Obstetrics and Gynecology International from 16 to 50% [5, 15, 24, 25]. This wide prevalence range may reﬂect diﬀerences in sample composition (educational level, rural versus urban residency, minority groups, social support) and how depression is diagnosed. In our study, depressed mood and resilience were categorized using two validated tools. Depressive symptoms were assessed with the CESD-10, a tool widely used for depression research in the general population [12]. Other tools used to assess depressive mood include the Beck Depression Inventory, the Edinburgh Postnatal Depression Scale, the World Health Organization’s Composite International Diagnostic Interview Short Form, among others [24]. The CESD-10 measures only current symptoms and reasonably identiﬁes clinically depressed from nondepressed subjects [11]; moreover, the CESD-10 has shown high sensitivity, speciﬁcity, and positive predictive values [12]. Previous studies addressing depressive symptoms in pregnancy have been performed during prenatal consulta- tions [26]. Depressive symptoms increase during the last trimester of pregnancy [27]. Positive depressive score for the 20-item CESD tool was more frequently found at mid- pregnancy among teens (46%) and disadvantaged American women (47%) [15]. Using the CESD-10, it has been reported that one out of ﬁve women in the antepartum period presents depressed states. This has been related to younger age, substance use (cigarette or alcohol), and having a past and current obstetrical or medical complication [28]. Using the CESD-10 tool, the present series found a similar rate of depressed mood among studied groups. Logistic regression analysis could not identify any single risk factor for depressed mood. Our ﬁndings suggest that factors explaining depressed mood in both groups must be similar and most likely not related to age yet to other conditions such as poverty, cultural, and risk behaviours seen in this speciﬁc low income population. Other factors related to depressed mood during pregnancy include cigarette, alcohol, or drug use [29] which were not present in the studied population. Although decreased fetal growth has been observed in low income women who present depressive symptoms [30], the eﬀect of psychosocial factors (i.e., depression, anxiety, stress, and low self-esteem) on infant birthweight and gestation duration in this population is still controversial [31]. A recent report found that depressed adolescents with suicidal ideation or attempts (as compared to those without) delivered babies with lower birthweight [5]. Perinatal out- come in our series did not diﬀer even after stratifying for the presence of depressed mood. CESD-10 scores indicative of depressed mood have been associated to higher assisted vaginal deliveries and cesarean section rates [32]. This trend was not observed in the present series. Resilience is a complex set of values that allows a person to withstand many of the negative eﬀects of adversity. There- fore, a resilient individual can cope with adversity. Resilience is central for adolescents to develop and mature in healthy ways, including sexual health and well-being maintenance [6, 7]. Adolescence, the family, and the community seem to modulate resilience. In addition, low self-esteem, unplanned pregnancies, sexually transmitted infections, drug misuse, and lack of family care and guidance may negatively inﬂuence 5 resilience [7]. Positive emotions assist high-resilient indi- viduals in their ability to eﬀectively overcome daily stress [33]. Assessing all the components of resilience is not easy. While many tools assess indirect measures of resilience such as self-esteem, sense of coherence, or school adjustment; others include a large number of measures or identify a particular subsample, making assessment diﬃcult in the clinical setting [34]. The resilience tool used in the present series has shown to be appropriate in diﬀerent situations, display high measures of consistency and correlation with life satisfaction scales [6, 35], and most importantly be useful among adolescents. Studies assessing resilience during pregnancy are scarce [8–10] and have mainly focused on anxiety/depressive components using nonspeciﬁc tools. For instance, one study measured level of anxiety rather than resilience after ultra- sound consultation in uncomplicated gravids with diﬀerent risks of fetal abnormalities [8]. A second report assessed resilience in a cohort of pregnant women exposed to a hurricane. Resilience was based on an interview performed at delivery and 8 weeks later using the Edinburgh depression Scale and the Post-Traumatic Stress Checklist (nonspe- ciﬁc resilience measuring tools) as an indirect measure of mental health resilience after the hurricane experience during pregnancy [9]. The authors concluded that some women were resilient from depression and posttraumatic stress. A third paper examined resilience factors (maturity, self-esteem, and mother-grandmother relationships) shortly after delivery and parenting behavior at 6 months in a African-American adolescent cohort. Despite this no speciﬁc resilience measuring tool was used [10]. Our approach aimed at speciﬁcally assessing resilience in a sociodemographically homogeneous gravid population (adolescents versus adults) attending a particular healthcare system. To the best of our knowledge, it is perhaps the ﬁrst to assess resilience in a case, control fashion (adolescents versus controls) at the time of delivery and most of all using a speciﬁc validated resilience tool. As compared to adults, our adolescents displayed lower total RS scores indicating less resilience in which having an adolescent partner and delivering preterm were related risk factors. Individual characteristics of teen mothers and positive family support increase their resilience [10]. Our results indicate that there is a need to develop clinical and emotional support programs for pregnant adolescents to strengthen resilience and improve emotional, mental and social capacities to overcome adversity. More research is warranted in this regard. A high false positive rate for depressed mood can be found when the CESD tool is used [36]. This could be the case in our study. Although this may be seen as a limitation, it could, on the other hand, reﬂect a highly prevalent problem characteristic of our low income women. Risk factors for depression in our obstetrical population need to be further addressed; moreover, panic disorders, domestic violence or the presence of several comorbidities, determinants of psychosocial stress during pregnancy, were not explored [37]. We recognize that timing of the survey may also be seen as a limitation. Nevertheless, research was carried in the best possible Ecuadorian conditions considering the fact that