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Prenatal Depression, Prenatal Anxiety, and Spontaneous Preterm Birth: A Prospective Cohort Study Among Women With Early and Regular Care

From the Department of Child and Adolescent Psychiatry (J.D.), the Biostatistics and Clinical Research Unit (C.C.), and the Department of Obstetrics and Gynecology (M.H., M.D.), University Hospital of Caen, Caen, France; the Perinatal Mental Health Research Unit, Institute of Psychiatry, London, U.K. (M.N.M., S.C.); and the Department of Child and Adolescent Psychiatry, Rennes University Hospital, Rennes, France (S.T.).

Address correspondence and reprint requests to Jacques Dayan, MD, PhD, Service de Psychiatrie de l'enfant et de l'adolescent, Centre Hospitalier Universitaire Clemenceau, 14033 Caen Cedex, France. E-mail: dayan-j{at}chu-caen.fr

Objective: This article investigates the effects of antenatal depression and anxiety on spontaneous preterm birth resulting either from preterm labor or preterm premature rupture of membranes.

Methods: We conducted a prospective cohort study of 681 women with singleton pregnancies consecutively recruited between 20 and 28 weeks of gestation in the Obstetrics Department of the French University Hospital of Caen. Most were of European ethnic origin and received early and regular antenatal care. The assessment of gestational age was based on ultrasound examination (occurring before 13 weeks of gestation for 94.9% of the women). Depression and anxiety were assessed using self-administered questionnaires: the Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory. Logistic regression analysis, controlling for sociodemographic factors (e.g., maternal age, occupation) and obstetric factors (e.g., previous preterm birth, cervical or vaginal infection), provided adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Spontaneous preterm birth occurred in 31 women (4.8%). The rate of spontaneous preterm birth was significantly higher among women with high depression scores (9.7%) as opposed to other women (4.0%) even after adjustment for potential confounding factors (adjusted OR = 3.3, 95% CI = 1.2–9.2, p = .020). Anxiety was not significantly associated with the outcome. There were no significant interaction effects between psychological and biomedical factors.

Conclusions: These findings provide evidence that antenatal depression is significantly associated with spontaneous preterm birth in a population of European women receiving early and regular care.

Key Words: anxiety • depression • preterm birth • pregnancy • risk factors

Abbreviations: CRH = corticotropin-releasing hormone; EPDS = Edinburgh Postnatal Depression Scale; STAI-Y = State-Trait Anxiety Inventory; BMI = body mass index; HPA = hypothalamic–pituitary–adrenocortical; ACTH = adrenocorticotropin hormone.