Depression in pregnancy: A multinational prospective cohort study

Depression in pregnancy is associated with adverse outcomes for both mother and baby. Estimates of the prevalence of depression in pregnancy vary considerably across low- and middle-income countries. We set out to prospectively determine the prevalence of depression in pregnancy in two low- and middle-income countries, and to investigate its association with adverse pregnancy outcomes.

This multinational prospective cohort study was conducted in Pakistan and South Africa from 2021 to 2023 in two tertiary referral centres. The Edinburgh Postnatal Depression Scale was administered to women between 20- and 34- weeks' gestation. Women were followed up and pregnancy outcomes collected. A Bayesian model accounting for the sensitivity and specificity of the Edinburgh Postnatal Depression Scale was used to estimate prevalence.

1537 participants were recruited. The adjusted prevalence of depression in pregnancy was 17.1 % (95 % credible interval [CrI] 13.3 % - 21.1 %). Estimates varied across sites, in Pakistan, 10.8 % (95 % CrI 7.7 % - 14.3 %), and in South Africa, 25.9 % (95 % Crl 20.8 % - 31.1 %) of women experienced depression in pregnancy. There were no associations between screening positive on the Edinburgh Postnatal Depression Scale (score ≥ 11) and spontaneous preterm birth (adjusted odds ratio [aOR] 1.20 95 % confidence interval [CI] 0.79-1.83), low birthweight (aOR 1.25 95 % CI 0.91-1.72), or admission to a special care/neonatal intensive care unit (aOR 0.95 95 % CI 0.59-1.52).

Within our study cohort, spanning two centres in Pakistan and South Africa, one in six women experienced depression in pregnancy. Reassuringly, depression was not associated with an increase in adverse pregnancy outcomes; spontaneous preterm birth, low birthweight or admission to neonatal intensive care/special care nursery. Our study provides robust estimates of the burden of depression in pregnancy in two low- and middle-income countries; an important first step in addressing maternal mental health.