Risk of adverse perinatal outcomes and antenatal depression based on the zung self-rating depression scale

Objective: The aim of the study is to investigate the relationship between antenatal depression and adverse perinatal outcomes. Methods: This prospective cohort study enrolled pregnant women between gestational ages of 12-20 weeks to complete the Chinese version of the Zung Self-Rating Depression Scale (SDS) and followed them for delivery from September 2015 to September 2016. Participants were classified into mild, moderate, and severe depression groups according to the SDS scores. Logistic regression was performed to assess the association between antenatal depression and perinatal outcomes including preterm birth (PTB), cesarean section use, hypertension disorders, gestational diabetes, and thyroid diseases during pregnancy. An age-stratified analysis was performed. Results: A total of 4,663 pregnant women were analyzed. As a result, 13.8%, 1.7%, and 0.2% of women were classified as mild, moderate, and severe depression, respectively. Severely depressed mothers were at higher risk for PTB (adjusted odds ratio [OR] =11.31, 95% confidence interval [CI] 2.13-60.03), especially spontaneous PTB. Moderate-depressed women were at higher risk for hyperthyroidism during pregnancy (adjusted OR = 3.67, 95% CI 1.10-12.27), while women with mild depression tended to choose cesarean sections (OR = 1.24, 95% CI = 1.04-1.49). Age-stratified analysis indicated an elevated risk of adverse outcomes associated with depression in women aged <25 years, but the association was not significant. Conclusions: Antenatal depression was associated with PTB, hyperthyroidism, and cesarean use. Studies with large sample sizes should verify the relationship between PTB and antenatal depression to avoid casual events.