The Impact Of Antenatal Depression And Early Child Development

Main Category: Women's Health / Gynecology
Also Included In: Pregnancy / Obstetrics;  Depression;  Mental Health
Article Date: 27 Jun 2008 - 5:00 PDT

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A new study published in BJOG: An International Journal of Obstetrics and Gynaecology has found that antenatal depression can have a negative impact on child development.

It is widely accepted that postnatal depression can have a detrimental effect on child development, however few studies have looked at the effect of antenatal depression. This research, which comes from a collaboration between the University of the West of England and the University of Bristol, aimed to assess maternal depression during pregnancy and subsequent child development.

The study, which used data from Children of the 90s (also known as ALSPAC - the Avon Longitudinal Study of Parents and Children)1, included 11 098 women in Avon, England, who had an estimated date of delivery between April 1991 and December 1992.

The research found that children of women with persistent depression during pregnancy have a 50% increase in the odds of developmental delay. The presence of continuing postnatal depression made a contribution, but when the results were adjusted to allow for this, there was still an independent 34% increase in the odds of developmental delay attributable to the antenatal component.

The Edinburgh Postnatal Depression Scale (EPDS)2 was used to assess the level of maternal depression and the Denver Developmental Screening Test II (DDST)3 was employed to assess child development. Women completed the EPDS at 18 and 32 weeks gestation and again at eight weeks and then eight months after birth. Applying the standard 12/13 EPDS cut-off, 1565 (14%) women were depressed antenatally but not at either postnatal time-point. In total 893 (9%) children in the study group were developmentally delayed at 18 months of age.

Researchers found that persistent antenatal depression (EPDS ≥ 10 at both 18 and 32 weeks) was associated with developmental delay with an adjusted odds ratio of 1.34 (adjusted OR 1.34, 95% CI 1.11-1.62). Applying the 12/13 and 14/15 cut-offs gave similar results. After adjustment for postnatal depression, the effect sizes were reduced but still very significant.

Dr Toity Deave, Research Fellow, Centre for Child & Adolescent Health, University of the West of England, said: "I believe the most important finding from our study is that maternal antenatal depression has a negative impact on children's cognitive development, even when postnatal depression has been taken into account. The other important message is that it is the persistence of depression, as well as the intensity of antenatal depression, that has an impact on the child."

Professor Philip Steer, BJOG Editor-in-Chief said: "Although there is clear evidence that women who experience antenatal depression are more likely to develop postnatal depression, little research has looked separately at antenatal depression and its effects on child development. This study is important because it has done just that and has found a significant link.

"Maternal depression, both antenatally and postnatally, has a significant impact on women and their families. It is essential for doctors, midwives and other healthcare professionals to be aware and play an active role in assessing and identifying maternal depression, so that those at-risk can receive appropriate support and care during pregnancy and post-birth."

Notes

BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal.

Children of the 90s (also known as ALSPAC - the Avon Longitudinal Study of Parents and Children) is a unique ongoing research project based in the University of Bristol. It enrolled 14,000 mothers during pregnancy in 1991-2 and has followed most of the children and parents in minute detail ever since. The Children of the 90s study could not have been undertaken without the continuing financial support of the Medical Research Council, the Wellcome Trust, and the University of Bristol among many others.

The Edinburgh Postnatal Depression Scale is a widely used 10-item self-rating questionnaire on which women rate their feelings over the previous seven days, giving a score ranging from 0 to 30. The scoring system is effective for both antenatal and postnatal depression, the standard cut-off point for women who are at risk or suffering from ante or postnatal depression is a score of 12-13/30.

The Denver Developmental Screening Test II (DDST) is a screening questionnaire designed to identify cognitive and behavioural problems in preschool children. The children were screened at 18 months of age and the developmentally delayed group were those who failed two or more items.

Reference

Deave T, Heron J, Evans J, Emond A. The impact of maternal depression in pregnancy on early child development. BJOG 2008;115:1043-1051.

Royal College of Obstetricians and Gynaecologists