Major depressive episodes during pregnancy and after childbirth: A prospective longitudinal study in Taiwan

Background: Major depressive episodes (MDEs) are common during pregnancy and postpartum periods, and the consequences can be severe to mother and offspring. Few studies have investigated the clinical factors associated with the onset and remission of perinatal depression in different time points. Methods: A cohort of 234 pregnant women was recruited and assessed with structured Mini-International Neuropsychiatric Interview (MINI) for diagnoses of MDEs. The severity of mood status was measured with Taiwanese version of the Edinburgh Postnatal Depression Scale (EPDS-T) and the second edition of Beck Depression Inventory (BDI-II) at 16 weeks’ gestation, 28 weeks’ gestation and 4 weeks postpartum. Statistical analysis was conducted by independent t-tests, chi-squared, and Fisher’s exact tests. Results: Thirty-one pregnant women (13.2%) developed MDEs; 11 (4.7%) at the 16th week, 8 (3.4%) at the 28th week of gestation, and 12 (5.1%) at the 4th week of postpartum. Among the 19 women with prenatal MDEs, 9 (47%) experienced remission by the end of pregnancy, and 10 sustained, resulting in the cumulative prevalence of 9.4% (22 out of 234) for postpartum MDEs. Women with lower levels of education, family history of psychiatric disorders, lack of postpartum recuperation, and family-bond stress were more likely to experience MDEs. More preterm birth and lower birth weights were reported in postpartum-onset than pregnancy-onset MDEs. Psychiatric interventions were associated with a higher percentage of remission of MDE during the perinatal period. Conclusion: The findings of this study provide clinical implications for early detection and intervention of MDEs throughout the pregnancy. Keywords: Major depressive episode, Pregnancy, Taiwan, Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI)