Infant and Childhood Outcomes
A robust amount of evidence has shown for years that maternal depression is associated with morbidity and/or developmental delays in children. This review confirmed that and described it in greater detail.
A half-dozen studies showed that women with untreated prenatal depression have a greater risk of pregnancy complications, including preterm delivery, than women without depression. Their infants are also more likely to be underweight, with 1 recent meta-analysis finding the odds 1.5 times higher than in mothers without depression. One small study from Turkey found that newborns of depressed mothers were born an average 1.4 weeks earlier and weighed an average 343 g less than newborns of non-depressed mothers.
“Available evidence supports the notion that impaired intrauterine growth is associated with antepartum depression,” the investigators wrote.“ In addition, infants delivered of depressed mothers also appear to have deficits in postnatal growth as compared with infant delivered of mothers without depression.”
Those differences after birth have previously been linked to “differences in breastfeeding practices and insecure infant-mother attachments among depressed and non-depressed mothers,” the researchers added.
It is less clear what might account for the greater burden of diarrhea, fever, and infectious disease that multiple studies have found in the infants of mothers with depression. The researchers also investigated evidence on the links between maternal depression and child obesity, but most of it comes primarily from high-income countries and is not consistent.
Evidence for developmental difficulties, however, appeared stronger.
A variety of studies found that children of mothers with postpartum depression, compared with children of non-depressed mothers, had lower scores in social and motor development at 3 months old, fewer cognitive, motor and development skills at 6 to 12 months old, and greater behavioral problems at 2 years old.
In a study from Ethiopia, children had 6-fold greater odds of emotional development delays and 5-fold greater odds of delayed language development when their mothers had depression. Although another study identified no association between maternal mood and infant temperament, the overall consensus clearly shows “significant clinical and developmental consequences for children” of mothers with postpartum depression.
The investigators noted that evidence-based guidelines for screening pregnant and postpartum women for depression exists in the United States from the US Preventive Services Task Force, but not for women in low- and middle-income countries.
“A broader guideline by the World Health Organization suggests integrating mental health services into primary care as the most viable way of closing [the] treatment gap for mental health in the low- and middle-income countries,” the researchers wrote. “One of the main challenges for such integration in the low- and middle-income countries has been the low recognition rates of mental disorders by primary care health workers, in part, due to shortage of clinicians with specialized training in assessing and managing the treatment of patients with mental health disorders.”
They recommend developing protocols for early identification and treatment of perinatal depression to prevent the associated negative effects. But they also noted the lack of cross-culturally valid screening and diagnostic instruments that must be addressed in addition to new, effective treatment strategies.
Gelaye B, Rondon M, Araya R, Williams M. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries [published online September 17, 2016]. Lancet Psychiatry. doi:10.1016/S2215-0366(16)30284-X.