Abstract

Background: Depression during pregnancy has not generally been considered as a priority area of intervention in low income countries as it is not fatal and not well documented. We aimed to comprehensively present the burden of prenatal depression and its consequences on birth outcomes.

Methods: CINHAL, MEDLINE, EMCare, PubMed, Psychiatry online and Scopus databases were systematically searched for depression during pregnancy and its association with adverse birth outcomes. We included observational studies with good quality, conducted in low and middle income countries, written in English-language, and published in between January 1^st 2007 and December 31^st 2017. We excluded studies in which the main outcomes were not measured following a standardized approach. We used Higgins and Egger’s test to identify any heterogeneity and publication bias. Primary estimates were pooled using a random effect meta-analysis. All analysis were conducted in Stata 14. The study protocol was registered in PROSPERO with protocol number CRD42017082624.

Result:  We included 64 studies (among 44, 035 women) on prenatal depression and nine studies (among 5,540 women) on adverse birth outcomes. Prenatal depression was higher in the lower income countries (Pooled Prevalence (PP) =34.0%; 95%CI: 33.1%-34.9%) compared to the middle income countries (PP= 22.7%, 95%CI: 20.1%-25.2%) and it was increased over the three trimesters. Pregnant women with history of economic difficulties, poor marital relationship, common mental disorders, poor social support, bad obstetric history, and exposure to violence were at higher risk of developing prenatal depression. The risk of having adverse birth outcomes (low birth weight/preterm birth) was 59% higher among depressed pregnant mothers (Pooled Relative Risk (PRR) = 1. 59; 95%CI: 1.34-2.92). Preterm birth (2.41; 1.47- 3.56) and low birth weight (1.66; 1.06-2.61) were the main types of adverse birth outcomes observed in depressed mothers relative to mothers without depression.

Interpretation: Prenatal depression was higher in low income countries and found to be a risk factor for low birth weight and preterm birth. While they may be a demanding agenda for health policy makers in low-income countries, interventions for depression during pregnancy are vitally important, in order to prevent the poor maternal and perinatal outcomes identified by our analyses.

Keywords: Prenatal depression, adverse birth outcomes, systematic review, Meta-analysis, Low and Middle-income countries.