Trajectories of antenatal depression and adverse pregnancy outcomes

Emily S. Miller, George R. Saade, Hyagriv N. Simhan, Catherine Monk, David M. Haas, Robert M. Silver, Brian M. Mercer, Samuel Parry, Deborah A. Wing, Uma M. Reddy, William A. Grobman

Research output: Contribution to journalArticlepeer-review


Background: Antenatal depression affects approximately 1 of 7 pregnancies, with an increasing prevalence across gestation. Data regarding the associations between antenatal depression and adverse pregnancy outcomes yielded conflicting results. However, previous studies evaluated the cross-sectional prevalence of depression at various time points and not the depressive symptom trajectory across gestation. Objective: This study aimed to identify whether the trajectory of antenatal depressive symptoms is associated with different risks of adverse pregnancy outcomes. Study Design: This was a secondary analysis of a large multisite prospective cohort of nulliparous women across the United States. The Edinburgh Postpartum Depression Scale was administered at 2 study visits: between 6 and 14 weeks’ gestation and between 22 and 30 weeks’ gestation. The Edinburgh Postpartum Depression Scale score trajectories were categorized as improved, stable, or worsened based on whether the scores changed by at least 1 standard deviation between the 2 visits. The frequencies of adverse pregnancy outcomes (hypertensive disorders of pregnancy, abruption, cesarean delivery, preterm birth [ie, <37 weeks’ gestation], small for gestational age neonates, neonatal intensive care unit admission, and maternal readmission) were compared with depression trajectories across gestation in bivariable and multivariable analyses. Secondary analyses evaluated the frequencies of spontaneous and medically indicated preterm births and frequencies of spontaneous and medically indicated preterm births before 35, 32, and 28 weeks’ gestation. Results: Of the 8784 women who completed the 2 antenatal Edinburgh Postpartum Depression Scale screens, 1141 (13.0%) had improved, 6663 (75.9%) had stable, and 980 (11.2%) had worsened depressive symptom trajectories across gestation. Compared with women with improved or stable depressive symptoms, those with worsened symptoms were more likely to experience preterm birth (8.3% vs 7.4% vs 9.9%, respectively; P=.018). After controlling for potential confounders, worsened depressive symptoms remained associated with more frequent preterm birth (adjusted odds ratio, 1.68; 95% confidence interval, 1.10–2.57). Conclusion: Women with depression symptoms that worsen as pregnancy progresses have increased odds of preterm birth. Future research is warranted to optimize and implement effective prevention, screening, and treatment protocols for antenatal depressive symptoms as a strategy to prevent preterm birth.

Original languageEnglish (US)
Pages (from-to)108.e1-108.e9
JournalAmerican journal of obstetrics and gynecology
Issue number1
StatePublished - Jan 2022


  • adverse pregnancy outcomes
  • antenatal depression
  • mood disorder
  • perinatal depression
  • preterm birth
  • prevention of perinatal depression
  • trajectory

ASJC Scopus subject areas

  • Obstetrics and Gynecology


Dive into the research topics of 'Trajectories of antenatal depression and adverse pregnancy outcomes'. Together they form a unique fingerprint.

Cite this