Janice Wissart, Omkar Parshad and Santosh Kulkarni, Contributors
THE FOLLOWING piece was taken from the discussion section of a research article published November 8, 2005 by the Department of Basic Medical Sciences, The University of the West Indies (UWI).
Maternal depression during pregnancy, pre-partum depression, is not as well studied as that in the post-partum period. A study among 140 healthy pregnant women in the corporate area was conducted, in order to investigate the link between pre- and post-partum depression. All the women attended the antenatal clinic in the Department of Obstetrics, Gynecology and Child Health at the University Hospital of the West Indies.
The study demonstrated a higher prevalence rate of 56 per cent maternal depression at 28 weeks pre-partum as compared to 34 per cent at six weeks postpartum confirming that depression during pregnancy is as common as after delivery. Our prevalence rates for both pre- and post-partum depression are higher than the rates reported earlier. This may be attributed to the fact that greater percentages of women during both periods suffered from minimal to mild depression only, a score that might have been ignored by previous authors, who may have regarded it as clinically non-significant depression. Further analysis of the data on postpartum depression showed that pre-partum depression was the major risk factor for post-partum depression.
ONSET OF DEPRESSION
Though the postnatal depression was observed only at six weeks postpartum, it is possible that the onset could have been within the first week after the delivery as reported earlier.
This study revealed that single mothers are more prone to depression both during pre- and post-partum periods. This can be interpreted as either that being single implies lack of a stable supporting union, hence influencing depression, and/or there is a predominance of single mothers in Jamaica (50 of the 73 mothers in this study were single). In both circumstances, whatever the cause of depression, the majority of subjects would be single. Employment, parity and the previous miscarriages did not seem to have any effect in producing depression.
RELATIVE HYPOTHYROIDISM
In the sub-group of women representing 9.6 per cent of the cohort, who developed depression in the post-partum period, relative hypothyroidism was observed during the late gestation and early post-partum periods. In addition, changes in mean TT4 (Total Thyroxin) levels were significantly related to post-partum depression. This finding is supported by previous studies that suggest that post-partum thyroid dysfunction may be responsible for post-partum depression. However, this is debatable as a previous study done has reported no link between post-partum thyroid dysfunction and post-partum depression.
A high prevalence of depression was found, through the study, during pre- and post-partum periods of pregnancy and childbirth. Especially for single mothers, pre-partum depression and changes in TT4 were factors found to be significantly associated with postpartum depression. In light of this, women who develop depression during pregnancy should be monitored for thyroid functions and social support be provided to single mothers to avoid the risk of post-partum depression.
Based on the study, further research is being carried out island wide to predict, the risk factors involved in depression, by studying the thyroid antibodies titer and thyrotrophic hormone levels in the blood of pregnant women attending antenatal clinics at booking.
