Trajectories of Depressive and Anxiety Symptoms Throughout Pregnancy in Relation to Obstetric Outcomes.

BACKGROUND:High levels of depressive and anxiety symptoms during pregnancy have been linked to adverse pregnancy outcomes. However, it is unclear to what extent this depends on these symptoms' specific change-patterns during pregnancy. Therefore, we aimed to identify different trajectories of depressive and anxiety symptoms during pregnancy and to investigate their associations with obstetric outcomes. METHODS:We administered depression and anxiety questionnaires six times during pregnancy (n = 598) and extracted pregnancy-outcome information from obstetric records. We used growth mixture modeling (GMM) to estimate different depressive- and anxiety-symptom course-trajectories and multivariable regression analyses to investigate their associations with pregnancy outcomes, adjusting for known risk factors (e.g., smoking). RESULTS:GMM identified four depressive-symptom and three anxiety-symptom trajectory-classes. Only depression trajectories showed associations with obstetric outcomes. Compared with a trajectory-class with stable low depression scores, a class with high and then decreasing scores showed a lower mean gestational age at delivery, and a class with stable moderate scores showed a higher mean birthweight and less frequent low Apgar scores. Overall, trajectory-classes showed limited associations with obstetric outcomes compared with the included known risk factors. LIMITATIONS:The depression questionnaire applied may overestimate depression in pregnancy because it covers many somatic symptoms. The range of obstetric outcomes was limited. CONCLUSIONS:Depressive-symptom course-trajectories during pregnancy were associated with some obstetric outcomes. However, their associations with obstetric risk seemed limited compared with known risk factors (e.g., smoking, primiparity), stressing the importance of considering a full range of factors when aiming to predict obstetric risk in research and practice.