Effect of depressive disorders and other psychiatric disorders on pregnancy and perinatal outcomes in a Hong Kong obstetrics unit

CC CHENG; KH SIONG; HC LEE; KC  AU YEUNG

doi:10.12809/hkjgom.20.1.03

Authors

CC CHENG
KH SIONG
HC LEE
KC AU YEUNG

DOI:

https://doi.org/10.12809/hkjgom.20.1.03

Keywords:

Depression, Diabetes, gestational, Mental disorders, Premature birth

Abstract

Objectives: To determine the prevalence of psychiatric disorders in Chinese pregnant women in Hong Kong, the effect of psychiatric disorders on pregnancy and perinatal outcomes, and the effect of antidepressants on pregnancy and perinatal outcomes.
Methods: We retrospectively reviewed medical records of women who delivered in Tuen Mun Hospital after 24 weeks of gestation between 1 January 2016 and 31 December 2017. Chinese pregnant women with psychiatric disorders were identified. Women with multiple pregnancy were excluded.
Results: Of 9049 Chinese pregnant women included, 216 (2.4%) reported psychiatric disorders, with depressive disorders being the most prevalent (1%). Compared to pregnant women with no psychiatric disorders, pregnant women with psychiatric disorders were more likely to have gestational diabetes (10.2% vs 5.7%, p=0.005) and/or pre-existing diabetes (4.2% vs 1.9%, p=0.018) and preterm births before 37 weeks (13.9% vs 7.5%, p=0.001). Similarly, women with depressive disorders were more likely to have gestational diabetes (11.4% vs 5.7%, p=0.022) and preterm birth before 37 weeks (13.6% vs 7.5%, p=0.031). In multiple logistic regression, pregnant women with psychiatric disorders or depressive disorders were associated with nearly two-fold increase in the risks of gestational diabetes mellitus and preterm birth before 37 weeks, after adjusting for cofounding factors.
Conclusion: Depression and psychiatric disorders were associated with preterm birth and gestational diabetes. Use of antidepressants had no adverse effect on maternal or fetal outcomes.

References

Andersson L, Sundstrom-Poromaa I, Bixo M, Wulff M, Bondestam K, åStröm M. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 2003;189:148-54.

Ross LE, Grigoriadis S, Mamisashvili L, et al. Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and metaanalysis. JAMA Psychiatry 2013;70:436-43.

Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry 2013;74:e321-41.

Jarde A, Morais M, Kingston D, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry 2016;73:826-37.

Eastwood J, Ogbo FA, Hendry A, Noble J, Page A; Early Years Research Group (EYRG). The impact of antenatal depression on perinatal outcomes in Australian women. PLoS One 2017;12:e0169907.

Grigoriadis S, Graves L, Peer M, et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. J Clin Psychiatry 2018;79.pii:17r12011.

Einarson A, Choi J, Einarson TR, Koren G. Adverse effects of antidepressant use in pregnancy: an evaluation of fetal growth and preterm birth. Depress Anxiety 2010;27:35-8.

Brameld KJ, Jablensky A, Griffith J, Dean J, Morgan VA. Psychotropic medication and substance use during pregnancy by women with severe mental illness. Front. Psychiatry 2017;8:28.

Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 2008;65:805-15.

Hinkle SN, Buck Louis GM, Rawal S, Zhu Y, Albert PS, Zhang C. A longitudinal study of depression and gestational diabetes in pregnancy and the postpartum period. Diabetologia 2016;59:2594-602.

Rustad JK, Musselman DL, Nemeroff CB. The relationship of depression and diabetes: pathophysiological and treatment implications. Psychoneuroendocrinology 2011;36:1276-86.

Oberlander TF, Warburton W, Misri S, Aghajanian J, Hertzman C. Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry 2006;63:898-906.

Szegda K, Markenson G, Bertone-Johnson ER, Chasan-Taber L. Depression during pregnancy: a risk factor for adverse neonatal outcomes? A critical review of the literature. J Matern Fetal Neonatal Med 2014;27:960-7.

Venkatesh KK, Riley L, Castro VM, Perlis RH, Kaimal AJ. Association of antenatal depression symptoms and antidepressant treatment with preterm birth. Obstet Gynecol 2016;127:926-33.

Osborne LM. Monk C. Perinatal depression: the fourth inflammatory morbidity of pregnancy? Theory and literature review. Psychoneuroendocrinology 2013;38:1929-52.

Wadhwa PD, Culhane JF, Rauh V, Barve SS. Stress and preterm birth: neuroendocrine, immune/inflammatory, and vascular mechanisms. Matern Child Health J 2001;5:119-25.

Kelly R, Zatzick D, Anders T. The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Am J Psychiatry 2001;158:213-9.