The Link Between Depression and Infant Health
By Neel Shah, MD, MPP
October 22, 2021
Neel Shah is Chief Medical Officer of Maven Clinic and Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, where he also serves as senior advisor to Ariadne Labs. His work focuses on designing and building health systems that ensure every person can choose to grow their family with dignity.
A baby born in the U.S. is nearly twice as likely to die before their first birthday compared to a baby born in similar countries, and babies born to Black mothers in the U.S. are more than twice as likely to die as those born to white mothers. A new meta-analysis examines the impact of untreated maternal mental health on infants and sheds light on the magnitude of persisting racial disparities.
The study, published in the October issue of Health Affairs by an interdisciplinary team led by Shannon Simonovich of DePaul University, pulls together evidence from nine studies from 2010-2020 that show depression during pregnancy increases the risk of adverse birth outcomes. The analysis found that pregnant people with depression were nearly 50% more likely to give birth preterm than those without depression and 90% more likely to deliver a low-birthweight infant (both of which increase the likelihood of infant mortality).
Black pregnant people with depression were more than twice as likely to give birth preterm and to a low-birthweight infant than Black people without depression, risks that were persistently higher compared with white Americans. This aligns with broader racial disparities that exist in maternal and infant mortality, driven by many factors including structural racism and lack of access to health care. The authors noted that only three of the nine studies included in their analysis broke results out by race and none did so by ethnicity, and called for future research to include disaggregated data to better identify disparities.
This analysis is the first of its kind in more than 10 years and is notable to me for two reasons. First, while there were enough studies to draw important conclusions about the relationship between depression and infant health, it is disappointing that only nine studies have rigorously looked at this critical issue in the last decade. It’s also notable for showing how little has changed, which should be a resounding call to make mental health care a core component of how we take care of pregnant people. Yet the authors noted that the most basic tool available to us today — a standardized mental health questionnaire offered in the prenatal and postpartum periods — is barely utilized.
Universal mental health screening is just a starting point for a shift toward pregnancy care that supports the whole person — including their mental and physical health needs. The Momnibus provisions currently included in the Build Back Better Act under consideration in Congress include funding for perinatal mental health. Too many discussions around improving care for pregnant people focus only on the physical safety of the baby and ignore everything else. But maternal health and infant health are inextricable. Mental health and physical health are indivisible. As this analysis shows, improving the condition of pregnant people and their babies requires a holistic approach.