LAUSR

Dear Editor, We have read with great interest the paper by Hermon et al. (2019) regarding the impact of maternal depression on perinatal outcomes, wherein the authors observed the association of maternal depression with preterm delivery. We would like to congratulate the authors, although we would like to make two considerations on this study. The first is that the recruited pregnant women had medical diseases that can contribute per se to the development of antenatal depression (e.g., obesity) (Steinig et al. 2017). The second is that the authors used an Edinburgh Postnatal Depression Scale (EPDS) cutoff score < or ≥ 10. However, there is not a complete agreement about what is the most appropriate EPDS score to detect women with or without depression (O’Connor et al. 2016). EPDS is properly a tool to assess the severity of depression and not to make diagnosis of perinatal major depression (PMD), and a score > 15 indicates the risk to fulfill the criteria of PMD according to the Diagnostic and Statistical Manual for Mental Disorders (DSM) (Matthey et al. 2006). Taking into account these considerations and trying to produce an advancement in the research in this area, we conducted a similar preliminary study on a smaller sample by recruiting 30 women in their third trimester of pregnancy with a diagnosis of PMD according to DSM (Structured Clinical Interview for DSM-5 [SCID-5]) and 14 healthy pregnant women. All women were evaluated in a single visit, as well as by SCID-5, by EPDS and State Anxiety Inventory (STAI-S). The women with depression were followed up in the outpatient consultancy psychiatry service within the high-risk pregnancy department, Fondazione IRCCS Policlinico, Milan (Italy). Both cases and controls had no other medical comorbidities potentially affecting obstetric outcomes as well as increasing the risk of antenatal maternal depression (e.g., gestational diabetes) (Hinkle et al. 2016). Cases and controls were compared in terms of age, gestational age at time of assessment, number of previous pregnancies, birth weight, gestational age at birth by independent samples t tests, and in terms of frequency of cesarean delivery by a chi-square test. Two linear logistic regressions with EPDS and STAI-S scores as independent variables and birth weight or gestational age at birth as dependent variables have been performed to evaluate if severity of depressive or anxiety symptoms was associated with these obstetrical outcomes. Mean age of the total sample was 35.65 ± 7.07 years. The two groups were not statistically different in terms of age (p = 0.32), gestational age at time of assessment (p = 0.35), number of previous pregnancies (p = 0.14), frequency of cesarean delivery (p = 0.51), and neonatal birth weight (p = 0.14; mean values 3175 ± 387.13 g in cases versus 3382 ± 401.34 g in controls). In contrast gestational age at birth was significantly earlier in cases (38.79 ± 1.32 weeks) than in controls (40 ± 1.1 weeks) (p < 0.01). Furthermore, higher EPDS scores were associated with both an earlier gestational age at birth (B = − 0.061; p = 0.02; expected mean values 39.17 ± 0.50 weeks) as well as with a lower birth weight (B = − 15.950; p = 0.02; expected mean values 3268 ± 134.39 g). Also, higher STAI-S scores resulted to be associated with a lower birth weight (B = − 7.44; p = 0.04; expected mean values 3268 ± 113.60 g). We showed that a diagnosis of PMD and severity of depressive or anxiety symptoms are associated with worse obstetrical outcomes, thus replicating the results reported by Hermon and collaborators in a different cultural context. Our results, despite coming from a smaller sample, are strengthened by the lack of medical comorbidity, by a precise * Massimiliano Buoli [email protected]; [email protected]