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Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis

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  • Abel Fekadu Dadi
  • Emma R Miller
  • Lillian Mwanri

Abstract

Background: Depression in pregnancy (antenatal depression) in many low and middle-income countries is not well documented and has not been given priority for intervention due to competing urgencies and the belief that it does not immediately cause fatalities, which mainly emanated from lack of comprehensive research on the area. To fill this research gap, this systematic review was conducted to investigate the burden of antenatal depression and its consequences on birth outcomes in low- and middle-income countries. Methods: We systematically searched the databases: CINHAL, MEDLINE, EMCare, PubMed, PSyc Info, Psychiatry online, and Scopus for studies conducted in low and middle-income countries about antenatal depression and its association with adverse birth outcomes. We have included observational studies (case control, cross-sectional and cohort studies), written in English-language, scored in the range of “good quality” on the Newcastle Ottawa Scale (NOS), and were published between January 1, 2007 and December 31, 2017. Studies were excluded if a standardized approach was not used to measure main outcomes, they were conducted on restricted (high risk) populations, or had fair to poor quality score on NOS. We used Higgins and Egger’s to test for heterogeneity and publication bias. Primary estimates were pooled using a random effect meta-analysis. The study protocol was registered in PROSPERO with protocol number CRD42017082624. Result: We included 64 studies (with 44, 035 women) on antenatal depression and nine studies (with 5,540 women) on adverse birth outcomes. Antenatal depression was higher in the lower-income countries (Pooled Prevalence (PP) = 34.0%; 95%CI: 33.1%-34.9%) compared to the middle-income countries (PP = 22.7%, 95%CI: 20.1%-25.2%) and increased over the three trimesters. Pregnant women with a history of economic difficulties, poor marital relationships, common mental disorders, poor social support, bad obstetric history, and exposure to violence were more likely to report antenatal depression. The risk of having preterm birth (2.41; 1.47–3.56) and low birth weight (1.66; 1.06–2.61) was higher in depressed mothers compared to mothers without depression. Conclusions: Antenatal depression was higher in low-income countries than in middle-income countries and was found to be a risk factor for low birth weight and preterm births. The economic, maternal, and psychosocial risk factors were responsible for the occurrence of antenatal depression. While there could be competing priority agenda to juggle for health policymakers in low-income countries, interventions for antenatal depression should be reprioritized as vitally important in order to prevent the poor maternal and perinatal outcomes identified in this review.

Suggested Citation

  • Abel Fekadu Dadi & Emma R Miller & Lillian Mwanri, 2020. "Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-23, January.
    • Handle: RePEc:plo:pone00:0227323
    DOI: 10.1371/journal.pone.0227323
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    1. Anna Kucab & Edyta Barnaś & Joanna Błajda, 2022. "Assessment of the Postpartum Emotional Wellbeing among Women Participating and Not Participating in Antenatal Classes," IJERPH, MDPI, vol. 19(8), pages 1-11, April.
    2. Xichenhui Qiu & Ting Li & Qiyu Fang & Lingling Huang & Xujuan Zheng, 2022. "Online and Offline Intervention for the Prevention of Postpartum Depression among Rural-to-Urban Floating Women: Study Protocol for a Randomized Control Trial," IJERPH, MDPI, vol. 19(13), pages 1-13, June.
    3. Qianqian Chen & Wenjie Li & Juan Xiong & Xujuan Zheng, 2022. "Prevalence and Risk Factors Associated with Postpartum Depression during the COVID-19 Pandemic: A Literature Review and Meta-Analysis," IJERPH, MDPI, vol. 19(4), pages 1-11, February.
    4. Miyoung Lee & Yeon-Suk Kim & Mi-Kyoung Lee, 2021. "The Mediating Effect of Marital Intimacy on the Relationship between Spouse-Related Stress and Prenatal Depression in Pregnant Couples: An Actor–Partner Interdependent Model Test," IJERPH, MDPI, vol. 18(2), pages 1-10, January.
    5. Cecilia Peñacoba Puente & Carlos Suso-Ribera & Sheila Blanco Rico & Dolores Marín & Jesús San Román Montero & Patricia Catalá, 2021. "Is the Association between Postpartum Depression and Early Maternal–Infant Relationships Contextually Determined by Avoidant Coping in the Mother?," IJERPH, MDPI, vol. 18(2), pages 1-14, January.
    6. Juan Xiong & Qiyu Fang & Jialing Chen & Yingxin Li & Huiyi Li & Wenjie Li & Xujuan Zheng, 2021. "States Transitions Inference of Postpartum Depression Based on Multi-State Markov Model," IJERPH, MDPI, vol. 18(14), pages 1-11, July.
    7. Seo Ah Hong & Doungjai Buntup, 2023. "Maternal Depression during Pregnancy and Postpartum Period among the Association of Southeast Asian Nations (ASEAN) Countries: A Scoping Review," IJERPH, MDPI, vol. 20(6), pages 1-16, March.
    8. Sarah Van Haeken & Marijke Anne Katrien Alberta Braeken & Anne Groenen & Annick Bogaerts, 2024. "A Supported Online Resilience-Enhancing Intervention for Pregnant Women: A Non-Randomized Pilot Study," IJERPH, MDPI, vol. 21(2), pages 1-17, February.
    9. Palfreyman, Alexis & Gazeley, Ursula, 2022. "Adolescent perinatal mental health in South Asia and Sub-Saharan Africa: A systematic review of qualitative and quantitative evidence," Social Science & Medicine, Elsevier, vol. 313(C).

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