Skip to main content
Log in

Perceived social support interacts with prenatal depression to predict birth outcomes

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Prenatal depression has been linked to adverse reproductive outcomes including preterm labor and delivery, and low birth weight. Social support also has been linked to birth outcomes, and may buffer infants from the adverse impact of maternal depression. In this prospective study, 235 pregnant women completed questionnaires about depression and social support. Clinical interviews were administered to assess for DSM-IV axis I disorders. Following delivery, birth outcomes were obtained from medical records. Babies of depressed mothers weighed less, were born earlier and had lower Apgar scores than babies of nondepressed mothers. Depressed women had smaller social support networks and were less satisfied with support from social networks. We found no direct associations between perceived social support and birth weight. However, depressed women who rated their partners as less supportive had babies who were born earlier and had lower Apgar scores than depressed mothers with higher perceived partner support. Women’s perception of partner support appears to buffer infants of depressed mothers from potential adverse outcomes. These results are notable in light of the low-risk nature of our sample and point to the need for continued depression screening in pregnant women and a broader view of risk for adverse birth outcomes. The results also suggest a possible means of intervention that may ultimately lead to reductions in adverse birth outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. Additional symptom level measures were obtained; however, they were not associated with birth outcomes and were not included in the present study; results are specific to clinical diagnoses of depression, not self-reported depression symptoms or a diagnosed anxiety disorder.

References

  • Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, Text Revision (4th ed.). Washington, DC.

  • Arias, E., MacDorman, M. F., Strobino, D. M., & Guyer, B. (2003). Annual summary of vital statistics—2002. Pediatrics, 112, 1215–1230.

    Article  PubMed  Google Scholar 

  • Barry, R. A., Bunde, M., Lawrence, E., & Brock, R. (2009). Validity and utility of a multidimensional model of received support in intimate relationships. Journal of Family Psychology, 23, 48–57.

    Article  PubMed  Google Scholar 

  • Berle, J. Ø., Mykletun, A., Daltveit, A. K., Rasmussen, S., Holsten, F., & Dahl, A. A. (2005). Neonatal outcomes in offspring of women with anxiety and depression during pregnancy. Archives of Women’s Mental Health, 8, 181–189.

    Article  PubMed  CAS  Google Scholar 

  • Blanchard, A., Hodgson, J., Gunn, W., Jesse, E., & White, M. (2009). Understanding social support and the couple’s relationship among women with depressive symptoms in pregnancy. Issues in Mental Health Nursing, 30, 764–776.

    Article  PubMed  Google Scholar 

  • Bryce, R. L., Stanley, F. J., & Garner, J. B. (1991). Randomized controlled trial of antenatal social support to prevent preterm birth. British Journal of Obstetrics and Gynaecology, 98, 1001–1008.

    Article  PubMed  CAS  Google Scholar 

  • Caitlin, E. A., Carpenter, M. W., Brann, B. S. 4th., Mayfield, S. R., Shaul, P. W., Goldstein, M. et al. (1986). The Apgar score revisited: Influence of gestational age. Journal of Pediatrics, 109, 865–868.

    Article  Google Scholar 

  • Campos, B., Dunkel Schetter, C., Abdou, C. M., Hobel, C. J., Glynn, L. A., & Sandman, C. A. (2008). Familialism, social support, and stress: Positive implications for pregnant Latinas. Cultural Diversity and Ethnic Minority Psychology, 14, 155–162.

    Article  PubMed  Google Scholar 

  • Chung, T. K. H., Lau, T. K., Yip, A. S. K., Chiu, H. F. K., & Lee, D. T. S. (2001). Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosomatic Medicine, 63, 830–834.

    PubMed  CAS  Google Scholar 

  • Collins, N. L., Dunkel-Schetter, C., Lobel, M., & Schrimshaw, S. C. M. (1993). Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65, 1243–1258.

    Article  PubMed  CAS  Google Scholar 

  • Coussons-Read, M. E., Okun, M. L., & Nettles, C. D. (2007). Psychosocial stress increases inflammatory markers and alters cytokine production across pregnancy. Brain, Behavior, and Immunity, 21, 343–350.

    Article  PubMed  CAS  Google Scholar 

  • Crippa, J. A. S., de Lima Orsorio, F., Del-Ben, C. M., Filho, A. S., da Silva Freitas, M. C., & Loureiro, S. R. (2008). Comparability between telephone and face-to-face structured clinical interview for DSM-IV in assessing social anxiety disorder. Perspectives in Psychiatric Care, 44, 241–247.

    Article  PubMed  Google Scholar 

  • Cutrona, C. E., & Suhr, J. A. (1994). An analysis of couples’ supportive interactions. In B. R. Burleson, T. L. Albrecht, D. J. Goldsmith, & I. G. Sarason (Eds.), Communication of social support: Messages, interactions, and community (pp. 113–135). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Dayan, J., Creveuil, C., Herlicoviez, M., Herbel, C., Baranger, E., Savoye, C., et al. (2002). Role of anxiety and depression in the onset of spontaneous preterm labor. American Journal of Epidemiology, 155, 293–301.

    Article  PubMed  CAS  Google Scholar 

  • Dehle, C., Larsen, D., & Landers, J. E. (2001). Social support in marriage. American Journal of Family Therapy, 29, 307–324.

    Google Scholar 

  • Dole, N., Savitz, D. A., Hertz-Picciotto, I., Siega-Riz, A. M., McMahon, M. J., & Buekens, P. (2003). Maternal stress and preterm birth. American Journal of Epidemiology, 157, 14–24.

    Article  PubMed  CAS  Google Scholar 

  • Feldman, P. J., Dunkel-Schetter, C., Sandman, C. A., & Wadhwa, P. D. (2000). Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosomatic Medicine, 62, 715–725.

    PubMed  CAS  Google Scholar 

  • Field, T., Diego, M., Hernandez-Reif, M., Figueiredo, B., Deeds, O., Ascencio, A., et al. (2010). Comorbid depression and anxiety effects on pregnancy and neonatal outcome. Infant Behavior and Development, 33, 23–29.

    Article  PubMed  Google Scholar 

  • Field, T., Hernandez-Reif, M., & Diego, M. (2006). Risk factors and stress variables that differentiate depressed from nondepressed pregnant women. Infant Behavior and Development, 29, 169–174.

    Article  PubMed  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured clinical interview for DSM-IV Axis I disorders: Research version, non-patient edition. New York: New York State Psychiatric Institute.

    Google Scholar 

  • Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics & Gynecology, 106, 1071–1083.

    Article  Google Scholar 

  • Ghosh, J. K. C., Wilhelm, M. H., Dunkel-Schetter, C., Lombardi, C. A., & Ritz, B. R. (2010). Paternal support and preterm birth, and the moderation of effects of chronic stress: A study in Los Angeles County mothers. Archives of Women’s Mental Health, 13, 327–338.

    Article  PubMed  Google Scholar 

  • Glazier, R. H., Elgar, F. J., Goel, V., & Holzapfel, S. (2004). Stress, social support, and emotional distress in a community sample of pregnant women. Journal of Psychosomatic Obstetrics and Gynecology, 25, 247–255.

    Article  PubMed  CAS  Google Scholar 

  • Goodman, S. H., & Tully, E. C. (2009). Recurrence of depression during pregnancy: Psychosocial and personal functioning correlates. Depression and anxiety, 26, 557–567.

    PubMed  Google Scholar 

  • Grote, N. K., Bridge, J. A., Gavin, A. R., Melville, J. L., Iyengar, S., & Katon, W. L. (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry, 67, 1012–1024.

    Article  PubMed  Google Scholar 

  • Hoffman, S., & Hatch, M. C. (2000). Depressive symptomatology during pregnancy: Evidence for an association with decreased fetal growth in pregnancies of lower social class women. Health Psychology, 19, 535–543.

    Article  PubMed  CAS  Google Scholar 

  • Hedegaard, M., Henriksen, T. B., Secher, N. J., Hatch, M. C., & Sabroe, S. (1996). Do stressful life events affect duration of gestation and risk of preterm delivery? Epidemiology, 7, 339–345.

    Article  PubMed  CAS  Google Scholar 

  • Hegyi, T., Carbone, T., Anwar, M., Ostfeld, B., Hiatt, M., & Koons, A. (1998). The Apgar score and its components in the preterm infant. Pediatrics, 101, 77–81.

    Article  PubMed  CAS  Google Scholar 

  • Heinrichs, M., Baumgartner, T., Kirschbaum, C., & Ehlert, U. (2003). Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry, 54, 1389–1398.

    Article  PubMed  CAS  Google Scholar 

  • Hodnett, E. D., Fredericks, S., & Weston, J. (2003). Support during pregnancy for women at increased risk of low birthweight babies. Cochrane Database of Systematic Reviews, CD000198.

  • Jose, P. E. (2008). Modgraph-I: A programme to compute cell means for the graphical display of moderational analyses: The internet version, Version 2.0. Victoria University of Wellington: Wellington, New Zealand.

  • Kiecolt-Glaser, J. K., Gouin, J. P., & Hantsoo, L. V. (2010). Close relationships, inflammation, and health. Neuroscience and Biobehavioral Reviews, 35, 33–38.

    Article  PubMed  Google Scholar 

  • Kurki, T., Hiilesmaa, V., Raitasalo, R., Mattila, H., & Ylikorkala, O. (2000). Depression and anxiety in early pregnancy and risk for preeclampsia. Obstetrics & Gynecology, 95, 487–490.

    Article  CAS  Google Scholar 

  • Lawrence, E., Bunde, M., Barry, R. A., Brock, R. L., Sullivan, K. T., Pasch, L. A., et al. (2008). Partner support and marital satisfaction: Support amount, adequacy, provision, and solicitation. Personal Relationships, 15, 445–463.

    Article  Google Scholar 

  • Lobel, M., DeVincent, C. J., Kaminer, A., & Meyer, B. A. (2000). The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women. Health Psychology, 19, 544–553.

    Article  PubMed  CAS  Google Scholar 

  • Lowe, S. R., Chan, C. S., & Rhodes, J. E. (2010). Pre-hurricane perceived social support protects against psychological distress: A longitudinal analysis of low-income mothers. Journal of Consulting and Clinical Psychology, 4, 551–560.

    Article  Google Scholar 

  • Mancuso, R. A., Schetter, C. D., Rini, C. M., Roesch, S. C., & Hobel, C. J. (2004). Maternal prenatal anxiety and corticotrophin-releasing hormone associated with timing of delivery. Psychosomatic Medicine, 66, 762–769.

    Article  PubMed  CAS  Google Scholar 

  • Mathews, T. J., Menacker, F., & MacDorman, M. F. (2003). Infant mortality statistics from the 2001 period linked birth/infant death data set. National Vital Statistics Reports, 52, 1–27.

    PubMed  CAS  Google Scholar 

  • Neggers, Y., Goldenberg, R., Cliver, S., & Hauth, J. (2006). The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta Obstetricia et Gynecologica, 85, 277–285.

    Article  Google Scholar 

  • Nkansah-Amankra, S., Dhawain, A., Hussey, J. R., & Luchok, K. J. (2010). Maternal social support and neighborhood income inequality as predictors of low birth weight and preterm birth outcome disparities: Analysis of South Carolina pregnancy risk assessment and monitoring system survey, 2000–2003. Maternal and Child Health Journal, 14, 774–785.

    Article  PubMed  Google Scholar 

  • Norbeck, J. S., & Tilden, V. P. (1983). Life stress, social support, and emotional disequilibrium in complications of pregnancy: A prospective, multivariate study. Journal of Health and Social Behavior, 24, 30–46.

    Article  PubMed  CAS  Google Scholar 

  • O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression—A meta-analysis. International Review of Psychiatry, 8, 37–54.

    Article  Google Scholar 

  • O’Hara, M. W., Varner, M. W., & Johnson, S. R. (1986). Assessing stressful life events associated with childbearing: The Peripartum Events Scale. Journal of Reproductive and Infant Psychology, 4, 85–98.

    Article  Google Scholar 

  • Olsen, I. E., Groveman, S. A., Lawson, M. L., Clark, R. H., & Zemel, B. S. (2010). New intrauterine growth curves based on United States Data. Pediatrics, 125, e214–e224.

    Article  PubMed  Google Scholar 

  • Rini, C., Dunkel Schetter, C., Hobel, C., Glynn, L. M., & Sandman, C. A. (2006). Effective social support: Antecedents and consequences of partner support during pregnancy. Personal Relationships, 13, 207–229.

    Article  Google Scholar 

  • Sarason, I. G., Sarason, B. R., Shearin, E. H., & Pierce, G. R. (1987). A brief measure of social support: Practical and theoretical implications. Journal of Social and Personal Relationships, 4, 497–510.

    Article  Google Scholar 

  • Sobin, C., Sobin, C., Weissmam, M. M., Goldstein, R. B., Adams, P., Wickramaratne, P., et al. (1993). Diagnostic interviewing for family studies: Comparing telephone and face-to-face methods for the diagnosis of lifetime psychiatric disorders. Psychiatric Genetics, 3, 233.

    Article  Google Scholar 

  • SPSS for Windows, Release 17.0.1. (2008). Chicago: SPSS Inc.

  • Sugiura-Ogasawara, M., Furukawa, T. A., Nakano, Y., Hori, S., Aoki, K., & Kitamura, T. (2002). Depression as a potential casual factor in subsequent miscarriage in recurrent spontaneous aborters. Human Reproduction, 17, 2580–2584.

    Article  PubMed  CAS  Google Scholar 

  • Wadhwa, P. D. (2005). Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology, 30, 724–743.

    Article  PubMed  CAS  Google Scholar 

  • Wadhwa, P. D., Culhane, J. F., Rauh, V., Barve, S. S., Hogan, V., Sandman, C. A., et al. (2001). Stress, infection, and preterm birth: A biobehavioral perspective. Pediatric and Perinatal Epidemiology, 15, 17–29.

    Article  PubMed  Google Scholar 

  • Zachariah, R. (2009). Social support, life stress, and anxiety as predictors of pregnancy complications in low-income women. Research in Nursing & Health, 32, 391–404.

    Article  Google Scholar 

  • Zelkowitz, P., Saucier, J., Wang, T., Katofsky, L., Valenzuela, M., & Westreich, R. (2008). Stability and change in depressive symptoms from pregnancy to two months postpartum in childbearing immigrant women. Archives of Women’s Mental Health, 11, 1–11.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported in part by a grant from the G.W. Stairs Memorial Fund of McGill University, awarded to Dr. Suzanne King, Dr. O’Hara, and others (McGill ref. no. 216908), The University of Iowa Department of Psychology, College of Liberal Arts and Sciences, and the Office of the Vice President for Research, and a $1000 grant from the University of Iowa Student Government, awarded to Dr. Kimberly Nylen. We thank Maddie Adams, Melissa Buttner, Lilian Dindo, Kilee Evans, Jenny Gringer-Richards, Jessica Leeper, Sarah Mott, and Erin Springer, for their assistance with data collection and tracking. We thank Suzanne King (McGill University) and David Laplante (Douglas Hospital Research Institute) in Montreal, Quebec, Canada, for their assistance in reviewing and editing this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kimberly J. Nylen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nylen, K.J., O’Hara, M.W. & Engeldinger, J. Perceived social support interacts with prenatal depression to predict birth outcomes. J Behav Med 36, 427–440 (2013). https://doi.org/10.1007/s10865-012-9436-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-012-9436-y

Keywords

Navigation