The risk for emotional and behavioral problems is known to be high among
children of depressed mothers, but little is known about the impact of prenatal
and postnatal depression on the physical health of infants.
To determine whether maternal depression is a risk factor for malnutrition
and illness in infants living in a low-income country.
Prospective cohort study.
Rural community in Rawalpindi, Pakistan.
Six hundred thirty-two physically healthy women were assessed in their
third trimester of pregnancy to obtain at birth a cohort of 160 infants of
depressed mothers and 160 infants of psychologically well mothers.
Main Outcome Measures
All infants were weighed and measured at birth and at 2, 6, and 12 months
of age, and they were monitored for episodes of diarrhea and acute respiratory
infections. The mothers' mental states were reassessed at 2, 6, and 12 months.
Data were collected on potential confounders of infant outcomes, such as birth
weight and socioeconomic status.
Infants of prenatally depressed mothers showed significantly more growth
retardation than controls at all time points. The relative risks for being
underweight (weight-for-age z score of less than
−2) were 4.0 (95% confidence interval [CI], 2.1 to 7.7) at 6 months
of age and 2.6 (95% CI, 1.7 to 4.1) at 12 months of age, and the relative
risks for stunting (length-for-age z score of less
than –2) were 4.4 (95% CI, 1.7 to 11.4) at 6 months of age and 2.5 (95%
CI, 1.6 to 4.0) at 12 months of age. The relative risk for 5 or more diarrheal
episodes per year was 2.4 (95% CI, 1.7 to 3.3). Chronic depression carried
a greater risk for poor outcome than episodic depression. The associations
remained significant after adjustment for confounders by multivariate analyses.
Maternal depression in the prenatal and postnatal periods predicts poorer
growth and higher risk of diarrhea in a community sample of infants. As depression
can be identified relatively easily, it could be an important marker for a
high-risk infant group. Early treatment of prenatal and postnatal depression
could benefit not only the mother's mental health but also the infant's physical
health and development.