The association between depressive symptoms during pregnancy and post-delivery fear of childbirth; a prospective study.

BACKGROUND: Fear of childbirth is an important reason for a caesarean section on request. OBJECTIVE: To assess the association between depressive symptoms during pregnancy and post-delivery fear of childbirth (PFOC). METHODS: We prospectively studied pregnant women from two hospitals in the Netherlands. Women completed the Edinburgh Depression Scale (EPDS), the Wijma Delivery Experience Questionnaire (W-DEQ B) and questions concerning risk factors. Depressive symptoms were assessed at baseline and six weeks post-delivery. PFOC was assessed six weeks post-delivery. Baseline characteristics and pregnancy outcomes were compared between women with and without a depression at baseline. The association between depression and PFOC was assessed with multivariable logistic regression analysis. RESULTS: 245 women participated in this study. At baseline 11% suffered from depressive symptoms. There were no differences in pregnancy outcomes. Women with depressive symptoms more often suffered from depressive symptoms six weeks post-delivery (adjusted OR 4.9, 95% CI 1.4-17). PFOC six weeks post-delivery was present in 11%. Women with depression were at increased risk of PFOC six weeks post-delivery (adjusted OR 9.2, 95% CI 2.6-32). CONCLUSION: This study shows that women with depression at baseline are at increased risk for depression and PFOC six weeks post-delivery.

The role of depressive symptoms in the pathway of demographic and psychosocial risks to preterm birth and small for gestational age.

OBJECTIVE: depressive symptoms during pregnancy are associated with preterm birth (PTB) and small for gestational age (SGA). Depressive symptoms and PTB and SGA, however, share similar demographic and psychosocial risk factors. Therefore, we investigated whether depressive symptomatology is an independent risk factor, or a mediator in the pathway of demographic and psychosocial risks to PTB and SGA. DESIGN: multicentre follow-up study. PARTICIPANTS AND SETTING: pregnant women (n=1013) from midwifery practices, secondary hospitals and a tertiary hospital in three urban areas in the Netherlands. MEASUREMENTS: initial risk factors and depressive symptoms were assessed with the Mind2Care instrument, including Edinburgh Depression Scale (EDS) during early pregnancy. Pregnancy outcomes were extracted from medical records. A formal mediation analysis was conducted to investigate the role of depressive symptoms in the pathway to PTB and SGA. FINDINGS: a univariate association between depressive symptoms and PTB (OR:1.04; 95% CI:1.00-1.08) was observed. After adjusting for the risk factors educational level and smoking in the mediation analysis, this association disappeared. One educational aspect remained associated: low education OR: 1.06; 95%-CI:1.02-1.10. KEY CONCLUSIONS: depressive symptomatology appeared no mediator in the pathway of demographic and psychosocial risks to PTB or SGA. The presumed association between depressive symptoms and PTB seems spurious and may be explained by demographic and psychosocial risk factors. IMPLICATIONS FOR PRACTICE: for the prevention of PTB and SGA, interventions directed at demographic and psychosocial risk factors are likely to be of primary concern for clinicians and public health initiatives. As depressive symptoms and PTB and SGA share similar risk factors, both will profit.

Postpartum depression after mild and severe preeclampsia.

OBJECTIVE: To describe the prevalence of postpartum depressive symptoms after preeclampsia, to assess the extent to which the prevalence of postpartum depressive symptoms differs after mild and severe preeclampsia, and to investigate which factors contribute to such differences. METHODS: Women diagnosed with preeclampsia (n=161) completed the Edinburgh Postnatal Depression Scale (EPDS) at 6, 12, or 26 weeks postpartum. Multiple logistic regression analysis was used to investigate the association between severity of preeclampsia, contributing factors and postpartum depression (PPD) (1) at any time during the first 26 weeks postpartum and (2) accounting for longitudinal observations at three time points. RESULTS: After mild preeclampsia, 23% reported postpartum depressive symptoms at any time up to 26 weeks postpartum compared to 44% after severe preeclampsia (unadjusted odds ratio [OR] 2.65, 95% confidence interval [CI] 1.16-6.05) for depression at any time up to 26 weeks postpartum (unadjusted OR 2.57, 95% CI, 1.14-5.76) while accounting for longitudinal observations. Admission to the neonatal intensive care unit (NICU) (adjusted OR 3.19, 95% CI 1.15-8.89) and perinatal death (adjusted OR 2.96, 95% CI 1.09-8.03) contributed to this difference. CONCLUSIONS: It appears that not the severity of preeclampsia itself but rather the consequences of the severity of the disease (especially admission to the NICU and perinatal death) cause postpartum depressive symptoms. Obstetricians should be aware of the high risk of postpartum depressive symptoms after severe preeclampsia, particularly among women whose infant has been admitted to the NICU or has died.

Prenatal diagnosis of alobar holoprosencephaly, cyclopia, proboscis, and isochromosome 18q in the second trimester.

We would like to present a rare case of alobar holoprosencephaly (HPE) in a fetus diagnosed by routine sonography in the second trimester. Structural sonography demonstrated multiple facial anomalies including absent nasal bone, flat facial profile, hypotelorism, fusion of the orbits and proboscis. After counseling, termination of pregnancy was performed by vaginally administered misoprostol. Karyotyping of amniotic fluid cells revealed an isochromosome 18q, resulting in a trisomy 18q and monosomy 18p. A stillborn female of 390 g with several congenital anomalies was born. Postmortem examination demonstrated several anomalies including the HPE, cyclopia, double fused eye, absence of the nose, and the presence of a proboscis. In the literature only a few cases have been published.