818: Maternal depression and impaired fetal growth

Deborah Berman, Elizabeth Campbell, Juan Lopez, Delia Vasquez, Sheila Marcus, Marjorie Treadwell University of Michigan Medical Center, Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Ann Arbor, MI, University of Michigan Medical Center, Department of Obstetrics and Gynecology, Ann Arbor, MI, University of Michigan Medical Center, Department of Psychiatry, Ann Arbor, MI OBJECTIVE: Maternal depression is known to be associated with small for gestational age neonates. We seek to assess whether an association between maternal depression and abnormal fetal growth can be determined by prenatal ultrasound and to define the timing of abnormal fetal growth. STUDY DESIGN: One hundred and thirty eight women receiving prenatal care through the University of Michigan Health System were recruited, including 105 depressed/high risk (HR) and 33 non-depressed /low risk (LR) patients. Depressive symptomatology was assessed using Beck Depression Inventory (BDI) scores at 24, 32, and 37 weeks gestation. Ultrasounds performed at 20, 24,32,and 37 weeks included measurements and corresponding percentiles for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). RESULTS: Baseline EFW at 20 weeks gestation is similar in both HR and LR groups (p 0.833), however the rate of fetal growth between 20 and 37 weeks is significantly decreased in HR versus LR women, using either the calculated EFW or EFW percentiles (p 0.02 and p 0.01, respectively). Mean EFW was lower in the HR group as compared to the LR at all gestational ages, and approached statistical significance at 32 and 37 wks (p 0.05 and p 0.06, respectively). When controlling for smoking, the mean EFW in the HR group was significantly lower than LR group at both 32 and 37 wks (p 0.05 and p 0.01, respectively). Mean AC and FL measurements were significantly lower in HR pregnancies at 37 wks (p 0.01 and p 0.02, respectively). Head measurements were not different between the HR and LR groups during the third trimester. Although none of the growth parameters were significantly associated with severity of depressive symptomatology as assessed by the BDI, overall growth was decreased with depression. CONCLUSION: Our findings suggest that ultrasound can detect decreased fetal growth patterns in depressed women. Whether impaired growth can be improved by adequate treatment of maternal depression deserves further study. 819 Antenatal depression, altered maternal and neonatal neuroendocrine profiles, and fetal growth patterns Deborah Berman, Elizabeth Campbell, Marjorie Treadwell, Delia Vasquez, Juan Lopez, Sheila Marcus University of Michigan Medical Center, Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Ann Arbor, MI, University of Michigan Medical Center, Obstetrics and Gynecology, Ann Arbor, MI, University of Michigan Medical Center, Department of Psychiatry, Ann Arbor, MI OBJECTIVE: An association has been identified between maternal depression and adverse neonatal outcomes, including altered growth. Marcus, et al (2011) has previously reported that maternal cortisol and ACTH increase in depressed pregnant women. It has been proposed that these effects may be mediated through the neuroendocrine axis. The aim of our study was to examine the relationship between maternal and neonatal neuroendocrine profiles and fetal growth patterns as determined by prenatal ultrasound. STUDY DESIGN: We designed a prospective case-control study of 138 women receiving prenatal care at University of Michigan Health System, 105 depressed/high risk (HR) and 33 non-depressed/low risk (LR) patients were enrolled. Maternal cortisol and ACTH levels were obtained at 24, 32, and 37 weeks gestation. Neonatal cortisol and ACTH levels were obtained from cord blood. Ultrasounds performed at 24, 32, and 37 weeks included measurements for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW). RESULTS: Cortisol is higher at all gestational ages in HR as compared to LR women and reaches significance at 37 weeks (p 0.05). ACTH is significantly increased in HR women beginning at 32 weeks (p 0.02). Neonatal ACTH levels are elevated in offspring of HR as compared to LR mothers (p 0.01), while neonatal cortisol levels are not different. Increased maternal cortisol and ACTH in HR women were not associated with decreased estimated fetal weights, and neonatal ACTH and cortisol levels did not correlate with fetal morphometrics (EFW, BPD, HC, AC, FL) (p 0.76) CONCLUSION: Antenatal depression is associated with elevated neuroendocrine markers and may contribute to poor neonatal outcomes such as low birth weight. We did not find an association between maternal or infant neuroendocrine status and fetal ultrasound morphometrics. While this suggests that the neuroendocrine system does not mediate fetal growth patterns as measured by fetal biometry, further evaluation of the association between depression, markers, and fetal growth is warranted.