Depression, Anxiety During Pregnancy Associated with Significant Increase in Adverse Perinatal Outcomes

When we meet with women who are pregnant or planning to conceive, we spend most of our time discussing the potential risks associated with taking particular medications during pregnancy. However, there is significant data to indicate that untreated depression or anxiety in the mother may increase risk for perinatal complications, including low birth weight, preterm birth, and pre-eclampsia. A recent study suggests that the magnitude of the risk associated with a diagnosis of a mood or anxiety disorder in the mother is high and is similar to, or maybe greater than, the risk associated with other well-defined risk factors for adverse perinatal outcomes, such as advanced maternal age or high BMI.

Women taking part in the Healthy Babies Before Birth study conducted from 2013 to 2018 were screened for depression and anxiety. Psychiatric diagnostic data and screening information was available for 82 women with single gestations. Women who scored over 10 or endorsed suicidality on the Patient Health Questionnaire (PHQ-9) or scored over 7 on the Overall Anxiety Severity and Impairment Scale (OASIS), were interviewed using the Structured Clinical Interview for DSM-IV (SCID) Axis I Disorders.

Adverse perinatal outcomes included gestational diabetes mellitus, intrauterine growth restriction, preeclampsia, chorioamnionitis, hemorrhage, fetal death, preterm birth, or a low birthweight baby. In this cohort, 37% of the women experienced an adverse perinatal outcome.

Women were between 22 and 45 years of age (mean age = 33.1 ± 4.3). In this cohort, 19% of the 82 women had a SCID diagnosis of a perinatal mood and/or anxiety disorder.  The following risk factors were associated with increased risk for adverse outcomes: SCID diagnosis of a perinatal mood or anxiety disorder (OR = 3.58, 95% CI 1.03-12.44), increased maternal age (OR = 2.30, 95% CI 1.21-4.38), and higher BMI (OR = 1.69, 95% CI 1.06-2.69).

In summary, a diagnosis of a perinatal mood or anxiety disorder was associated with 3.5 times greater odds of having an adverse perinatal outcome. For every five years increase in age and for every increase by five units in BMI, the risk of having an adverse outcome increased. While BMI and advanced maternal age are well established risk factors for adverse perinatal outcomes, this study indicates that having a mood or anxiety disorder during pregnancy may result in a significant increase in risk as well.  What this study does not tell us, however, is whether this is a modifiable risk factor and if interventions used to treat anxiety or depression during pregnancy may help to decrease risk for adverse outcomes.  

Ruta Nonacs, MD PhD

Accortt E, Mirocha J, Jackman S, Coussons-Read M, Dunkel Schetter C, Hobel C. Association between diagnosed perinatal mood and anxiety disorders and adverse perinatal outcomes. J Matern Fetal Neonatal Med. 2022 Dec; 35(25):9066-9070.