Burden and risk factors for antenatal depression and its effect on preterm birth in South Asia: A population-based cohort study

Rasheda Khanam, Jennifer Applegate, Imran Nisar, Arup Dutta, Sayedur Rahman, Ambreen Nizar, Said Mohammed Ali, Nabidul Haque Chowdhury, Farzana Begum, Usha Dhingra, Fahmida Tofail, Usma Mehmood, Saikat Deb, Salahuddin Ahmed, Sajid Muhammad, Sayan Das, Saifuddin Ahmed, Harshita Mittal, Nicole Minckas, Sachiyo YoshidaRajiv Bahl, Fyezah Jehan, Sunil Sazawal, Abdullah H. Baqui

Research output: Contribution to journalArticlepeer-review


Introduction Women experience high rates of depression, particularly during pregnancy and the postpartum periods. Using population-based data from Bangladesh and Pakistan, we estimated the burden of antenatal depression, its risk factors, and its effect on preterm birth. Methods The study uses the following data: maternal depression measured between 24 and 28 weeks of gestation using the 9–question Patient Health Questionnaire (PHQ-9); data on pregnancy including an ultrasound before 19 weeks of gestation; data on pregnancy outcomes; and data on woman’s age, education, parity, weight, height, history of previous illness, prior miscarriage, stillbirth, husband’s education, and household socioeconomic data collected during early pregnancy. Using PHQ-9 cutoff score of ≥12, women were categorized into none to mild depression or moderate to moderately severe depression. Using ultrasound data, preterm birth was defined as babies born <37 weeks of gestation. To identify risk ratios (RR) for antenatal depression, unadjusted and adjusted RR and 95% confidence intervals (CI) were calculated using log- binomial model. Log-binomial models were also used for determining the effect of antenatal depression on preterm birth adjusting for potential confounders. Data were analyzed using Stata version 16 (StataCorp LP). Results About 6% of the women reported moderate to moderately severe depressive symptoms during the antenatal period. A parity of ≥2 and the highest household wealth status were associated with an increased risk of depression. The overall incidence of preterm birth was 13.4%. Maternal antenatal depression was significantly associated with the risk of preterm birth (ARR, 95% CI: 1.34, 1.02–1.74). Conclusion The increased risk of preterm birth in women with antenatal depression in conjunction with other significant risk factors suggests that depression likely occurs within a constellation of other risk factors. Thus, to effectively address the burden of preterm birth, programs require developing and providing integrated care addressing multiple risk factors.

Original languageEnglish (US)
Article numbere0263091
JournalPloS one
Issue number2 February
StatePublished - Feb 2022

ASJC Scopus subject areas

  • General


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