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A Cohort Study

Atif Rahman, PhD; Zafar Iqbal, MSc; James Bunn, MSc, MRCP; Hermione Lovel, PhD; Richard Harrington, MD

Arch Gen Psychiatry. 2004;61:946-952.

Background  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.

Objective  To determine whether maternal depression is a risk factor for malnutrition and illness in infants living in a low-income country.

Design  Prospective cohort study.

Setting  Rural community in Rawalpindi, Pakistan.

Participants  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.

Results  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.

Conclusions  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.

From the School of Psychiatry and Behavioural Sciences, University of Manchester, Manchester, England (Drs Rahman and Harrington); Human Development Research Foundation, Islamabad, Pakistan (Dr Rahman and Mr Iqbal); Department of Tropical Child Health, Liverpool School of Tropical Medicine, Liverpool, England (Dr Bunn); and World Health Organization Collaborating Centre for Primary Care, School of Primary Care, University of Manchester (Dr Lovel).

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