Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA.
Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
Curr Psychiatry Rep. 2021 Feb 25;23(3):14. doi: 10.1007/s11920-021-01223-1.
Informed by the evidence of links between physiology of stress and parturition, we review recent epidemiologic evidence (2015-2020) of antenatal depression as a risk factor for preterm birth (PTB). We also explain racial/ethnic disparities in depression and preterm birth as a consequence of structural racism.
Epidemiologic evidence is consistent in linking antepartum depression with an elevated risk of PTB. Antidepressant usage has been linked with an elevated risk of PTB. However, recent evidence suggests that severity of depression is the underlying driver of the elevated risk attributed to antidepressant usage. The number of depressive symptoms, as a proxy for severity of maternal stress, may be a more informative predictor of PTB than criterion based predictors. Across various study designs, measurement modalities, and populations, antenatal depression predicts an elevated risk of delivering preterm. The physiology of stress provides a plausible explanation for this observation. Excessive stress-induced elevations in maternal and then fetal HPA hormones can alter maternal and fetal homeostasis and hasten the timing of parturition. Antenatal depression and exposure to structural racism are two stressors that can trigger the maternal stress response. Chronically elevated levels of stress hormones among women of color in the USA provide a likely physiologic explanation for Black-White disparities in the risk of PTB. Focusing on the number of depressive symptoms as the more informative predictor of PTB raises several questions. We consider these questions as well as directions for future research in the context of recent advances in the field.
根据压力生理学与分娩之间关联的证据，我们回顾了 2015 年至 2020 年期间关于产前抑郁作为早产（PTB）风险因素的最新流行病学证据。我们还解释了种族/民族差异导致的抑郁和早产，这是结构性种族主义的后果。
流行病学证据一致表明产前抑郁与早产风险增加有关。抗抑郁药的使用与早产风险增加有关。然而，最近的证据表明，抑郁的严重程度是抗抑郁药使用风险增加的潜在驱动因素。作为母体应激严重程度的替代指标，抑郁症状的数量可能是预测早产的更具信息量的指标，而不是基于标准的预测指标。在各种研究设计、测量方式和人群中，产前抑郁都预示着早产风险增加。应激生理学为这一观察结果提供了一个合理的解释。过度应激诱导的母体和胎儿 HPA 激素升高会改变母体和胎儿的内稳态，并加速分娩时间。产前抑郁和结构性种族主义暴露是两种应激源，可引发母体应激反应。在美国，有色人种女性的应激激素水平长期升高，可能为黑人和白人之间早产风险的差异提供了一个合理的生理解释。关注抑郁症状的数量作为预测早产的更具信息量的指标，引发了一些问题。我们在该领域的最新进展背景下考虑了这些问题以及未来研究的方向。
