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The study found that pregnant women with symptoms of depression have anincreased risk of preterm delivery, and that the risk grows with the severityof the depressive symptoms. These findings also provide preliminary evidencethat social and reproductive risk factors, obesity, and stressful events mayexacerbate the depression-preterm delivery link, according to the researchers.
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Because the majority of the women in the study did not useanti-depressants, the study provides a clear look at the link betweendepression and preterm delivery.
The study -- which is among the first to examine depression and pre-termdelivery in a representative and diverse population in the United States --looked at 791 pregnant Kaiser Permanente members in San Francisco city andcounty from October 1996 through October 1998.
Researchers interviewed the women around their 10th week of pregnancy andfound that 41 percent of the women reported significant or severe depressivesymptoms. The women with less severe depressive symptoms had a 60 percenthigher risk of preterm delivery -- defined as delivery at less than 37completed weeks of gestation -- compared with women without significantdepressive symptoms, and the women with severe depressive symptoms had morethan twice the risk.
"Preterm delivery is the leading cause of infant mortality, and yet wedon't know what causes it. What we do know is that a healthy pregnancyrequires a healthy placenta, and that placental function is influenced byhormones, which are in turn influenced by the brain," said lead author Dr.De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente'sDivision of Research in Oakland.
"This study adds to emerging evidence that depression during earlypregnancy may interfere with the neuroendocrine pathways and subsequentlyplacental function. The placenta and neuroendocrine functions play animportant role in maintaining the health of a pregnancy and determining theonset of labor," Li explained.
"Post-partum depression has been extensively studied and discussed by thepublic, but depression during pregnancy is significantly under-recognized andunder-diagnosed. Clinicians should pay close attention to depression duringpregnancy to catch it early," Li said. "If prenatal depression is indeed asprevalent as reported in this and other studies and doubles the risk ofpreterm delivery, then bringing depression to the forefront of prenatal carecould lead to a significant reduction of preterm deliveries."
In addition to being the leading cause of infant mortality and morbidity,preterm delivery is also the leading medical expenditure for infants, withestimated annual cost of about $26 billion in the United States alone.Presently, other than a prior history of preterm delivery and some pregnancycomplications, very little is known for its risk factors and origins.
"The key strengths of this study are that it ascertained the depressivesymptoms early in pregnancy, long before the preterm delivery occurred,therefore avoiding recall bias. In addition, the study was not clouded byantidepressant use because only 1.5 percent of the study population wasprescribed antidepressants and we could exclude them in the analyses," Lisaid. "Considering the increased use of antidepressants among pregnant women,this study's findings may provide a rare opportunity to evaluate the effect ofdepression on risk of preterm delivery without the entanglements ofantidepressants."
Limitations of the study include researchers measuring the women'sdepressive symptoms only once during pregnancy, rather than throughout thepregnancy, and participation rate in the study was low.
The study was funded in part by the California Public Health Foundation.It was authored by De-Kun Li, L. Liu, and Roxana Odouli, MSPH, KaiserPermanente Division of Research in Oakland.
About the Kaiser Permanente Division of Research(http://www.dor.kaiser.org/)
The Kaiser Permanente Division of Research conducts, publishes, anddisseminates epidemiologic and health services research to improve the healthand medical care of Kaiser Permanente members and the society at large. Itseeks to understand the determinants of illness and well being and to improvethe quality and cost-effectiveness of health care. Currently, the center's400-plus staff is working on more than 250 epidemiological and health servicesresearch projects.
About Kaiser Permanente Research
Kaiser Permanente's eight research centers comprise one of the largestresearch programs in the United States and engage in work designed to improvethe health of individuals everywhere. KP HealthConnect(TM), KaiserPermanente's electronic health record, and other resources provide populationdata for research, and in turn, research findings are fed into KPHealthConnect to arm physicians with research and clinical data. KaiserPermanente's research program works with national and local health agenciesand community organizations to share and widely disseminate its research data.Kaiser Permanente's research program is funded in part by Kaiser Permanente'sCommunity Benefit division, which in 2007 directed an estimated $1 billion inhealth services, technology, and funding toward total community health.
About Kaiser Permanente
Kaiser Permanente is America's leading integrated health plan. Founded in1945, the program is headquartered in Oakland, Calif. Kaiser Permanente serves8.7 million members in nine states and the District of Columbia. Today itencompasses Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitalsand their subsidiaries, and the Permanente Medical Groups. Nationwide, KaiserPermanente includes approximately 159,000 technical, administrative andclerical employees and caregivers, and 14,000 physicians representing allspecialties. The organization's Labor Management Partnership is the largestsuch health care partnership in the United States. It governs how more than130,000 workers, managers, physicians and dentists work together to makeKaiser Permanente the best place to receive care, and the best place to work.For more Kaiser Permanente news, visit the KP News Center at:http://xnet.kp.org/newscenterhttp://www.kaiserpermanente.org
SOURCE Kaiser Permanente
