In brief

A multi-year study with participants from three continents found that depressive symptoms often start during pregnancy and remain stable post-childbirth, challenging existing public health policies and highlighting the need for early detection and support for maternal depression.

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Supporting mothers from the start

3 Jul 2024

The term ‘postpartum depression’ may be misleading, as researchers have discovered that maternal depressive symptoms often begin during pregnancy.

For many families, the joyous arrival of a new baby is overshadowed by an invisible struggle: postpartum depression. Although the term suggests it begins after childbirth, the reality of when and how maternal depression manifests has remained elusive.

Addressing this knowledge gap to shape public health policies that effectively support families during this crucial time is vital for both mother and child, stated Michelle Kee, a Principal Scientist at A*STAR’s Singapore Institute for Clinical Sciences (SICS).

“Previous studies, including those conducted in Singapore, have underscored the importance of maternal mood during pregnancy in influencing a child’s neurodevelopmental outcomes,” elaborated Kee.

Kee and Michael Meaney, Programme Director of Translational Neuroscience at SICS, together with collaborators from the National University of Singapore and KK Women’s and Children’s Hospital in Singapore; McGill University, University of Montreal and University of Calgary, Canada; and Yale School of Medicine, US; launched a comprehensive multi-year study to gain deeper insights into postpartum depression.

Together, they recruited seven participant cohorts from Singapore, Canada and the United Kingdom to study the course and stability of depressive symptoms from pregnancy to two years post-childbirth across varied ethnic and geographic groups.

Participants underwent psychological tests and self-reported their depressive symptoms at various stages, from the beginning of pregnancy to two years after giving birth. The research team analysed this self-reported data, which was measured using well-established depression scales, applying advanced statistical methods such as item response theory and K-means clustering to categorise women with similar depressive symptom patterns.

Three distinct groups were identified: women with consistently low, mild and high levels of depressive symptoms. These patterns remained stable throughout the perinatal period for nearly all participants.

Moreover, the findings revealed that variations in depressive levels frequently start during pregnancy and persist into the postpartum period. “Our findings contradict common misconceptions perpetuated by influential guidelines that maternal depression only manifests after childbirth,” Kee explained, noting that this challenges the appropriateness of the term 'postpartum depression'.

These observations corroborate clinical experiences of the early onset of maternal depressive symptoms, now supported by empirical data from Kee and colleagues. In addition, the researchers noted the need for additional research to confirm these results in other socioeconomic settings, particularly in low- and middle-income countries.

By determining the onset and trajectory of maternal depression, the researchers hope that their findings can refine public health guidelines, enabling mothers to recognise symptoms earlier and access necessary support.

Kee’s team is currently developing a preconception screening tool to identify individuals at risk for maternal mental health issues.

The A*STAR-affiliated researchers contributing to this research are from the Singapore Institute for Clinical Sciences (SICS).

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Kee, M.Z.L., Cremaschi, A., De Iorio, M., Chen, H., Montreuil, T., et al. Perinatal trajectories of maternal depressive symptoms in prospective, community-based cohorts across 3 continents. JAMA Network Open 6 (10), e2339942 (2023). | article

About the Researchers

Michelle Kee is currently a Principal Scientist in the Translational Neuroscience domain of A*STAR’s Singapore Institute for Clinical Sciences (SICS). She obtained her PhD from Duke-NUS Medical School in 2015. In 2023, she was awarded the Human Health Potential Young Investigator Research Grant to develop and validate a preconception screening tool for women at risk of prenatal mental health problems. Her work delves into dissecting the multi-faceted contributions of parents in shaping their child’s cognitive and socio-emotional development, including gene-by-environment interactions, parenting approaches and their emotional regulation skills.
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Michael Meaney

Programme Director of Translational Neuroscience

Singapore Institute for Clinical Sciences (SICS)
Michael Meaney serves as the Programme Director of Translational Neuroscience at A*STAR Singapore Institute for Clinical Sciences (SICS) and holds the distinguished position of James McGill Professor of Medicine at McGill University’s Douglas Mental Health University Institute. His academic journey began at Loyola College of Montreal, culminating in a PhD from Concordia University with postdoctoral training at the Rockefeller University. Meaney’s multidisciplinary research focuses on the enduring effects of early life experiences on gene expression and development, particularly variations in maternal care that can impact individuals’ risk for pathologies in later life. In recognition of his contributions, Meaney was elected as a member of the American Academy of Arts and Sciences in 2024.

This article was made for A*STAR Research by Wildtype Media Group