Trajectories of prenatal depression and their prediction of adverse pregnancy outcomes based on nomograms in Mainland China—Results from a national longitudinal survey

Abstract

Background

Cross-sectional data are commonly used to explore the relationships between prenatal depression and its relevant outcomes. Longitudinal studies of the influence of prenatal depressive trajectories on pregnancy outcomes are scarce. This study used nomograms to evaluate prenatal depressive trajectories as predictors of adverse pregnancy outcomes.

Methods

1169 participants were included in a national multicenter cohort study from five hospitals in Mainland China. Depression was measured by the Edinburgh Postnatal Depression Scale (EPDS) at 10–13, 15–18, 23–25, 30–32, and 36–37 weeks of gestation. A nomogram was constructed for each outcome based on multivariate logistic regression to evaluate the contribution of prenatal depressive trajectories to each outcome.

Results

Three different depressive trajectories were identified, namely “Low-stable,” “High-increasing,” and “High-decreasing,” accounting for 94.0 %, 4.3 %, and 1.7 % of participants, respectively. Prenatal high-increasing and high-decreasing trajectories elevated the likelihood of preterm term and small for gestational age (SGA) births occurring. Nomograms showed that prenatal depressive symptom trajectories predicted the above adverse outcomes more strongly than any other variable.

Limitations

Of the participants, 86.0 % had a education level of bachelor or higher. As the EPDS is highly aligned with the clinical diagnosis, it was used to assess depression levels.

Conclusions

Our study suggests that prenatal depressive trajectories can predict the likelihood of preterm and SGA births. These findings underscore the importance of early screening, identification, and intervention for prenatal depression.