of operative deliveries was greater in women with depression (relative risk 1.3, 95% CI 1.1-1.5) [18]. However, the observed effect was modest, and heterogeneity across studies was moderate to large.

A study of administrative claims data included pregnant women who were depressed (n >5000) or not depressed (n >20,000) [11]. After adjusting for potential confounding factors (eg, age, comorbidity such as chronic hypertension, and medication), the analyses found that cesarean delivery was more likely to occur in depressed women than in nondepressed women (odds ratio 1.25, 95% CI 1.16-1.34). However, the clinical effect was small.

General information about cesarean delivery and instrumentally assisted delivery is discussed separately. (See "Cesarean birth: Preoperative planning and patient preparation" and "Assisted (operative) vaginal birth".)

Preterm birth — Numerous studies consistently indicate that antenatal maternal depressive symptoms are associated with preterm birth (<37 weeks of gestation) [6,7,12,14,19-26]. Relatively old studies suggest that the clinical effect is small, whereas more recent studies indicate that the association between antenatal depression and preterm birth is moderately large.

Evidence that antenatal maternal depression is at least modestly associated with preterm birth includes the following:

A meta-analysis of 20 prospective observational studies (sample size not reported) found that antenatal maternal depression was associated with preterm birth (relative risk 1.13, 95% CI 1.06-1.21), and the risk was comparable for depressed patients who were treated or not treated with antidepressant medications. However, heterogeneity across the 20 studies was significant [27].

A second meta-analysis of 15 prospective observational studies (sample size not reported) found that the probability of premature delivery was greater in pregnant women who were depressed than in pregnant women who were not depressed (odds ratio 1.37, 95% CI 1.04-1.81); however, heterogeneity across studies was moderate to large [1]. In addition, a subgroup analysis of six studies that excluded or controlled for patients treated with medications found that depression was not associated with preterm birth.

In addition, more recent studies indicate that antenatal depression is moderately associated with preterm birth:

A meta-analysis of 14 studies examined preterm birth in pregnant women with depression who received neither pharmacotherapy nor psychotherapy (n >3900) and in nondepressed pregnant women (n >17,000) [28]. All of the studies were prospective except one (total n = 66 pregnant women). Antenatal depression was associated with an increased risk of preterm birth, and the clinical effect was moderate (odds ratio 1.6, 95% CI 1.3-1.9).

A subsequent prospective study (n >2000 pregnant women) compared the risk of preterm birth in women with antenatal depression (n = 274) and in nondepressed women (n = 1799) [29]. After adjusting for potential confounding factors (eg, maternal age, marital status, and smoking status), the analyses found that antenatal depression was associated with an increased risk of preterm birth (relative risk 1.6, 95% CI 1.1-2.2).

In addition, multiple studies suggest that antenatal depression may be associated with both very preterm birth (<32 weeks of gestation) and moderately preterm birth (32 to 36 weeks of gestation) [7,14,25].

Depression in expectant fathers may also be associated with an increased risk of preterm birth [14].

Relatively few studies suggest that antenatal depression is not associated with preterm birth:

A prospective study compared pregnant women with major depression (n = 222) at less than 17 weeks of gestation and pregnant women without major depression (n = 2432) [15]. After adjusting for potential confounding factors (eg, prepregnancy maternal body mass index [BMI], history of smoking and heavy drinking, and use of serotonin reuptake inhibitors), the analyses found that the risk of preterm birth was comparable for depressed and nondepressed women.

Another prospective study compared pregnant women with probable major depression (n = 145) at 19 to 26 weeks of gestation and pregnant women without major depression (n = 636) [30]. After adjusting for potential confounding factors (eg, prepregnancy maternal BMI, history of preterm birth, and smoking status), the analyses found that the risk of preterm birth was comparable for depressed and nondepressed women.

A study of administrative claims data included pregnant women who were depressed (n >5000) or not depressed (n >20,000) [11]. After adjusting for potential confounding factors (eg, age, comorbidity such as chronic hypertension, and medication), the analyses found that the frequency of preterm birth was comparable for depressed and nondepressed women (6 and 5 percent).

Separate topics discuss general information about preterm birth, including other risk factors. (See "Spontaneous preterm birth: Overview of risk factors and prognosis".)

Gestational age — Prospective observational studies generally suggest that antenatal depression is not associated with gestational age at delivery:

In a meta-analysis of eight prospective studies (sample size not reported), exposure to antenatal depression was not associated with gestational age [1].

A meta-analysis of seven studies examined gestational age in pregnant women with depression who received neither pharmacotherapy nor psychotherapy (n >2000) and in nondepressed pregnant women (n >10,000) [28]. All of the studies were prospective except one (total n = 66 pregnant women). Antenatal depression was not associated with gestational age.

A prospective study not included in either meta-analysis examined offspring of women with antenatal depression who were not treated with antidepressants (n = 54) and offspring of women who were healthy (n = 62); gestational age in the two groups was comparable [31].

However, other studies suggest that antenatal depression is associated with small for gestational age infants (birth weight <10th percentile for gestational age). As an example, a prospective study compared pregnant women with probable major depression (n = 145) at 19 to 26 weeks of gestation and pregnant women without major depression (n = 636) [30]. After adjusting for potential confounding factors (eg, prepregnancy maternal weight and height, history of intrauterine growth restriction, and use of antidepressants), the analyses found that the risk of small for gestational age was greater in women with probable major depression (odds ratio 1.82, 95% CI 1.01-3.25).

Fetal growth restriction — Most of the evidence suggests that antenatal depression does not increase the risk for fetal (intrauterine) growth restriction [11,12,24,32]:

A meta-analysis of 12 prospective observational studies (sample size not reported) found that antenatal maternal depression was not associated with intrauterine growth restriction [27].

A subsequent prospective study enrolled pregnant women (n >2100) during the first trimester and periodically assessed depressive symptoms and performed serial ultrasound examinations throughout pregnancy [32]. Greater depressive symptoms were not associated with altered fetal growth.

A national registry study of live births included infants born to women who were depressed (n >15,000) and women who were not depressed (n >340,000); the prevalence of small for gestational age babies was 2 percent in both groups [14].

Nevertheless, several studies suggest that depression during pregnancy may be associated with reduced fetal growth [6,7,22,33]. As an example, a prospective study examined fetal growth with ultrasonography each trimester in depressed pregnant women who were not treated with antidepressants (n = 570) and in a control group of pregnant women with few or no depressive symptoms (n = 7027) [34]. Compared with the control group, fetal weight gain in fetuses of depressed mothers was less by approximately 4.4 g per week.

Low birth weight — It is not known if antenatal depression is associated with low birth weight (<2500 g) due to inconsistent results across studies [19,22,25,31,35,36].

Evidence that supports an association between antenatal depression and low birth weight includes the following [24]:

A meta-analysis of 11 prospective observational studies (sample size not reported) found that antenatal maternal depression was associated with low birth weight, but the observed effect was small (relative risk 1.2, 95% CI 1.1-1.3) [27].

A subsequent meta-analysis of eight studies examined low birth weight in pregnant women with depression who received neither pharmacotherapy nor psychotherapy (n >900) and in nondepressed pregnant women (n >2300) [28]. All of the studies were prospective except one (total n = 66 pregnant women). Antenatal depression was associated with an increased risk of low birth weight, and the clinical effect was moderate to large (odds ratio 2.0, 95% CI 1.2-3.1).

A national registry study of women who delivered babies included patients with major depression during pregnancy (n >4000) and controls without depression (n >500,000) [6]. After adjusting for potential confounding factors (eg, maternal age, socioeconomic status, and smoking), the analyses found that low birth weight occurred more often in the offspring of depressed mothers than controls (odds ratio 1.4, 95% CI 1.2-1.6).

A retrospective study of pregnant women (n >17,000) found that depressive syndromes were present in 7 percent [26]. After adjusting for potential confounding factors (eg, maternal age, socioeconomic status, and health problems such as diabetes and hypertension), the analyses found that antenatal depression was associated with an increased risk of low birth weight (odds ratio 1.7, 95% CI 1.2-2.3).

However, several studies have found that antenatal depression is not associated with low birth weight:

A meta-analysis of 10 prospective observational studies (sample size not reported) found that birth weight in the offspring of pregnant women who were depressed and pregnant women who were not depressed was comparable [1]. In addition, the prevalence of low birth weight was comparable in the offspring of pregnant women who were depressed and pregnant women who were not depressed.

A subsequent prospective study not included in either meta-analysis enrolled pregnant women with depressive symptoms (n = 152) and nondepressed pregnant women (n = 539) [37]. After controlling for potential confounds (eg, prepregnancy BMI, alcohol use during pregnancy, and gestational age), the risk of low birth weight in the two groups was comparable.

A study of administrative claims data included pregnant women who were depressed (n >5000) or not depressed (n >20,000); the two groups were matched for age, pregnancy year, and parity [11]. The frequency of low birth weight was similar for each group (approximately 2.5 percent).

Neonatal intensive care unit admission — The best evidence suggests that maternal antenatal depression is not associated with an increased risk of admission to a neonatal intensive care unit (NICU) [21]:

In a meta-analysis of five prospective observational studies (sample size not reported), NICU admissions were comparable for the offspring of women who were depressed and the offspring of women who were not depressed [1].

A subsequent meta-analysis of two prospective studies examined NICU admissions for offspring of pregnant women with depression who received neither pharmacotherapy nor psychotherapy (n = 54) and offspring of nondepressed pregnant women (n = 146) [28]. Antenatal depression was not associated with an increased risk of NICU admission.

Breastfeeding — Antenatal depression may increase the risk of not breastfeeding one's infant, but the effect generally appears to be small:

A meta-analysis of four prospective observational studies (sample size not reported) found that the probability of breastfeeding was lower in postnatal women who were depressed during pregnancy than in women who were not depressed (odds ratio 0.7, 95% CI 0.6-0.8) [1]. However, the meta-analysis did not exclude patients using antidepressants or control for use of antidepressants; thus, it is possible that depressed women were less likely to breastfeed because they were taking antidepressant medications.

A subsequent prospective study of pregnant women (n = 145) found that antenatal depression was associated with a decreased probability of either initiating exclusive breastfeeding or breastfeeding exclusively for at least three months (odds ratio 0.86, 95% CI 0.76-0.99) [38].

In addition, a retrospective study of pregnant women (n >17,000, including 7 percent with depressive syndromes) found that antenatal depression was not associated with nonexclusive breastfeeding in the early postnatal period [26].

EFFECT OF TREATMENT — Beyond the known benefits of antidepressant treatment in the general population, more research is needed to understand the effect of successful treatment for antenatal depression upon pregnancy outcomes [39]. However, antenatal depression may perhaps cause adverse pregnancy and neonatal outcomes through the biological consequences of depression (eg, dysregulation of the hypothalamic-pituitary-adrenal axis) acting upon the fetus [40]. To the extent that this is true, it is possible that treating antenatal depression may prevent the adverse outcomes.

Evidence supporting the hypothesis that treating antenatal depression may avert adverse pregnancy outcomes includes a small retrospective study that compared outcomes in the offspring of women with antenatal major depression who were treated with selective serotonin reuptake inhibitors (SSRIs; n = 23), women with antenatal major depression who were not treated with SSRIs (n = 36), and women without depression who were not exposed to SSRIs (n = 30) [41]. Gestational age and birth weight were each lower in the newborns of depressed women who were not treated, compared with the control infants and the infants of depressed women who were treated. By contrast, outcomes for the controls and the infants exposed in utero to SSRIs were comparable. However, the meaning of these results is not clear because many studies suggest that antenatal depression is not associated with gestational age or low birth weight. (See 'Gestational age' above and 'Low birth weight' above.)

ABNORMAL INFANT AND CHILD DEVELOPMENT — Antenatal depression may be associated with abnormal infant and child development. (See "Antenatal depression: Risks of abnormal infant and child development".)

COGNITIVE PROBLEMS AND PSYCHOPATHOLOGY — Antenatal depression may be associated with cognitive problems and psychopathology in the offspring. (See "Antenatal depression: Risks of cognitive impairment and psychopathology in the offspring".)

TREATING ANTENATAL DEPRESSION — Several options are available for treating antenatal depression. (See "Mild to moderate episodes of antenatal unipolar major depression: Choosing treatment" and "Severe antenatal unipolar major depression: Choosing treatment".)

RISKS OF ANTIDEPRESSANTS — The risks of antenatal antidepressants with regard to fetal and infant/child development are discussed separately.

(See "Antenatal use of antidepressants and risks of teratogenicity and adverse pregnancy outcomes: Drugs other than selective serotonin reuptake inhibitors" and "Antenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs): Neonatal outcomes" and "Antenatal use of antidepressants and the potential risk of teratogenicity and adverse pregnancy outcomes: Selective serotonin reuptake inhibitors".)

(See "Antenatal use of antidepressants and risks of teratogenicity and adverse pregnancy outcomes: Drugs other than selective serotonin reuptake inhibitors" and "Antenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs): Neonatal outcomes" and "Antenatal use of antidepressants and the potential risk of teratogenicity and adverse pregnancy outcomes: Selective serotonin reuptake inhibitors".)

(See "Antenatal use of antidepressants and risks of teratogenicity and adverse pregnancy outcomes: Drugs other than selective serotonin reuptake inhibitors" and "Antenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs): Neonatal outcomes" and "Antenatal use of antidepressants and the potential risk of teratogenicity and adverse pregnancy outcomes: Selective serotonin reuptake inhibitors".)

POSTPARTUM DEPRESSION — Antenatal depression is a risk factor for postpartum depression, which in turn is associated with abnormal child development as well as cognitive problems and psychopathology in the child. (See "Postpartum depression: Adverse consequences in mothers and their children".)

INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, “The Basics” and “Beyond the Basics.” The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on “patient info” and the keyword(s) of interest.)

Basics topics (see "Patient education: Depression in adults (The Basics)")

Beyond the Basics topics (see "Patient education: Depression in adults (Beyond the Basics)")

SUMMARY

Information about the association between antenatal depression and adverse pregnancy outcomes and adverse outcomes in the offspring comes from low to moderate quality studies. (See "Antenatal depression: Risks of abnormal infant and child development", section on 'Quality of evidence'.)

Antenatal depression is associated with an increased risk of multiple adverse obstetric and neonatal outcomes, including pregnancy loss, operative deliveries, preterm birth, and not breastfeeding one's infant. However, the observed effects are typically small. (See 'Pregnancy loss' above and 'Operative delivery' above and 'Preterm birth' above and 'Breastfeeding' above.)

It is not clear whether antenatal depression is associated with teratogenicity, late fetal death, antenatal or postpartum hemorrhage, or low birth weight. (See 'Teratogenicity' above and 'Late fetal death' above and 'Bleeding' above and 'Low birth weight' above.)

Most of the evidence suggests that antenatal depression is not associated with preeclampsia, gestational diabetes, placental abruption, gestational age, fetal growth restriction, and admission to a neonatal intensive care unit. (See 'Preeclampsia' above and 'Gestational diabetes' above and 'Placental abruption' above and 'Gestational age' above and 'Fetal growth restriction' above and 'Neonatal intensive care unit admission' above.)

Antenatal depression may be associated with abnormal infant and child development, as well as cognitive problems and psychopathology in the offspring. (See "Antenatal depression: Risks of abnormal infant and child development" and "Antenatal depression: Risks of cognitive impairment and psychopathology in the offspring".)

Several options are available for treating antenatal depression. (See "Mild to moderate episodes of antenatal unipolar major depression: Choosing treatment" and "Severe antenatal unipolar major depression: Choosing treatment".)

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Topic 107638 Version 9.0

References

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