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Department of Obstetrics and Gynaecology (T.K.H.C., L.T.K., Y.S.K.), and the Department of Psychiatry (H.F.K.C., T.S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, NT, Hong Kong, and the Department of Social Medicine (T.S.L.), Harvard Medical School, Boston, Massachusetts.
Address reprint requests to: Tony Chung, MD, FRANZCOG, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Sha Tin, NT, Hong Kong. Email: tonychung{at}cuhk.edu.hk
OBJECTIVE: The purpose of this study was to examine if depressive symptomatology in pregnancy is associated with adverse obstetric and neonatal outcomes.
METHOD: In a prospective observational study, 959 women were followed up longitudinally from early pregnancy to postpartum. The level of depression was measured at baseline (first antepartum visit) and in late pregnancy using the Beck Depression Inventory (BDI). Adverse obstetric and neonatal outcomes were recorded at delivery.
RESULTS: Depression in late pregnancy was associated with increased risk of epidural analgesia (33% vs. 19%, p = .01, adjusted RR = 2.56, 95% CI 1.24–5.30), operative deliveries (caesarean sections and instrumental vaginal deliveries) (39% vs. 27%, p = .02, adjusted RR = 2.28, 95% CI 1.15–4.53), and admission to neonatal care unit (24% vs. 19%, p = .03, adjusted RR = 2.18, 95% CI 1.02–4.66). These effects remained significant even when controlled for potential confounders, such as antepartum complications.
CONCLUSION: Previous studies have shown that antepartum anxiety or stress was associated with growth retardation, premature delivery, and epidural analgesia. Our findings add to this body of evidence, which together suggest an adverse impact of antepartum psychological morbidity on maternal and neonatal well-being.
Key Words: depression • pregnancy • psychological complications • obstetric outcomes • epiduralanalgesia • operative deliveries • neonatal complications • prevention
Abbreviations: BDI = Beck Depression Inventory; NCU = Neonatal Care Unit; CPD = cephalopelvic disproportion
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