ANTENATAL DEPRESSION; ITS PREVALENCE OF POSITIVE SCREEN AND THE - - PowerPoint PPT Presentation

ANTENATAL DEPRESSION; ITS PREVALENCE OF POSITIVE SCREEN AND THE ASSOCIATING RISK FACTORS INCLUDING LABOUR AND NEONATAL OUTCOME

Dr Nurezwana Elias MD (UKM), MOG (UM) Clinical Lecturer Department of Obstetric and Gynaecology University of Malaya

INTRODUCTION

• Worldwide about 10% of pregnant women and 13% of women who have just

given birth experience a mental disorder, primarily depression. The percentage is higher in the developing countries (WHO)

• Antenatal depression is often neglected and unrecognized.
• Associated with various unwanted outcomes for both mothers and neonates.
• Detection of early symptoms of antenatal depression may protect against the
• nset of depression in postnatal period
• Although antenatal depression often resolves with the birth of baby, in 30-50%
• f cases, they continue to have postnatal depression

Austin and Lumley 2003, Bronwyn and Jeanette 2008, Gavin AR et al. 2011

EPDS

• Edinburgh Postnatal Depression Scale (EPDS)
• designed to identify postpartum depression
• Useful in screening for antenatal depression.
• was found to have satisfactory sensitivity and specificity, and was

also sensitive to change in the severity of depression over time.

• The scale can be completed in about 5 minutes and has a simple

method of scoring

Cox et al. 1987

OBJECTIVE

• This study aims to investigate the prevalence of antenatal

depressive disorder among obstetric patients that delivered in University Malaya Medical Centre, Malaysia.

• In addition, the relationship between socio-demographic,
• bstetric risks factor, labour outcomes and neonatal outcomes

with antenatal depressive disorder are assessed.

METHODOLOGY

• This is a prospective observational study conducted in the

maternity centre of University Malaya Medical Centre (UMMC) from 1st of April to 31st of August 2014.

• All pregnant women in the third trimester (32-41weeks) were

invited to participate in this study

• A total of 265 women were recruited and written consent was
• btained

• Participants were asked to fill the EPDS on two occasion; first,

during the third trimester and second, after delivery

• There are ten (10) statements specific for depressive
• symptoms. Each statement has four possible responses, which

are scored from 0 to 3 depending on the severity of the

• response. Higher scores indicate more severe depressive

symptoms with a maximum total score of 30.

• The Malay version of EPDS was validated by Rushdi, W.M.W.M.

& Mohamed, M.N. (2003), based on a study of Malay population in Malaysia.

• A score of 12 or higher is an indication that depressive

symptoms have been reported and that a psychiatric clinical assessment interview is required. It has sensitivity of 72.6% and specificity of 92.7%.

Rushdi, W.M.W.M. & Mohamed, M.N. (2003)

• The association between risk factors, labour and neonatal
• utcome with positive screen group on EPDS score were

analysed

RESULT

• Positive screen

for depression was found in 40 women (17%); whilst 190 (83%) women scored <12.

17% 83%

Positive Screen of Antenatal Depression

EPDS score >/= 12

ASSOCIATION BETWEEN SOCIO-DEMOGRAPHIC WITH POSITIVE SCREEN FOR ANTENATAL DEPRESSION

Variables EPDS >=12 EPDS <12 Chi Square sig (2- tailed) *Age (with ± standard dev) 29.6 ± 5.27 31.1 ± 4.64 0.71 Nationality Malaysian Non Malaysian 39 (95.1%) 2(4.9%) 181 (93.3%) 13 (6.7%) 0.66 Ethnicity Malay Chinese Indian Others 27 (65.9%) 5 (12.2%) 7 (17.1%) 2 (4.9%) 136 (70.1%) 21 (10.85) 19 (9.8 %) 18 (9.35) 0.47 Marital status Married Single/divorced 40 (97.6 %) 1 (2.4%) 188 (96.9%) 6 (3.1%) 0.82

Variables EPDS >=12 EPDS <12 Chi Square sig (2- tailed) Education Primary Secondary Tertiary 0 90.0%) 15 (36.6%) 25 (63.45) 14 (7.2%) 48 (24.7%) 26 (63.4%) 0.89 Household income (RM) <1500 1500-3000 3000-4500 >4500 7 (17.1%) 11 (26.8%) 15(36.5%) 8 (19.5%) 16 (8.3%) 62(32.1%) 74 (38.8%) 41 (21.2%) 0.38 Smoking Yes No 2 (4.9%) 39 (95.1%) 16 (8.2%) 178 (91.8%) 0.46 Alcohol Yes No 2 (4.9%) 39 (95.1%) 5 (2.6 %) 189 (97.4%) 0.43

ASSOCIATION BETWEEN OBSTETRIC RISK FACTORS WITH POSITIVE SCREEN FOR ANTENATAL DEPRESSION

Variables EPDS >=12 EPDS <12 Chi Square sig (2-tailed) *Parity (mean with ± standard dev) 0.74 ± 0.87 1.07 ± 1.2 0.9 h/o non-viable pregnancy (1st trimester) Yes No 4 (9.8%) 37 (90.2%) 37 (19.1%) 157 (80.9 %) 0.15 Pre-existing medical illness Yes No 16 (39.0%) 25 (61.0%) 44 (22/7%) 150 (77.3 %) 0.03 Antenatal risks Low Moderate-high 12 (29.3%) 29 (70.7%) 60 (30.9%) 134 (69.1%) 0.83 Hypertensive in pregnancy Yes No 6 (146%) 35 (85.4%) 26(13.4%) 168 (86.6%) 0.83 Diabetes in pregnancy Yes No 7 (17.1%) 34 (82.9 %) 28 (14.4%) 166 (85.6 %) 0.66

Variables EPDS >=12 EPDS <12 Chi Square sig (2- tailed) Antepartum haemorrhage Yes No 0(0.0%) 41(100%) 7 (3.6%) 186 (96.4%) 0.22 Threatened preterm labour Yes No 1 (2.4%) 40 (97.6%) 12(6.25) 182 (93.8%) 0.34 Placenta praevia Yes No 0 (0.0%) 41 (100%) 7 (3.6%) 186 (96.4%) 0.22 History of admission Yes No 3 (7.3%) 38 (92.7%) 27 (13.9%) 167 (86.1 %) 0.25

ASSOCIATION BETWEEN LABOUR AND NEONATAL OUTCOMES WITH POSITIVE SCREEN OF ANTENATAL DEPRESSION

Variables EPDS >=12 EPDS <12 Chi square; sig (2-tailed) Mode of delivery V agina birth Instrumental Caesarean 24 (58.5) 4 (9.8%) 13(31.7%) 126(66.0%) 14 (7.3%) 53 (26.7%) 0.65 Type of caesarean Elective Emergency 4 (30.8%) 9 (69.2%) 18 (34.0%) 35 (66.0%) 0.82 Induced labour Y es No 17 (50%) 17 (50%) 33 (22.8%) 122 (77.2%) 0.01 Analgesic in labour Epidural Opiod Entonox None 5 (19.2%) 12 (46.2%) 3 (11.5%) 6 (23.1%) 10 (7.4%) 59 (43.3%) 45 (33.1%) 2 (16.2%) 0.06 Gender Boy Girl 19 (46.3%) 22 (53.7%) 92 (48.2%) 99 (51.8%) 0.457 Immediate NICU admission Y es No 15(36.6%) 26 (63.4%) 20 (10.5%) 170 (89.4%) 0.00

CORRELATION BETWEEN LABOUR AND NEONATAL OUTCOMES WITH SIGNIFICANT ANTENATAL DEPRESSION ON EPDS SCORES.

Variables R p value N R2 Gestational weeks

• f delivery
• .100

0.125 235 0.01 Second stage of labour .306 0.002 166 0.093 Blood loss .201 0.002 232 0.041 Birth weight

• .321

0.000 232 0.103 Apgar score in 5 min

• .214

0.001 233 0.046 Cord Ph

• .285

0.000 224 0.082

A POSITIVE CORRELATION BETWEEN ANTENATAL EPDS SCORE AND POSTNATAL EPDS SCORE(R=.919, P<0.01)

FINAL LOGISTIC REGRESSION MODEL OF ANTENATAL EPDS SCORE ON RISK FACTORS, LABOUR & NEONATAL OUTCOMES

Variables OR SE 95% CI Wald Pre-existing medical illness 3.066 0.518 1.11-8.46 4.678 Blood loss 1.005 0.002 1.001-1.009 5.456 Birth weight 0.998 0.001 0.997-0.999 8.009 Cord pH 0.000 3.090 0.00-0.202 6.137

DISCUSSION

• Edinburgh Postnatal Depression Scale (EPDS) is a reliable tool

for screening depressive symptoms during antenatal period and it is sensitive to changes of severity of depression

• vertime
• It can detect depressive symptoms as early as first trimester

and its progression until postpartum periods

• This study demonstrate that antenatal depression is a strong

predictor of postnatal depression

• This finding support the evolution of antenatal depressive

symptoms from third trimester to postpartum period

• It is known that antenatal /postnatal depression commonly to
• ccur in lower social economic class and lower education level

group.

• However in this population sample, there was no significant

difference in socio-economic backgrounds

• It shows that ANY women during pregnancy are vulnerable for

ANTENATAL DEPRESSION.

• Therefore universal screening for antenatal depression should

be incorporated in standard antenatal care.

• Antenatal depression was found to be associated with adverse

labour and neonatal outcomes

• Therefore early detection and intervention may help in

reducing the risks of unwanted pregnancy outcomes.

• Health policy makers can contribute by giving more attention

to mental health status of pregnant mother.

• A guideline specific for management of mental health disorder

during pregnancy should be establish to help physician managing cases on daily basis.