Stress, history of depression, lack of social support and unintended pregnancy are among the major factors that contribute to increased risk of depression in pregnant women, a new study shows.

Other important factors are maternal anxiety, domestic violence and having public insurance coverage, said the University of Michigan researchers, who reviewed 159 studies conducted between 1980 and 2008.

The study appears in the January issue of the American Journal of Obstetrics & Gynecology.

Depression, which occurs in about 12.7 percent of pregnant women, can cause problems for mothers and babies, including pre-term delivery, preeclampsia, sleep disturbances and disrupted mother-infant bonding.

It's important for physicians to know how to identify depression in pregnant women, said the study authors, who noted that not all women who test positive on depression screening tests have or will develop clinical depression.

"We are hoping that [health-care] providers can use the presence or absence of risk factors such as those identified in our study to enhance their assessments for depression in addition to the information they obtain from the screening test," study author Dr. Christie A. Lancaster, a clinical lecturer in the obstetrics and gynecology department at U-M, said in a news release.

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PregnancyWeekly.com

Pregnant women who take certain drugs for depression or anxiety may have heightened risks of preterm delivery or other birth complications, according to a new study.

Researchers found that among nearly 3,000 women who gave birth in Washington State, those who started taking antidepressants known as selective serotonin reuptake inhibitors (SSRIs) in the second or third trimester had a higher risk of preterm birth.

Compared with their counterparts not on the medications, these women were nearly five times more likely to deliver prematurely.

The same risk was not seen, however, among women who started on an SSRI before pregnancy or during the first trimester. SSRIs include drugs like sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac).

The researchers also found a higher risk of preterm delivery among women who took anti-anxiety drugs known as benzodiazepines, regardless of when they began treatment.

Those drugs, which include medications like lorazepam (Ativan) and alprazolam (Xanax), were linked to higher risks of other complications as well - including low birth weight, newborn respiratory distress and a low Apgar score, a standard measure of newborn health.

The findings of the study are published in the American Journal of Obstetrics & Gynecology.

Exactly what the study means for women on SSRIs or benzodiazepines is not entirely clear. A major limitation is that it could not estimate the benefits of treatment, lead researcher Dr. Ronit Calderon-Margalit, of the Hebrew University-Hadassah School of Public Health in Jerusalem, noted in an email to Reuters Health.

Any risks of using the medications during pregnancy need to be balanced against the risks of leaving depression and anxiety disorders untreated.

"It is very important to have other studies of the risks associated with (these) drugs, but also of benefits associated with treating mothers," said Calderon-Margalit, who was at the University of Washington in Seattle at the time of the study.

In addition, SSRIs did not appear to present equal risks for all women. Calderon-Margalit described the antidepressant findings as "mostly reassuring" for women who start the drugs before pregnancy or in the first trimester -- as most SSRI users in the study had.

The study included 2,793 pregnant women, 11 percent of whom used a psychiatric medication during pregnancy. Of these, 138 were on an SSRI, while 85 used a benzodiazepine.

Among women who were not on any medication, 9 percent gave birth prematurely, versus nearly half of women on benzodiazepines.

Meanwhile, 14 percent of women on SSRIs had a preterm birth, but the elevated risk turned out to be concentrated among those who started an antidepressant after the first trimester. Of those 21 women, 16 delivered prematurely.

Several other birth complications, often related to preterm birth, were also higher-than-average among women on benzodiazepines.

Seventeen percent of their newborns suffered respiratory distress syndrome and one-third ended up in the neonatal intensive care unit. Those figures were 3 percent and 6 percent, respectively, among newborns whose mothers had not used psychiatric medications during pregnancy.

Calderon-Margalit pointed out that most women on benzodiazepines used lorazepam (Ativan), so it is possible that the risks are associated mainly with that drug. However, further research is needed to determine whether any particular medications carry particular risks.

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PregnancyWeekly.com

Children who were born prematurely and at a very low weight may have an increased risk of certain behavior problems and symptoms of depression and anxiety, research suggests.

As the survival rates of very preterm newborns have improved in recent years, studies have uncovered some of the potential long-term challenges these infants will face - including lower IQ and higher rates of behavioral problems compared with their peers born at term.

In the new study, researchers found that among 104 7- to 16-year-olds they assessed, the 49 who were born very prematurely had higher rates of hyperactivity and attention problems, as well as symptoms of depression and anxiety.

The higher risk was not explained by lower IQ scores, however. Nor was families' socioeconomic status an important factor in children's odds of behavioral or emotional issues.

Instead, birth weight itself was the strongest factor, the researchers report in the journal Pediatrics.

The finding "suggests that in children born prematurely, behavioral issues might be more biologically based and not easily compensated for by improvements in the environment," explained lead researcher Dr. Amy L. Conrad, of the University of Iowa College of Medicine in Iowa City.

"It does not mean that environment can't help," she told Reuters Health in an email, "just that it might not have as strong of an impact as for children born at term and of average birth weight."

In addition, while the study found that parents of premature children reported more behavioral and emotional symptoms than other parents did, most kids did not have significant problems.

According to Conrad, 18 percent of preterm children had hyperactivity/inattention problems that were in the "clinical range" -- or significant enough to warrant therapy -- while 14 percent had depression or anxiety symptoms in that range.

For the study, Conrad's team had 104 children and teenagers take standard intelligence tests, while their parents and teachers completed a standard questionnaire on behavioral issues. Forty-nine of the kids had been born significantly preterm -- between the 24th and 33rd week of pregnancy. A normal pregnancy lasts 40 weeks.

Their birth weights ranged from "extremely low" -- less than 2.2 pounds -- to "very low," or between 2.2 and 3.3 pounds.

In general, parents of preterm children reported more behavioral issues than parents of children born full-term, with the highest rates among children with extremely low birth weights. The link between birth weight and behavior did not fade after the researchers factored in children's age, gender, IQ and socioeconomic status.

It's possible that very low birth weight affected some children's brain development in a way that made them more vulnerable to behavioral problems.

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PregnancyWeekly.com

Raging hormones during pregnancy prompt mood swings, but may also lead to a heightened ability to recognize threatening or aggressive faces. This may have evolved because it makes future mothers hyper-vigilant, yet it could also make them more vulnerable to anxiety.

Previous studies have suggested that a woman's ability to correctly identify fearful or disgusted facial expressions varies according to her stage of the menstrual cycle, with perception heightened on days associated with high levels of the hormone progesterone. Since levels of progesterone and other hormones rise dramatically in late pregnancy, Rebecca Pearson and her colleagues at the University of Bristol in the UK investigated whether the ability to read faces varies during pregnancy.

They asked 76 pregnant women to assign one of six emotions to 60 computer-generated faces before the 14th week of pregnancy, and again after the 34th week. Faces expressing happiness and surprise tended to be correctly assigned at both stages of pregnancy, but for faces expressing fear, anger and disgust, the accuracy rates were higher in late pregnancy.

This may increase the chance that the woman will spot potential threats to her and her fetus, and prime her to be hyper-vigilant once she becomes a mother. But it could have a downside. Pearson points out that people with clinical anxiety are also better at identifying negative emotions in faces. Pregnant women aren't clinically anxious, but "they might interpret negative or emotional things around them in a slightly more sensitive way", she says.

The finding builds on a recent study by Ben Jones of the University of Aberdeen in the UK who found that pregnant women - and women in stages of the menstrual cycle where progesterone levels spike - are better at identifying faces showing signs of sickness. "It's preventing them from becoming sick by interacting with people who are ill," he says.

The next step will be to examine whether pregnant women and new mothers are also more sensitive to emotional cues in babies' faces, Jones says.

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PregnancyWeekly.com