Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India [In Press]
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Background: More than one million babies are born with Low birthweight (LBW) in India every year, often afflicting disadvantaged families. Earlier studies on LBW in India have mostly focused on addressing poverty, nutritional status, and obstetric factors for LBW babies, comprising of preterm babies (<37 weeks) or small for gestational age (SGA) or both. We aim to find the association between antepartum depression and SGA in a public hospital. Methods: Pregnant women with gestational age between 14 to 32 weeks were recruited. The Edinburgh Postnatal Depression Scale (EPDS) was administered to assess depression. Newborn anthropometry was performed soon after delivery. Birth weight less than 10 percentile were classified as SGA, between 10 to 90th percentile was appropriate for gestational age (AGA), and greater than 90th percentile was large for gestational age (LGA). Results: We found that 16.51% (108) of the antenatal mothers had depressive symptoms (EPDS score >11). The women with depressive symptoms delivered a greater proportion of SGA babies (21.3 v/s 15.8) and LGA (9.3 v/s 3.3) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.18; 95% CI = 1.23 - 3.87) compared to the women with EPDS scores of ≤11. In terms of Area under curve (AUC), EPDS 11 cut off (AUC: 0.533) narrowly outperformed EPDS 12 cut-off (AUC: 0.4738), which in turn was better than EPDS 13 cut off (AUC: 0.4687) for screening depression in mothers. Conclusions: We have demonstrated the usefulness of the 10-item EPDS screening tool in screening for symptoms of antenatal depression. There is a need to explore implementation of screening, diagnostic services and evidence-based antenatal mental health services by modifying the provisions of ongoing national programs.