title: Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a large multiethnic cohort study.
abstract: OBJECTIVE
  To explore whether 1) maternal depressive symptoms during pregnancy are associated with preterm birth (PTB), small for gestational age (SGA), a low Apgar score and child loss; 2) maternal smoking mediates the associations; and 3) the associations differ by ethnic background.
  
  
  METHODS
  Pregnant women in Amsterdam were approached during their first prenatal visit to participate in the Amsterdam Born Children and their Development study. They filled out a questionnaire covering sociodemographic data, life-style, and (psychosocial) health. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale. The baseline sample consisted of 8,052 women; the main ethnic groups were: Dutch, Creole, Turkish, and Moroccan.
  
  
  RESULTS
  The prevalence of perinatal outcomes was: 5.4% (PTB); 12.3% (SGA); l 1.5% (low Apgar score); and 1.4% (child loss). The prevalence of high depressive symptomatology was 30.6%. After adjustment for maternal age, parity, education, ethnicity, prepregnancy body mass index, hypertension, alcohol and drug use, and a small mediation effect of maternal smoking, high versus low levels of depressive symptoms were associated with SGA (odds ratio [OR], 1.19; p = .02) and a low Apgar score (OR, 1.74; p = .01), but not with PTB (OR, 1.16; p = .18) and child loss (OR, 1.28; p = .24). Stratified analyses by ethnic background showed a tendency toward higher risks, although insignificant, among Creole women.
  
  
  CONCLUSIONS
  Several pathways may explain the detrimental effects of maternal depressive symptomatology on perinatal health outcomes, including a psychoendocrinological pathway involving the hormone cortisol or mediation effects by maternal risk behaviors. Further research should explore the underlying pathways, in particular among ethnic subgroups.
authors.affiliation: Utrecht University, IRAS, Department of Environmental Epidemiology, Jenalaan 18d, 3584 CK Utrecht, the Netherlands. g.goedhart@uu.nl
authors.forename: Geertje
authors.initials: G
authors.lastname: Goedhart
authors.forename: Anne C
authors.initials: AC
authors.lastname: Snijders
authors.forename: Arlette E
authors.initials: AE
authors.lastname: Hesselink
authors.forename: Mireille N
authors.initials: MN
authors.lastname: van Poppel
authors.forename: Gouke J
authors.initials: GJ
authors.lastname: Bonsel
authors.forename: Tanja G M
authors.initials: TG
authors.lastname: Vrijkotte
mesh_terms: D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000208:ethnology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D008019:Life Style; D008425:Maternal Behavior / Q000208:ethnology / Q000523:psychology; D009017:Morbidity; D009035:Mothers / Q000523:psychology; D009426:Netherlands / Q000453:epidemiology; D054238:Perinatal Mortality / Q000208:ethnology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000208:ethnology; D047928:Premature Birth / Q000453:epidemiology / Q000208:ethnology; D011295:Prenatal Care