Impact of antenatal common mental disorders upon perinatal outcomes in Ethiopia: the P-MaMiE population-based cohort study.
OBJECTIVE
To examine the impact of antenatal psychosocial stressors, including maternal common mental disorders (CMD), upon low birth weight, stillbirth and neonatal mortality, and other perinatal outcomes in rural Ethiopia.


METHODS
A population-based sample of 1065 pregnant women was assessed for symptoms of antenatal CMD (Self-Reporting Questionnaire-20: SRQ-20), stressful life events during pregnancy (List of Threatening Experiences: LTE) and worry about the forthcoming delivery. In a sub-sample of 654 women from six rural sub-districts, neonatal birth weight was measured on 521 (79.7%) singleton babies within 48 h of delivery. Information about other perinatal outcomes was obtained shortly after birth from the mother's verbal report and via the Demographic Surveillance System.


RESULTS
After adjusting for potential confounders, none of the psychosocial stressors were associated with lower mean birth weight, stillbirth or neonatal mortality. Increasing levels of antenatal CMD symptoms were associated both with prolonged labour (>24 h) (SRQ 1-5: RR 1.4; 95% CI 1.0-1.9, SRQ >or= 6: RR 1.6; 95% CI 1.0-2.6) and delaying initiation of breast-feeding more than eight hours (SRQ 1-5: RR 1.4; 95% CI 0.8 to 2.4, SRQ >or= 6: RR 2.8; 95% CI 1.3-6.1). Worry about delivery was also associated with labour longer than 24 h (RR 1.5; 95% CI 1.0-2.1).


CONCLUSIONS
This study provides preliminary evidence of important public health consequences of poor maternal mental health in low-income countries but does not replicate the strong association with low birth weight found in South Asia.
Hanlon
Charlotte
C
Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK. charlotte.hanlon@iop.kcl.ac.uk
Medhin
Girmay
G
Alem
Atalay
A
Tesfaye
Fikru
F
Lakew
Zufan
Z
Worku
Bogale
B
Dewey
Michael
M
Araya
Mesfin
M
Abdulahi
Abdulreshid
A
Hughes
Marcus
M
Tomlinson
Mark
M
Patel
Vikram
V
Prince
Martin
M
D000293:Adolescent; D000328:Adult; D001007:Anxiety; D001724:Birth Weight; D001942:Breast Feeding; D015331:Cohort Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007743:Labor, Obstetric; D008016:Life Change Events; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D050497:Stillbirth; D055815:Young Adult