Depression During

Pregnancy
Kathleen S. Peindl, M.S., Ph.D.
Associate Professor in Psychiatry
Thomas Jefferson University
Philadelphia, PA 19107
Over the past 18 years, my interest in
prenatal depression grew for two
reasons. First, it has become
increasingly clear that prenatal
depression is a risk factor for recurrent
depression throughout the female life
cycle. Second, both prenatal and
postpartum depression adversely affect
child development. Breaking the cycle of
depression through identification,
education and treatment is one of my
goals.
 Depression During Pregnancy
Learning Objectives
• To understand what prenatal depression
is
• To learn about a tool for depression
screening
• To understand some consequences of
the illness
• To learn about treatments of depression
during pregnancy
 Performance Objectives
Depression During Pregnancy
• To be able to recognize depression
during pregnancy
• To know the risk factors for
depression during pregnancy
• To know some cost of the illness to
the mother and infant
• To understand treatments for the
disease
 Depression Onset in
Young Adult Women
• Depression in females is 2
times higher than the rate
found in males
• Change in rates occurs
during puberty and the
onset of menses
 Young Women and
Depression
• Women, aged 22, with major
depressive disorder had first
onset of illness in
adolescence
• 44% had their first episode of
major depression during
pregnancy
 What is Depression
During Pregnancy
• Diagnosis
• Symptoms
• Difficulty with Diagnosis
• Prevalence Rates of
Detection of Illness
 Diagnosis of Depression
• Most Mental Health Professionals
use DSM-IV criteria as the
standard to diagnose Psychiatric
Disorders
• The Prime-MD is used in general
clinical settings to diagnose
common psychiatric disorders and
will code the disease using DSM-IV
Criteria
 Symptoms of Depression
and of Normal Pregnancy
• Depression • Pregnancy
• Sadness
• Sleep
• Loss of interest
• Sleep disturbances
Disturbances
• Weight loss/gain • Weight Gain
• Guilt/Worthlessness • Appetite
• Thoughts of death Disturbances
• Appetite disturbances
• Fatigue
• Fatigue
 Difficulty with
Diagnosis of Illness
• 50% of women have
undiagnosed depression in an
obstetric/gynecology clinic*
• The rate of detection may be as
low as 0.8% among pregnant
women**
 Prevalence of Depression
During Pregnancy
• Assessments method for determining
prevalence rates of depression during
pregnancy fall into three categories:
• Self-reported symptoms
• Distress
• Structured psychiatric interviews using
Standard Diagnostic Criteria
• Real Prevalence worldwide is around 10%
in pregnant adult women
Valid Tool for Screening for
depression during
pregnancy

• A Tool for screening must

access only affective and
cognitive symptoms
• Edinburgh Postnatal
Depression Scale
Recognition of Depression
During Pregnancy
• Awareness of depression
during pregnancy starts with
screening. On the Edinburgh
Postnatal Depression Scale,
the score would be >10.
Risk Factors for Depression
During Pregnancy
• Race and Ethnicity: increased rates among
African-American and Hispanic populations
• Adolescents
• Single status
• Low Socio-economic status (world-wide risk
factor)
• Uninsured status
• Personal History of Depression
• Family History of Depression
Consequences of Depression
During Pregnancy

• Two sets of consequences need

to be identified for depression
during pregnancy
• A. Those affecting the mother
• B. Those affecting the fetus
Depression and the Mother
Women with Prenatal Depression have:
• Poor prenatal care and health
behaviors
• Poor weight gain and nutrition
• Fatigue and loss of functioning
• Disturbed sleep
• Use of drugs including cigarettes
and illicit drugs
Prenatal Depressive Symptoms
and Fetal Development
• Increase in Preterm Delivery
• Mean gestational age: 29.5 weeks
• Reduction in birth weight of 9.1
grams for every one point increase
in a self-report measure of
depression in low-SES group
• 4-fold increase in low birth weight
babies in an African-American
population
 More Childhood Outcomes
• At birth: the risk of
unconsolability is 2.64
• High Scores on the Childhood
Behavioral Checklist for
Externalizing for children whose
mothers had prenatal depression
Treatment of Depression
During Pregnancy

Experts differ on
optimal treatment
 Risk Benefit Ratio
• Discontinuation of treatment
before conception
• Continuation of Treatment
until conception
• Treatment if illness severe:
maintain through pregnancy
 Exposure of Psychotropic
Medication to Fetal Brain

• Morphological teratogenesis
• Behavioral teratogenesis
 Morphological
Teratogenesis
• Embryonic Period:
weeks 2-8
• Fetal Period (months 4-9)
Behavioral Teratogenesis

• Little is known about effects

of medication treatment for
prenatal depression
• Depressive symptoms do
adversely effect behavioral
outcomes in offspring
FDA Classification for
Antidepressants use
during pregnancy

Antidepressant
medication used to
treat depression
 FDA Category A

• Controlled studies show

no risk
• No Antidepressants are
Category A
 FDA Category B
• Inadequate number of human
studies, animal findings are
negative
• Animal studies show risk but
human studies do not show risk
• Bupropion is category B
 FDA Category C
• Risk cannot be ruled out.
Human studies are lacking.
• Animal studies show risk or
there are few animal studies
completed.
• Following list are category C
 FDA Category D

• Negative risk to the fetus

• No Antidepressants in this
category
 FDA Category X

• Contraindication for
Pregnancy
• Fetal Risk outweighs
benefits
 Successful Treatment
• Successful Treatment also found
with Therapy: Interpersonal
Psychotherapy

• No risk of exposure to the fetus