title: Risk Factors for Antenatal Depression and Associations with Infant Birth Outcomes: Results From a South African Birth Cohort Study.
abstract: BACKGROUND
  Maternal antenatal depression may be particularly prevalent in low- and middle-income countries, but there is a paucity of data on its effect on birth outcomes in such settings. We investigated risk factors for antenatal depression and the associations between depression and infant birth outcomes in the Drakenstein Child Health Study (DCHS), a birth cohort study in the Western Cape, South Africa.
  
  
  METHODS
  The prevalence of depression in pregnant women enrolled in the DCHS from primary care antenatal clinics was measured using the Beck Depression Inventory (BDI-II). Predictors of antenatal depression were investigated using logistic regression, and the associations between depression and infant birth outcomes were examined in linear regression models.
  
  
  RESULTS
  Among 726 pregnant women (median age: 26 years), 156 (21%) had BDI-II scores suggesting depression. Independent predictors of depression included single marital status, low socioeconomic status (SES), recent stressful life events, unplanned pregnancy, childhood trauma, and past-year intimate partner violence. No association was observed between antenatal depression and preterm birth. Strong associations were observed between antenatal depression and decreased infant weight-for-age (WAZ) and head circumference-for-age (HCAZ) z-scores at birth. In multivariable analysis, the association between depression and decreased HCAZ remained significant, when adjusted for clinic, SES, and recent stressful life events.
  
  
  CONCLUSIONS
  Antenatal depression and associated risk factors are highly prevalent in this setting and are associated with adverse fetal growth. Maternal mental health may be an important predictor of infant growth in utero.
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.|Medical Research Council (MRC) Unit on Child and Adolescent Health, Cape Town, South Africa.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Brittain
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa.
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, South Africa.|Medical Research Council (MRC) Unit on Anxiety and Stress Disorders, Cape Town, South Africa.
authors.forename: Nastassja
authors.initials: N
authors.lastname: Koen
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
authors.forename: Sheri
authors.initials: S
authors.lastname: Koopowitz
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: Donald
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.|Medical Research Council (MRC) Unit on Child and Adolescent Health, Cape Town, South Africa.
authors.forename: Whitney
authors.initials: W
authors.lastname: Barnett
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.|Medical Research Council (MRC) Unit on Child and Adolescent Health, Cape Town, South Africa.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, South Africa.|Medical Research Council (MRC) Unit on Anxiety and Stress Disorders, Cape Town, South Africa.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D011256:Pregnancy Outcome / Q000453:epidemiology* / Q000523:psychology*; D037841:Pregnant People / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: South Africa; antenatal depression; fetal growth