Different trajectories of depressive symptoms during pregnancy

Background: Up to 10-15% of women experience high levels of depressive symptoms during pregnancy. Since these levels of symptoms can vary greatly over time, the current study investigated the existence of possible longitudinal trajectories of depressive symptoms during pregnancy, and aimed to identify factors associated with these trajectories. Methods: Depressive symptoms were assessed prospectively at each trimester in 1832 women, using the Edinburgh (Postnatal) Depression Scale (E(P) DS). Growth mixture modeling was used to identify trajectories of depressive symptoms during pregnancy. Results: Three trajectories of depressive symptoms (E(P) DS scores) were identified: low stable (class 1, reference group, 83%), decreasing (class 2, 7%), and increasing (class 3, 10%). Classes 2 and 3 had significantly higher mean E(P) DS scores (7-13 throughout pregnancy) compared to the reference group (stable; E(P) DS < 4). Factors associated with trajectories 2 and 3 included previous depressive episodes, life events during pregnancy, and unplanned pregnancy. Notably, the only factor distinguishing classes 2 and 3 was the perception of partner involvement experienced by women during their pregnancies. Class 2 (with decreasing E(P) DS scores) reported high partner involvement, while class 3 (with increasing E(P) DS scores) reported poor partner involvement throughout pregnancy. Limitations: Depressive symptoms were assessed by self-report rather than a diagnostic interview. The participants were more often both highly educated and of Caucasian ethnicity compared to the general Dutch population. Conclusions: Poor partner involvement was associated with increasing depressive symptoms during pregnancy. Health professionals should focus on partner involvement during pregnancy in order to identify women who are potentially vulnerable for perinatal depression.