Maternal depressive symptoms could start in early pregnancy, study finds

Maternal depressive symptoms could begin from early pregnancy and last up to two years after childbirth, a large-scale international study has shown.

While health professionals often emphasise the postpartum stage after childbirth as a high-risk period for the onset of depression, this latest research has found that maternal depressive symptoms can appear from early pregnancy.

The study, led by researchers from A*STAR’s Translational Neuroscience Programme of the Singapore Institute for Clinical Sciences (SICS) in Singapore, involved seven prospective observational cohorts across the UK, Canada and Singapore.

The researchers analysed the maternal depressive symptom trajectories of 11,563 pregnant women, spanning multiple decades in the largest such analysis to date. Each cohort included depressive symptoms measured at multiple perinatal time points and analysed independently.

The data was based on prospective maternal self-reports of depressive symptoms, eliminating the potential bias collected from retrospective reports.

The study showed three distinct clusters of mothers with stable low, mild, and high symptom levels over the perinatal period – the period from the beginning of pregnancy up to two years post-birth. The trajectories of depressive symptoms were present for all mothers.

This was true even in the case of those who met clinical cut-offs for probable depression indicating that more serious instances of depression in women begin prior to the birth of the child.

“Several recent studies, including one conducted locally suggest that maternal depressive symptoms may begin before conception, which is why interventions, guidelines for care, and public health policies aimed at alleviating maternal depressive symptoms should target as early as preconception, at least during pregnancy, in addition to the postnatal period, for more effective outcomes,” explained Dr Michelle Kee, research scientist at A*STAR’s SICS and first author of the paper.

Professor Michael Meaney, the director of the translational neuroscience programme at SICS, said: “The medical media continues to refer to maternal depression as ‘postnatal depression’, implying that the onset of symptoms occurs following the birth of the child.

“This extensive analysis shows that the onset of symptoms is in the prenatal period and remains largely stable thereafter. This is true for women in the community as well as for those experiencing more severe symptom levels.”

He added: “The results of this study point to the early antenatal period as a crucial time point for the identification of stable trajectories of maternal depressive symptoms and emphasises the critical importance of prenatal intervention.”

Associate Professor Helen Chen, senior consultant, department of psychological medicine at the KK Women’s and Children’s Hospital, said: “This study provides strong evidence across populations that it is crucial to address depression during pregnancy so that mothers are well and ready to receive their babies, rather than to wait until the postnatal period, for postnatal depression has traditionally been the focus.

“Given what we know about the impact of perinatal depression on child development and health outcomes, the paper will help to inform healthcare systems to direct resources upstream to the antenatal period.

“This will benefit our mothers and their children, and population health of future generations.”

Previous findings from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) project showed that prenatal maternal mental health plays a significant role in the brain development and health of babies.

Research found that maternal depressive symptoms can negatively affect a child’s nutrition, physical health, cognitive functions, socioemotional development and academic achievement, in some cases increasing the risk of ADHD and depression.