title: Antenatal depressive symptoms among pregnant women: Evidence from a Southern Brazilian population-based cohort study.
abstract: Antenatal depression (AD) is a major public health issue but evidence regarding its prevalence and associated factors in low and middle-income countries (LMICs) is limited. The aim of the study was to estimate the prevalence and identify risk factors for AD among Brazilian pregnant women.
  
  
  
  All women living in the urban area of the city of Pelotas, Southern Brazil, with confirmed pregnancy and estimated delivery date in the year 2015, were invited to take part. Eligible pregnant women were recruited from health services. Symptoms of antenatal depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS) by face-to-face interviews. A cutoff-point of 13 or more was used to define probable AD.
  
  
  
  EPDS scores were available for 4130 women. The prevalence of AD was 16% (95%CI 14·9-17·1). After adjustment for potential confounders, the factors most strongly associated with higher EPDS scores were a previous history of depression (PR 2·81; 95%CI 2·44-3·25), high parity (PR 1·72; 95%CI 1·38-2·15 - ≥2 children vs. 1 child) and maternal education (PR 5·47; 95%CI 4·22-7·09 - 0-4 vs. ≥12 years of formal education).
  
  
  
  EPDS was administered through face-to-face interviews rather than questionnaires and some women may have felt uncomfortable reporting their symptoms leading to underreporting and consequently underestimation of the prevalence found.
  
  
  
  AD prevalence is substantially higher in Brazil than in high-income countries (HICs) but similar to other LMICs. Our study identified relevant risk factors that may be potential targets to plan interventions, particularly a history of depression.
authors.affiliation: Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil. Electronic address: carolinavncoll@gmail.com.
authors.forename: Carolina de Vargas Nunes
authors.initials: CVN
authors.lastname: Coll
authors.affiliation: Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil.
authors.forename: Mariângela Freitas
authors.initials: MF
authors.lastname: da Silveira
authors.affiliation: Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics and Dalla Lana School of Public Health, University of Toronto, Canada.
authors.forename: Diego Garcia
authors.initials: DG
authors.lastname: Bassani
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Netsi
authors.affiliation: Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil.
authors.forename: Fernando César
authors.initials: FC
authors.lastname: Wehrmeister
authors.affiliation: Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil; Catholic University of Pelotas, Brazil.
authors.forename: Fernando César
authors.initials: FC
authors.lastname: Barros
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D010298:Parity; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D037841:Pregnant People / Q000523:psychology*; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Depression; Epidemiology; LMICs; Mental health; Perinatal health; Pregnancy