title: The role of depressive symptoms in the pathway of demographic and psychosocial risks to preterm birth and small for gestational age.
abstract: OBJECTIVE
  depressive symptoms during pregnancy are associated with preterm birth (PTB) and small for gestational age (SGA). Depressive symptoms and PTB and SGA, however, share similar demographic and psychosocial risk factors. Therefore, we investigated whether depressive symptomatology is an independent risk factor, or a mediator in the pathway of demographic and psychosocial risks to PTB and SGA.
  
  
  METHODS
  multicentre follow-up study.
  
  
  METHODS
  pregnant women (n=1013) from midwifery practices, secondary hospitals and a tertiary hospital in three urban areas in the Netherlands.
  
  
  METHODS
  initial risk factors and depressive symptoms were assessed with the Mind2Care instrument, including Edinburgh Depression Scale (EDS) during early pregnancy. Pregnancy outcomes were extracted from medical records. A formal mediation analysis was conducted to investigate the role of depressive symptoms in the pathway to PTB and SGA.
  
  
  RESULTS
  a univariate association between depressive symptoms and PTB (OR:1.04; 95% CI:1.00-1.08) was observed. After adjusting for the risk factors educational level and smoking in the mediation analysis, this association disappeared. One educational aspect remained associated: low education OR: 1.06; 95%-CI:1.02-1.10.
  
  
  CONCLUSIONS
  depressive symptomatology appeared no mediator in the pathway of demographic and psychosocial risks to PTB or SGA. The presumed association between depressive symptoms and PTB seems spurious and may be explained by demographic and psychosocial risk factors.
  
  
  CONCLUSIONS
  for the prevention of PTB and SGA, interventions directed at demographic and psychosocial risk factors are likely to be of primary concern for clinicians and public health initiatives. As depressive symptoms and PTB and SGA share similar risk factors, both will profit.
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: c.quispel@erasmusmc.nl.
authors.forename: Chantal
authors.initials: C
authors.lastname: Quispel
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: m.bangma@erasmusmc.nl.
authors.forename: Meike
authors.initials: M
authors.lastname: Bangma
authors.affiliation: Department of Obstetrics and Gynaecology, Gelre Teaching Hospital, Apeldoorn, The Netherlands. Electronic address: brendakazemier@gmail.com.
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Kazemier
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: e.a.p.steegers@erasmusmc.nl.
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: w.hoogendijk@erasmusm.nl.
authors.forename: Witte J G
authors.initials: WJ
authors.lastname: Hoogendijk
authors.affiliation: Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands. Electronic address: hoog.pap@wxs.nl.
authors.forename: Dimitri N M
authors.initials: DN
authors.lastname: Papatsonis
authors.affiliation: Department of Obstetrics and Gynaecology, Gelre Teaching Hospital, Apeldoorn, The Netherlands. Electronic address: kmpaarlb@xs4all.nl.
authors.forename: K Marieke
authors.initials: KM
authors.lastname: Paarlberg
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: mijke.vandenberg@erasmusmc.nl.
authors.forename: Mijke P
authors.initials: MP
authors.lastname: Lambregtse-Van Den Berg
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: g.bonsel@erasmusmc.nl.
authors.forename: Gouke J
authors.initials: GJ
authors.lastname: Bonsel
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D007236:Infant, Small for Gestational Age / Q000523:psychology; D008425:Maternal Behavior / Q000523:psychology*; D008875:Middle Aged; D009426:Netherlands; D011247:Pregnancy; D011248:Pregnancy Complications; D047928:Premature Birth / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Depressive symptoms; Pregnancy; Preterm birth; Risk factor