Being depressed during pregnancy might be bad for the baby, a study of Bay Area Kaiser patients suggests.
Expectant mothers with symptoms of severe depression are more than twice as likely to give birth prematurely as those with no signs of depression, according to the study, published today in the journal Human Reproduction.
Premature births, even just a few weeks short of full term, can leave a baby at greater risk of infection, jaundice and longer hospitalizations.
Doctors don't know whether depression itself causes early births, or whether some underlying problem might cause depression and prematurity.
Either way, they say, women need to be aware that depression in pregnancy is common, might affect the baby – and can be treated.
"Having a healthy mood is an essential part of having a healthy pregnancy," said Priya Batra, a Sacramento Kaiser psychologist who specializes in women's health. "We want people to know that this is part of what the medical system can offer you."
That's an especially important message, because sometimes it can seem like the whole world expects pregnant women to be thrilled.
"That cultural myth, that you should be happy, you should be glowing, that adds to the stigma of being down," Batra said.
Kaiser facilities in and around Sacramento recently began screening all pregnant women for depression, she said, and offering them help ranging from classes to counseling to medication.
Desirae Tobey of Sacramento, whose son Chase was born healthy and full term in June, knows firsthand that sometimes pregnancy can be emotionally harrowing.
"I was having anxiety attacks at work," she said, made worse because she felt she was supposed to be happy and act as if nothing was wrong.
Meanwhile, she was battling morning sickness, exhaustion and a constant fear that "something bad is going to happen to my baby" because miscarriages run in her family.
Her first obstetrician didn't help, Tobey said, and she didn't feel listened to until she switched doctors.
"I almost had to fight for the health of my baby," Tobey said. "The OB-GYN I got the second time was fantastic. She listened to my fears, however irrational they were."
Tobey was treated for depression when she was a teenager, but she didn't want to take medication during pregnancy. She got counseling, working with Batra to talk through the terrors – and get confirmation she wasn't alone.
That's a powerful message Tobey said she wants to share with other mothers-to-be.
"If you are having depression during pregnancy … it's OK to feel the way you're feeling," she said. "It's just not something you want to deal with by yourself" because with help it can be "really easily treatable."
The new study linking depression with premature births, from Kaiser Permanente's division of research in Oakland, should help raise awareness, Batra said.
The study was based on surveys of hundreds of women during the early weeks of their pregnancies. Depressive symptoms were measured by a commonly used questionnaire, and nearly half the women had either significant or severe symptoms.
Nine percent of the women with the worst symptoms had premature babies, compared with 4 percent of the women with no symptoms. Just under 6 percent of those who fell in between gave birth early.
A questionnaire isn't as precise as a doctor's diagnosis, but high rates of unhappiness found by the survey suggest pregnancy blues are underdiagnosed, according to Dr. De-Kun Li, the study's lead author.
"Medical professionals and pregnant women should pay attention to depression during pregnancy. … They shouldn't just dismiss it," said Li, a reproductive epidemiologist.
Li's study excluded women with the earliest – and most dangerous – premature births, because those often have known medical causes. The women he included had either full-term babies or later-term premature births – more than 33 weeks but less than 37. After that, a pregnancy is considered full-term.
Babies born at 35 or 36 weeks are "almost there" in terms of development, but still can face problems, said Dr. Mark Underwood, a UC Davis neonatologist. While they often don't need to be placed in incubators, their immune systems and livers are immature, so they must be monitored in the hospital and at home for infections and jaundice.
"A high percentage of them end up back in the hospital, either to get antibiotics or phototherapy, shine a light on them" to combat the jaundice, Underwood said.
Babies born at 34 weeks, or just past 33 weeks, face those risks but also have less developed lungs, stomachs and brains, which can mean trouble with breathing, digestion, and coordinating breath with sucking and swallowing.
For babies born between 33 and 37 weeks, "long-term consequences are not real high like they are in the little ones," he said.
Still, the cost to society is huge.
That group "is extremely expensive in terms of dollars because there are so many of them," Underwood said.
Call The Bee's Carrie Peyton Dahlberg, (916) 321-1086.
