What is the course and stability of maternal depressive symptoms throughout the perinatal period?

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In a recently published study, Dr JAMA Network OpenResearchers have examined maternal depressive symptoms in different observational cohorts.

Study: perinatal trajectories of maternal depressive symptoms in prospective, community-based cohorts across 3 continents.  Image credit: Pormezz/Shutterstock.comStudy: Perinatal Trajectories of Maternal Depressive Symptoms in Prospective, Community-Based Cohorts Across 3 Continents. Image credit: Pormezz/Shutterstock.com


Maternal mental health is a risk factor for adverse outcomes in offspring. Nevertheless, conflicting data on the onset of prepartum versus postpartum depression complicates health policies regarding optimal intervention timing.

Studies indicate a higher incidence of clinical depression in mothers after delivery. Nevertheless, this study lacks prospective longitudinal analyzes to describe timing of initiation.

In contrast, large community-based prospective longitudinal studies report that depression levels increase slightly during pregnancy and persist thereafter. Therefore, it is necessary to determine the onset of depressive symptoms, considering the implications for the child, to ensure timely intervention.

About the study

In the present study, researchers examined the onset and stability of maternal depression. They analyzed data from the following groups:

1) Mapping Antenatal Maternal Stress (MAMS),

2) Singapore Pre-Conception Study of Long-Term Maternal and Child Outcomes (S-PRESTO),

3) Growing Up Singapore Towards Healthy Outcomes (GUSTO),

4) Montreal Prenatal Wellbeing Study (MAWS),

5) Maternal Adversity, Vulnerability, and Neurodevelopment (MAVAN) Study,

6) Alberta Pregnancy Outcomes and Nutrition (APrON) Study, and

7) Avon Longitudinal Study of Parents and Children (ALSPAC).

Participants were recruited during pregnancy or pre-pregnancy. The team adjusted data on maternal depression symptoms from pregnancy to two years after delivery.

The 20-item Center for Epidemiological Studies-Depression (CES-D) scale was administered to the MAVAN cohort, whereas the 10-item Edinburgh Postnatal Depression Scale (EPDS) was administered to the remaining cohorts. The EPDS and CES-D measured the frequency of depressive symptoms in the past week.

Maternal age, education level, marital status and ethnicity were obtained. Individual responses to the CES-D and EPDS were analyzed using item response theory techniques.

The team obtained a latent depression trait estimate for each participant for each time point, providing a trajectory of depressive symptoms over time. Participant groups with similar trajectories were identified using K-means clustering.


The study included 11,563 pregnant women with an average age of 29 years. The majority of participants (87%) were white, followed by East Asian (5%) and Southeast Asian (2.6%) individuals. The ALSPAC, APrON, MAWS, GUSTO, MAVAN, S-PRESTO, and MAMS cohorts included 8,704, 953, 710, 329, 350, 86, and 431 participants, respectively.

All subjects in the S-PRESTO cohort, 97.4% in the MAMS cohort, 94.9% in the MAVAN cohort, 96.9% in the GUSTO cohort, 97.2% in the MAWS cohort, 97.4% in the APrON cohort, and 80% in SPAL. The group had a partner or were married at the time of recruitment.

The researchers observed three groups of mothers based on the level of depressive symptoms (high, mild or low level) in each group.

Average trajectories remained stable during pregnancy for two years postpartum. Additionally, the team examined symptoms in a subgroup with possible depression, defined as an EPDS score ≥ 15 during pregnancy and ≥ 13 postpartum.

Consistently, this subgroup showed a stable trajectory of depressive symptoms across the perinatal period.


Together, the study delineated three stable trajectory groups of participants with low, mild, or high levels of depressive symptoms, consistent with previous research.

Results suggest that maternal depressive symptoms appear during (early) pregnancy and remain stable in the postpartum period. Notably, this pattern was also observed among mothers with clinical levels of depressive symptoms.

Thus, the early perinatal period may serve as a time point to detect trajectories of depressive symptoms. The findings underscore the American Psychiatric Association’s approach to naming postpartum depression as peripartum depression.

Limitations of the study include the lack of peers from the global South, as well as the exclusion of participants using psychotropic medications in some cohorts.

Overall, the study found that inter-individual differences in maternal depressive symptoms appear early in pregnancy and persist for up to two years postpartum. Thus, public health initiatives and interventions should focus on reducing depressive symptoms during pregnancy and postpartum.

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