Trajectories of depressive and anxiety symptoms throughout pregnancy in relation to obstetric outcomes.

BACKGROUND

High levels of depressive and anxiety symptoms during pregnancy have been linked to adverse pregnancy outcomes. However, it is unclear to what extent this depends on these symptoms' specific change-patterns during pregnancy. Therefore, we aimed to identify different trajectories of depressive and anxiety symptoms during pregnancy and to investigate their associations with obstetric outcomes.

METHODS

We administered depression and anxiety questionnaires six times during pregnancy (n = 598) and extracted pregnancy-outcome information from obstetric records. We used growth mixture modeling (GMM) to estimate different depressive- and anxiety-symptom course-trajectories and multivariable regression analyses to investigate their associations with pregnancy outcomes, adjusting for known risk factors (e.g., smoking).

RESULTS

GMM identified four depressive-symptom and three anxiety-symptom trajectory-classes. Only depression trajectories showed associations with obstetric outcomes. Compared with a trajectory-class with stable low depression scores, a class with high and then decreasing scores showed a lower mean gestational age at delivery, and a class with stable moderate scores showed a higher mean birthweight and less frequent low Apgar scores. Overall, trajectory-classes showed limited associations with obstetric outcomes compared with the included known risk factors.

LIMITATIONS

The depression questionnaire applied may overestimate depression in pregnancy because it covers many somatic symptoms. The range of obstetric outcomes was limited.

CONCLUSIONS

Depressive-symptom course-trajectories during pregnancy were associated with some obstetric outcomes. However, their associations with obstetric risk seemed limited compared with known risk factors (e.g., smoking, primiparity), stressing the importance of considering a full range of factors when aiming to predict obstetric risk in research and practice.