Maternal Depressive Symptoms, Depression, and Psychiatric Medication Use in Relation to Risk of Preterm Delivery
Received 19 August 2008; received in revised form 29 April 2009; accepted 29 May 2009.
Purpose
This study examined the associations among maternal depression, measured in several ways, psychiatric medication use in pregnancy, and preterm delivery (PTD).
Methods
Data were collected from 3,019 women enrolled in the Pregnancy Outcomes and Community Health Study (1998–2004), a prospective study of pregnant women in five Michigan communities. Information on depressive symptoms, history of depression, and psychiatric medication use was ascertained through interviews at mid-pregnancy. These variables and other relevant covariates were incorporated into regression models with a binary outcome, that is, term (≥37 weeks' gestation) as referent and PTD (<37 weeks' gestation). A second set of models used a multicategory outcome, namely, term as the referent and PTD further subdivided by gestational weeks and clinical circumstances.
Main Findings
The odds of overall PTD was increased among women who used psychiatric medication during pregnancy and had either elevated levels of depressive symptoms at mid-pregnancy (adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.1–3.6) or a history of depression before pregnancy (AOR, 1.6; 95% CI, 1.1–2.5). The combination of psychiatric medication use in pregnancy and depression, before pregnancy, or within pregnancy was most strongly linked to a medically indicated delivery before 35 weeks' gestation (AOR, 2.9 and 3.6, respectively).
Conclusions
There are at least two plausible explanations for these findings. First, psychiatric medication use in pregnancy may pose an excess risk of PTD. Second, medication use may be an indicator of depressive symptom severity, which is a direct or indirect (i.e., alters behavior) contributing factor to PTD.
aUniversity of Washington, School of Social Work, Seattle, Washington
bMichigan State University, Department of Epidemiology, East Lansing, Michigan
cUniversity of Michigan, School of Social Work, Ann Arbor, Michigan
Correspondence to: Amelia R. Gavin, University of Washington, School of Social Work, 4101 15th Avenue NE, Box 354900, Seattle, Washington, 98105, Phone: 206-616-8847; Fax: 206-543-1228.
This publication was made possible by Grant Number 1KL2RR025015-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Additional sources of financial support include the National Institute of Child Health and Human Development grant number R01 HD034543, National Institute of Nursing Research (Renewal NIH POUCH) grant number R01 HD34543, March of Dimes Foundation (Perinatal Epidemiological Research Initiative Program) Grants 20-FY98-0697 through 20-FY04-37, Thrasher Research Foundation grant 02816-7 and Centers for Disease Control and Prevention grant U01 DP000143-01.
ABSTRACT