(137) The impact of prenatal maternal depression during the COVID-19 pandemic on maternal postpartum depression: A prospective cohort study within the CONCEPTION study.

Background: The COVID-19 pandemic has increased the prevalence of prenatal maternal depression.

Objectives: We aimed to quantify the association between prenatal depression (PD) and postpartum depression (PPD) during the COVID-19 pandemic.

Methods: Data were collected from Canadian pregnant individuals (aged≥18) through web-based questionnaires. Individuals who completed the baseline questionnaire between 06/2020 and 12/2021 and the 2-month postpartum follow-up questionnaire, were included. PD was assessed during pregnancy with the Edinburgh Postnatal Depression Scale (EPDS), categorized as no depression (EPDS=0), mild (1-8), moderate (9-12), and severe depression (EPDS≥13). PPD was assessed at 2 months postpartum also using EPDS, and categorized as no to mild depression (EPDS˂9), moderate to severe depression (EPDS≥9). Maternal sociodemographics, comorbidities (before/ during pregnancy), gestational age (during pregnancy/ at delivery), prenatal antidepressant use, other mental health measures (General Anxiety Disorder-7; stress, assessed during pregnancy), and maternal hardship (CONCEPTION Assessment of Stress from COVID-19) were self-reported during and after pregnancy using web-based questionnaires. We calculated relative risks (RRs) with 95% confidence interval (CI) to assess the risk of PPD associated with prenatal depression during the COVID-19 pandemic, using a multivariate Poisson regression model.

Results: Among 1,247 pregnant participants, 5.1% had no depression, 52.8% mild, 22.0% moderate, and 20.1% severe symptoms. Overall, 10.6% used antidepressants during pregnancy. Compared to those without depression, pregnant persons with severe depressive symptoms were more less likely to be nulliparous (25.1% vs 46.0%, p=0.004), and more likely to have asthma (14.6% vs 1.6%, p=0.0117) and anemia (15.0% vs 4.8%, p=0.0199). They also had higher mean scores of anxiety (9.0, SD 4.2 vs 0.6, SD 0.9;p˂0.0001), stress (6.2, SD 1.7 vs 2.5, SD 1.6;p˂0.0001) and hardship (32.6, SD 10.9 vs 23.6, SD 7.3; p˂0.0001). The overall prevalence of PPD was 39.5%. After adjustments, prenatal moderate depression symptoms increased the risk of PPD (aRR 3.1, 95% CI 1.4 – 6.8); severe depression symptoms further heightened that risk (aRR: 4.0, 95% CI 1.8 – 9.1). The risk of PPD also increased with maternal stress during pregnancy (aRR 1.1; 95% CI 1.0 – 1.1) and nulliparity status (aRR 1.3, 95% CI 1.0 – 1.6).

Conclusions: PD was strongly associated with an increased risk of PPD, especially among pregnant individuals with severe symptoms, regardless of prenatal antidepressant use. Identifying interventions for depressed pregnant women, particularly during global crises, is crucial to mitigate PPD risk and potential long-term effects on maternal and children’s health.