title: Prevalence of depression during pregnancy: systematic review.
abstract: OBJECTIVE
  Current estimates of the prevalence of depression during pregnancy vary widely. A more precise estimate is required to identify the level of disease burden and develop strategies for managing depressive disorders. The objective of this study was to estimate the prevalence of depression during pregnancy by trimester, as detected by validated screening instruments (ie, Beck Depression Inventory, Edinburgh Postnatal Depression Score) and structured interviews, and to compare the rates among instruments.
  
  
  METHODS
  Observational studies and surveys were searched in MEDLINE from 1966, CINAHL from 1982, EMBASE from 1980, and HealthSTAR from 1975.
  
  
  METHODS
  A validated study selection/data extraction form detailed acceptance criteria. Numbers and percentages of depressed patients, by weeks of gestation or trimester, were reported.
  
  
  RESULTS
  Two reviewers independently extracted data; a third party resolved disagreement. Two raters assessed quality by using a 12-point checklist. A random effects meta-analytic model produced point estimates and 95% confidence intervals (CIs). Heterogeneity was examined with the chi(2) test (no systematic bias detected). Funnel plots and Begg-Mazumdar test were used to assess publication bias (none found). Of 714 articles identified, 21 (19,284 patients) met the study criteria. Quality scores averaged 62%. Prevalence rates (95% CIs) were 7.4% (2.2, 12.6), 12.8% (10.7, 14.8), and 12.0% (7.4, 16.7) for the first, second, and third trimesters, respectively. Structured interviews found lower rates than the Beck Depression Inventory but not the Edinburgh Postnatal Depression Scale.
  
  
  CONCLUSIONS
  Rates of depression, especially during the second and third trimesters of pregnancy, are substantial. Clinical and economic studies to estimate maternal and fetal consequences are needed.
authors.affiliation: Faculty of Pharmacy and Department of Medicine, University of Toronto, Ontario, Canada. heather.bennett@utoronto.ca
authors.forename: Heather A
authors.initials: HA
authors.lastname: Bennett
authors.forename: Adrienne
authors.initials: A
authors.lastname: Einarson
authors.forename: Anna
authors.initials: A
authors.lastname: Taddio
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Einarson
mesh_terms: D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011264:Pregnancy Trimesters / Q000523:psychology*; D015995:Prevalence; D011581:Psychological Tests