Researchers at the University of Michigan, Michigan State University and University of Washington found that a combination of medication use and depression—either before or during pregnancy—was strongly linked to delivery before 35 weeks’ gestation.
“Medication use may be an indicator of depressive symptom severity, which is a direct or indirect contributing factor to pre-term delivery,” said Kristine Siefert, the study’s co-author and U-M professor of social work.
Most physicians initiated pre-term deliveries after the women suffered complications, such as preeclampsia, poor fetal growth, or acute hemorrhage.
The study examined the associations among maternal depression, psychiatric medication use in pregnancy and pre-term delivery among women in five Michigan communities who received pre-natal care at one of 52 participating clinics. These women had to be at least 15 years or older, with no history of diabetes, and were 15 to 27 weeks of pregnancy between September 1998 and June 2004.
Researchers analyzed responses of nearly 3,020 women who participated in the Michigan-based Pregnancy Outcomes and Community Health study, which asked about depressive symptoms that occurred within the week of taking the questionnaire. The study also asked about the women’s history of depression that required medication, such as tranquilizers or sleeping pills.
Overall, 335 women (11 percent) delivered pre-term. Among the women who reported having depression during pregnancy, 75 percent had a history of depression and 62 percent used medication in the first half of pregnancy.
Another finding showed that without medication use, elevated levels of depressive symptoms at mid-pregnancy and history of depression did not pose an increased risk of pre-term delivery.
Amelia Gavin, lead author and assistant professor of social work at the University of Washington, said the findings highlight the need for carefully planned studies that can clarify associations between depression, psychiatric medications and preterm delivery.
“Women with depression face difficult decisions regarding the benefits and risks of using psychotropic medications in pregnancy,” Gavin said. “Therefore, a focus on disentangling medication effects and depression effects on mother and offspring health should be a major clinical priority.”
The study’s other researchers—both at Michigan State University—include Claudia Holzman, professor of epidemiology, and Yan Tian, a data analyst.
The findings appear in the September/October issue of Women’s Health Issues.
Contact: Jared Wadley
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