Gunilla Sydsjö

Prevalence of depressive symptoms in late pregnancy and postpartum.

Background. Postnatal depression refers to a non‐psychotic depressive episode that begins in or extends into the postpartum period. The aims of this study were to examine the prevalence of depressive symptoms in a pregnant and later postnatal population, to determine the natural course of these symptoms and whether there is an association between antenatal and postnatal depressive symptomatology.

Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms ☆

OBJECTIVE To identify and test the predictive power of potential independent risk factors of postpartum depressive symptoms during pregnancy and the perinatal period. METHODS We conducted a case‐control study where 132 women with postpartum depressive symptoms were selected as an index group and 264 women without depressive symptoms as a control group. Data related to sociodemographic status, medical, gynecologic, and obstetric history, pregnancy, and perinatal events were collected from standardized medical records. RESULTS The strongest risk factors for postpartum depressive symptoms were sick leave during pregnancy and a high number of visits to the antenatal care clinic. Complications during pregnancy, such as hyperemesis, premature contractions, and psychiatric disorder were more common in the postpartum depressed group of women. No association was found between parity, sociodemographic data, or mode of delivery and postpartum depressive symptoms. CONCLUSION Women at risk for postpartum depression can be identified during pregnancy. The strongest risk factors, sick leave during pregnancy and many visits to the antenatal care clinic, are not etiologic and might be of either behavioral or biologic origin. The possibilities of genetic vulnerability and hormonal changes warrant further investigation to reach a more thorough understanding.

Weight gain restriction for obese pregnant women : A case-control intervention study

Objective  To minimise obese women’s total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome.

Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms.

OBJECTIVE: To study whether women with antepartum depression have an increased risk for adverse perinatal outcome. METHODS: From a sample of 1,489 women, an index group (n = 259) of all women with depressive symptoms on the Edinburgh Postnatal Depression Scale in gestational week 35–36 was selected. Two hundred fifty-nine women with no depressive symptoms on the Edinburgh Postnatal Depression Scale antepartum or postpartum were randomly chosen as the reference group. Medical, gynecologic, and obstetric history, socioeconomic status, pregnancy, and perinatal data were collected from standardized medical records for all women. RESULTS: Women with antepartum depressive symptoms were more often multiparas with a history of earlier obstetric complications. Complications during the present pregnancy were more frequent in the antepartum-depressed group of women. There were no differences concerning outcome of delivery, puerperium, and neonatal health between the index and reference groups. Forty-six percent of the women with antepartum depressive symptoms had depressive symptoms at 6–8 weeks or 6 months postpartum or both. CONCLUSION: Women depressed during pregnancy constitute a group without an increased risk for adverse obstetric or neonatal outcome but with a high risk for postpartum depressive symptoms. LEVEL OF EVIDENCE: II-2

The Swedish validation of Edinburgh Postnatal Depression Scale (EPDS) during pregnancy

Background: Around 10–15% of women suffer from depressive illness during pregnancy or the first year postpartum. Depression during pregnancy constitutes a risk for prenatal stress and preterm birth. No validated screening instrument for detecting depression during pregnancy was available in Swedish. Aims: We aimed to validate the Edinburgh Postnatal Depression Scale (EPDS) against DSM-IV criteria for depression during pregnancy, establish a reliable cut-off and estimate the correlation between the EPDS and HAD-S (Hospital Anxiety and Depression Scale). Methods: In a population-based community sample of 1175 pregnant women, 918 women (78%) answered questionnaires with the EPDS and HAD-S. In all, 121 were interviewed using the PRIME-MD (Primary Care Evaluation of Mental disorders) for diagnosing depression. Women were interviewed in mean gestational week 13 (range 8–21). For the EPDS, a receiver operating characteristic (ROC) curve was calculated for prediction of depression. Pearsons correlation coefficient was used to investigate the association between EPDS and HAD-S scores. Results: The optimal cut-off score on the EPDS scale for detecting depression was ≥13 (standard error coefficient of 1.09 and c-statistics of 0.84) giving a sensitivity of 77% and specificity of 94%. The EPDS scores correlated strongly with the HAD-S, Pearsons correlation was 0.83 (P < 0.0001). Conclusions: This study confirms that the EPDS is a valid screening instrument for detection of depressive symptoms during pregnancy. The EPDS shows persuasive measuring outcomes with an optimal cut-off at ≥13. Clinical implications: Healthcare for pregnant women should consider screening procedures and follow-up routines for depressive symptoms.

A follow-up study of postpartum depressed women: recurrent maternal depressive symptoms and child behavior after four years

SummaryObjective: To investigate the prevalence of depressive symptoms and self reported health of women who have shown previous postpartum depressive symptoms. To examine the behavior of four-year-old children born to mothers affected by postpartum depression. Methods: Longitudinal study. The index group (n = 251) constituted of all women with postpartum depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS), in a population-based study made in the late 1990s. The control group (n = 502) consisted of women without postpartum depressive symptoms on the EPDS at the same occasion. Approximately four years after delivery these women were asked to answer a short questionnaire on general health, the EPDS, and also to assess their child’s behavior with the Richman Pre-School Behaviour Checklist. Results: Women with a history of postpartum depressive symptoms were approximately 6 times more likely to have recurrent depressive symptoms (OR = 5.82, 95% CI: 3.79–8.93), compared to those without postpartum depressive symptoms, and they were also more likely to experience physical and mental illness. Although postpartum depressive symptoms in the mothers were involved in explaining the likelihood of behavioral problems in their four-year-old children, mothers with current depressive symptoms were the most likely to have a child with behavioral problems (OR = 4.71, 95% CI: 1.88–11.78). Conclusion: Postpartum depressive illness constitutes a risk for future illness as well as maternal perceived behavioral problems in offspring. In order to diminish long-term adverse consequences for the mother and the child there is a great need to recognize and treat women with postpartum depressive symptoms as early as possible.

Intergenerational effects of preterm birth and reduced intrauterine growth: a population‐based study of Swedish mother–offspring pairs

Objective  To estimate the intergenerational effects of preterm birth and reduced intrauterine growth.

Impact of pregnancy on gender differences in sickness absence

Women in general have a higher sickness absence than men, and sickness absence is particularly high among pregnant women. Study objectives: To study the level of male sickness absence as compared to female, including and excluding pregnant women. Design: Studies of incidence and length of sickness absence exceeding 7 days using population-based sick-leave records. Setting: The community of Linköping, Sweden, 117,000 inhabitants. Participants: Subjects included in the analysis were all men and women aged 16–44 who in 1985 or 1986 had at least one sick-leave spell exceeding 7 days. Results: Pregnant women had a very high sickness absence. When pregnant women were excluded, the female sick-leave rate decreased from 0.18 (95% C.I. 0.17–0.18) to 0.15 (95% C.I. 0.15–0.16) for all women. The corresponding male sick-leave rate was 0.12 (95% c.i. 0.12–0.13). Gender differences in length of sickness absence decreased to the same extent. The results were similar when restricting the analysis to employed persons. The decrease varied a little with occupational group and was largest in the age-group 25–34. Conclusions: When pregnant women were excluded the excess female sick-leave rate was halved, but still remained 25% higher than the male. The impact of excluding pregnant women was highest in the age group 25–34, where the fertility-rate was highest. Although only 5% of all women aged 16–44 were pregnant, they had a large impact on gender differences in sickness absence.

Obstetric outcome for women who received individualized treatment for fear of childbirth during pregnancy

Objective. To compare obstetric outcomes for women with fear of childbirth who received counseling during pregnancy with women without fear of childbirth. Design. Descriptive, retrospective case‐control study. Setting. University Hospital, Linköping, Sweden. Sample. 353 women who were referred to a unit for psychosocial obstetrics and gynecology because of fear of childbirth constituted the index group and 579 women without fear of childbirth formed a reference group. Methods. Data were collected from standardized antenatal and delivery records. Main outcome measures. Delivery data. Results. Elective cesarean sections (CS) were more frequent in the index group (p<0.001). Induction of delivery was also more common among the women with fear of childbirth (16.5 compared with 9.6%, p<0.001). Women with fear of childbirth who were scheduled for vaginal delivery were more often delivered by emergency CS (p=0.007). Elective CS was more common among the parous women with fear of childbirth and instrumental delivery was more common among nulliparous women with fear of childbirth. There were no differences in complications during pregnancy, delivery or postpartum between the two groups. Conclusion. Fear of childbirth is a predisposing factor for emergency and elective CS even after psychological counseling. Maximal effort is necessary to avoid traumatizing deliveries and negative experiences, especially for nulliparous women.

Preterm birth or foetal growth impairment and psychiatric hospitalization in adolescence and early adulthood in a Swedish population-based birth cohort.

Objective:  Preterm birth and restricted foetal growth are related to symptoms of psychiatric disorder. Our aim was therefore to investigate possible relations between being born preterm and/or small for gestational age (SGA) and later psychiatric hospitalization.