Global burden of antenatal depression and its association with adverse birth outcomes: An umbrella review

  • BMC Public Health, Volume 20, No. 1, Year 2020

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Study Justification:
– Antenatal depression is a common mood disorder among women of childbearing age.
– Antenatal depression is associated with poor maternal and infant outcomes.
– There is a lack of focus on mental health issues in antenatal care, especially in lower-income countries.
– This study aims to provide evidence on the burden of antenatal depression to guide health policy development and planning.
Highlights:
– The study included ten reviews with a total of 306 studies and 877,246 participants.
– Antenatal depression prevalence ranged from 15% to 65% globally.
– Prominent risk factors for antenatal depression included exposure to abuse and violence, lack of social and partner support, and personal or family history of mental disorders.
– Infants born to depressed mothers had a higher risk of low birth weight and preterm birth.
Recommendations:
– Increase focus on mental health issues in antenatal care, particularly in lower-income countries.
– Develop and implement screening programs for antenatal depression.
– Provide support and interventions for women at risk of or experiencing antenatal depression.
– Improve access to quality mental health services for pregnant women.
Key Role Players:
– Health policymakers and government officials
– Healthcare providers and professionals
– Mental health specialists and counselors
– Non-governmental organizations (NGOs) working in maternal and child health
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers on mental health screening and interventions
– Development and implementation of screening programs
– Provision of mental health services and counseling for pregnant women
– Awareness campaigns and public education materials
– Monitoring and evaluation of the effectiveness of interventions
Please note that the cost items provided are general categories and not actual cost estimates. The actual cost will depend on the specific context and implementation strategies.

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Background: Women of childbearing age are at high risk of developing depression and antenatal depression is one of the most common mood disorders. Antenatal depression is also associated with a number of poor maternal and infant outcomes, however, there remains a lack of focus on mental issues in antenatal care, particularly in lower income countries. This systematic review of reviews provides useful evidence regarding the burden of antenatal depression which may provide guidance for health policy development and planning. Methods: We searched CINAHL(EBSCO), MEDLINE (via Ovid), PsycINFO, Emcare, PubMed, Psychiatry Online, and Scopus databases for systematic reviews that based on observational studies that were published in between January 1st, 2007 and August 31st, 2018. We used the Assessment of Multiple Systematic Reviews (AMSTAR) checklist scores to assess the quality of the included reviews. We applied vote counting and narrative review to summarize the prevalence of antenatal depression and its associated factors, while statistical pooling was conducted for estimating the association of antenatal depression with low birth weight and preterm birth. This systematic review of reviews was registered on PROSPERO with protocol number CRD42018116267. Results: We have included ten reviews (306 studies with 877,246 participants) on antenatal depression prevalence and six reviews (39 studies with 75,451 participants) conducted to identify the effect of antenatal depression on preterm and low birth weight. Globally, we found that antenatal depression prevalence ranged from 15 to 65%. We identified the following prominent risk factors based on their degree of influence: Current or previous exposure to different forms of abuse and violence (six reviews and 73 studies); lack of social and/or partner support (four reviews and 47 studies); personal or family history of any common mental disorder (three reviews and 34 studies). The risk of low birth weight and preterm birth was 1.49 (95%CI: 1.32, 1.68; I 2 = 0.0%) and 1.40 (95%CI: 1.16, 1.69; I 2 = 35.2%) times higher among infants born from depressed mothers. Conclusions: Globally, antenatal depression prevalence was high and could be considered a common mental disorder during pregnancy. Though the association between antenatal depression and adverse birth outcomes appeared to be modest, its absolute impact would be significant in lower-income countries with a high prevalence of antenatal depression and poor access to quality mental health services.

A systematic review of systematic reviews, also known as an ‘umbrella review’ is a synthesis that includes only other systematic reviews, which represent the highest form of evidence. This approach aims to provide a single comprehensive source of evidence and in recent years has been increasingly used to guide policymakers and those developing intervention modalities, clinical guidelines, and in the evaluation of health care interventions [38, 39]. As with other reviews, a systematic review of reviews, follows a systematic approach in searching the literature, appraisal, quality assessment, synthesis and reporting of the compiled results [37, 40, 41]. We searched CINAHL(EBSCO), MEDLINE (via Ovid), PsycINFO, Emcare, PubMed, Psychiatry Online, and Scopus databases for systematic reviews based on observational studies. To include the most up to date reviews on the topic, only those published between January 1st, 2007 and August 31st, 2018 were considered. The primary outcomes of this review of reviews was the burden of antenatal depression and any associated adverse birth outcomes – specifically, low birth weight, preterm birth, and still birth. systematic reviews that clearly measured and reported the following outcomes were included: [1] depression during pregnancy measured using a validated screening or diagnostic tool [2]; objectively measured birth weight and low birth weight was classified as a weight less than 2500 g [3]; gestation and age measured using a Last Menstrual Cycle (LMP) or supported by an ultrasound and preterm birth defined as a birth before 37 completed weeks of gestation; and [4] stillbirth defined as a fetal death after 20 completed weeks of gestation and weighing at least 500 g, intrauterine fetal death prior to the onset of labor, or intrauterine fetal death during labor and delivery. (((antenatal depression.mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures]) OR (depression during pregnancy.mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures]))) AND (((systematic review.mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures]) OR (meta-analysis.mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures] OR (review.mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures]))) reviews fulfilling the following criteria were included: [1] published with systematic review/meta-analysis in their title [2]; antenatal depression and its effect on birth outcomes was the primary objective [3]; systematically searched for primary studies in at least two medical literature data bases [3]; included at least one primary study that aimed to investigate antenatal depression and/or its effect on birth outcomes [5]; quality of included primary studies was assessed and considered in the analysis; and [6] if estimates in the primary reviews were meta-analyzed; the methodology, the model, publication bias, and heterogeneity issues were addressed and clearly reported. reviews were excluded if they included primary studies that screened depression in high risk populations (obese, overweight, diabetes, mothers with poor obstetric history, unintended pregnancy, primi-mothers) and reviews for which it was not possible to retrieve the full article. All reviews meeting the inclusion criteria were imported to an Endnote database. After duplicates were removed, titles and abstracts were assessed for eligibility prior to full text review. Reviews fulfilling the inclusion criteria through full text review were then assessed for their quality. Quality was assessed using Assessment of Multiple Systematic Reviews (AMSTAR) checklist scores. The checklist contains 11 indicators that are used to derive an overall score assessed as high quality (score > =8), medium quality (score 4–7), and low quality (score < =3). Two reviewers (AF & TA) independently assessed the quality of each review with an internal consistency of 98% and agreement was reached by discussion for the remaining 2%. The data were extracted and tabulated: author and publication year; geographic coverage of the review; data base searched; depression assessment tool used; number of primary studies included; if meta-analyses were conducted, the pooled number of participants (N); main findings; and AMSTAR score. The data synthesis was undertaken independently for each outcome of interest. Vote counting and narrative review were used to summarize and present the main findings for antenatal depression and associated factors. Statistical pooling (meta-analysis) was conducted for quantifying the effect of antenatal depression on low birth weight and preterm birth. A funnel plot and Egger’s regression test was used to check for potential publication bias. Where minor publication bias was identified, Tweedie’s and Duval’s trim and fill analysis was used as an adjustment. Heterogeneity among the studies was tested using the Higgins method, in which I2 statistics were calculated and compared with the standard. The data were imported and analyzed using Stata 14 software (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP). This systematic review of reviews was registered on PROSPERO with protocol number CRD42018116267.

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Based on the information provided, it appears that the research study is focused on understanding the burden of antenatal depression and its association with adverse birth outcomes. The study conducted a systematic review of reviews to gather evidence on the prevalence of antenatal depression and its impact on low birth weight and preterm birth.

To improve access to maternal health and address the findings of this study, here are some potential innovations that could be considered:

1. Integrated Mental Health Services: Integrate mental health services into antenatal care to ensure that pregnant women have access to screening, diagnosis, and treatment for antenatal depression. This could involve training healthcare providers to identify and address mental health issues during routine antenatal visits.

2. Telemedicine and Digital Health Solutions: Utilize telemedicine and digital health solutions to provide remote access to mental health support for pregnant women, especially in areas with limited access to mental health services. This could include virtual counseling sessions, online support groups, and mobile applications for self-management of antenatal depression.

3. Community-Based Interventions: Implement community-based interventions that aim to raise awareness about antenatal depression, reduce stigma, and provide support to pregnant women. This could involve community health workers or peer support programs that offer emotional support, education, and referral services.

4. Training and Capacity Building: Provide training and capacity building programs for healthcare providers to improve their knowledge and skills in identifying and managing antenatal depression. This could include training on screening tools, counseling techniques, and evidence-based interventions.

5. Policy and Advocacy: Advocate for policy changes and increased funding to prioritize mental health in antenatal care. This could involve working with policymakers and stakeholders to develop guidelines, allocate resources, and integrate mental health services into existing maternal health programs.

It is important to note that these recommendations are based on the information provided and may need to be tailored to specific contexts and resource availability. Additionally, further research and evaluation may be needed to assess the effectiveness and feasibility of these innovations in improving access to maternal health.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health based on the described systematic review of reviews is to integrate mental health services into antenatal care, particularly in lower-income countries.

The review highlights that antenatal depression is a common mental disorder during pregnancy and is associated with poor maternal and infant outcomes. However, there is a lack of focus on mental health issues in antenatal care, especially in lower-income countries with limited access to quality mental health services.

To address this issue, an innovation could be to develop and implement comprehensive antenatal care programs that include mental health screening, support, and treatment. This could involve training healthcare providers in identifying and addressing antenatal depression, as well as integrating mental health professionals into antenatal care teams.

Additionally, innovative approaches such as telemedicine and mobile health technologies could be utilized to improve access to mental health services for pregnant women in remote or underserved areas. This could involve providing virtual counseling sessions, educational resources, and remote monitoring of mental health symptoms.

By integrating mental health services into antenatal care and utilizing innovative approaches, access to maternal mental health support can be improved, leading to better overall maternal and infant outcomes.
AI Innovations Methodology
Based on the provided description, the systematic review of reviews aims to assess the burden of antenatal depression and its association with adverse birth outcomes. To improve access to maternal health, the following innovations could be considered:

1. Integrating mental health services into antenatal care: This could involve training healthcare providers to screen for and address antenatal depression during routine prenatal visits. It could also include the provision of counseling or therapy services for pregnant women experiencing depression.

2. Telemedicine and digital health solutions: Utilizing technology to provide remote access to mental health support for pregnant women in areas with limited access to healthcare facilities. This could involve virtual counseling sessions or the use of mobile applications to provide self-help resources and monitoring tools.

3. Community-based interventions: Implementing community-based programs that raise awareness about antenatal depression, reduce stigma, and provide support networks for pregnant women. This could involve training community health workers or volunteers to identify and support women at risk of or experiencing antenatal depression.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the target population: Identify the specific population or region where the recommendations will be implemented. Consider factors such as the prevalence of antenatal depression, access to healthcare facilities, and existing resources.

2. Collect baseline data: Gather data on the current state of access to maternal health services, including the prevalence of antenatal depression, rates of adverse birth outcomes, and availability of mental health support.

3. Develop intervention scenarios: Create different scenarios that represent the implementation of the recommended innovations. This could involve varying levels of integration of mental health services, different types of technology-based solutions, or variations in community-based interventions.

4. Simulate the impact: Use statistical modeling or simulation techniques to estimate the potential impact of each intervention scenario on access to maternal health. This could involve analyzing data on antenatal depression prevalence, birth outcomes, and the effectiveness of the recommended innovations.

5. Evaluate outcomes: Assess the projected outcomes of each intervention scenario, including improvements in access to maternal health services, reductions in antenatal depression prevalence, and potential reductions in adverse birth outcomes.

6. Compare scenarios: Compare the outcomes of each intervention scenario to determine which recommendations are most effective in improving access to maternal health. Consider factors such as cost-effectiveness, scalability, and feasibility of implementation.

7. Refine and implement: Based on the simulation results, refine the recommendations and develop an implementation plan. Consider the resources, infrastructure, and policy changes required to implement the innovations effectively.

By following this methodology, policymakers and healthcare providers can make informed decisions about the most effective strategies to improve access to maternal health and address antenatal depression.

Statistics:
Citations: 96
Authors: 4
Identifiers:
DOI: 10.1186/s12889-020-8293-9
Research Areas:
Community Interventions, Disparities, Genetics and Genomics, Health System and Policy, Maternal Access, Maternal and Child Health, Mental Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Design:
Cross Sectional Study, Narrative Study, randomised-control-trial
Study Approach:
Mixed-methods, Qualitative, Quantitative, Systematic Review
Participants Gender:
Female
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