Women living in low and medium-income nations experience many health-related issues during pregnancy and in childbirth. Still, little attention is given to antenatal depression, which a PLOS ONE study reveals is on the rise in developing countries.

The study by Flinders University public health researchers found rising levels of reported antenatal depression in these countries and recommends more services are urgently needed – particularly in low-income economies.

“Depression during pregnancy is often believed to be an issue of developed countries,” says biostatistician Abel Fekadu Dadi, who led the systematic review and analysis of antenatal depression levels in low and middle-income countries. 

“From the study, we found 34 per cent and 22.7 per cent of pregnant women in low and middle-income countries respectively had depression symptoms during pregnancy.”

Mr Dadi, who is also affiliated with the Institute of Public Health at the University of Gondar, Ethiopia, said depression was a precursor to adverse birth outcomes.

“Moreover, compared to non-depressed pregnant women, depressed women had respective rates of 2.41 times and 66 per cent higher risk of preterm birth and low birth weight.

“We found that antenatal depression is highly prevalent and increases over the duration of pregnancy. We also noted increases in prevalence over the last ten years.”

Antenatal depression impacts the physical, psychological, mental, and overall wellbeing of mothers and newborns, said Mr Dadi, and awareness is critical amongst health practitioners and policymakers in developing countries.

“It is vital for these governments to address women’s mental health issues before and during pregnancy to improve health outcomes for both mothers and babies, and contribute to socio-economic development and Sustainable Development Goals,” said co-author Associate Professor Lillian Mwanri, Flinders College of Medicine and Public Health. 

Key findings

• One in three (34%) and one in five (22.7%) pregnant women in low-and middle-income countries, respectively had depression.

• Having depression during pregnancy increased the risk of low birth weight and preterm births. Severe depression is known to directly lead to suicide in women during pregnancy or after birth – and to neonatal, infant and child mortality.

• A poor obstetric history, previous episodes of common mental disorders, poor social support, financial difficulties, a history of exposure to violence (during pregnancy or earlier), and unsatisfactory relationships were factors that increased chances of depression.

• Low-cost interventions such as psychotherapy services at maternity clinics – and relationship and partner support advice – are among the social and health system interventions badly needed in these countries.

These findings are consistent with the World Health Organisation’s position, which states that 10 per cent of pregnant women and 13 per cent of women who have recently given birth experience a mental disorder – primarily depression. A rate which is much higher in developing countries, 15.6 per cent during pregnancy and 19.8 per cent after childbirth.

“In severe cases, mothers’ suffering might be so severe that they may even commit suicide. In addition, affected mothers cannot function properly.

“As a result, the children’s growth and development may be negatively affected as well. Maternal mental disorders are treatable. Effective interventions can be delivered even by well-trained non-specialist health providers,” reports WHO.