Impact of antenatal depressive and anxiety symptoms on adverse birth outcomes in Baghdad, Iraq: a prospective cohort study


  • Ola Ali Nassr Department of clinical pharmacy, College of pharmacy, Mustansiriyah University, Baghdad
  • Mohammed Mahmood Mohammed Department of clinical pharmacy, College of pharmacy, Mustansiriyah University, Baghdad
  • Hind abdulkhaliq Showman Department of Obsterics and Gynecology, College of Medicine, Mustansiriya University, Baghdad, Iraq



: antepartum depression, anxiety, adverse birth outcome, low birth weight, preterm birth, Iraq


Background: Psychiatric symptoms are common during pregnancy, potentially leading to an increased risk of adverse birth outcomes. Studies assessing the impact of depression and/or anxiety on adverse birth outcomes in Iraq are currently lacking. This study aims to


determine whether depression and/or anxiety is independently associated with preterm birth (PTB) and low birth weight (LBW).

Methods: A prospective cohort study included 352 pregnant women from outpatient clinics of Al-Yarmouk hospital and private clinics in Baghdad, Iraq from March 2021 to February 2022 using a convenience sampling. They were screened for depression using Edinburgh Postnatal Depression Scale (EPDS) during pregnancy and followed up to assess adverse birth outcomes. Multivariable logistic regression was used to determine predictors associated with adverse birth outcomes.

Results: The prevalence of PTB and LBW was 7.7% and 11.6%, respectively. After adjustment of all potential sociodemographic, clinical and obstetric confounders, depression was independently associated with giving birth to LBW neonate (odd ratio (OR):3.64; 95% confidence interval (CI) 1.70, 7.79), but not PTB. Prevalence of LBW in depressed was 21.2% compared to 7.7% for non-depressed. LBW was also associated with a history of LBW and PTB. In contrast, anxiety did not seem to affect birth outcomes.

Conclusion: Depression during pregnancy, regardless of the trimester, is independently associated with a higher likelihood of giving birth to LBW neonates (OR: 3.64; 95% CI 1.70, 7.79). Effective interventions that target maternal depression are vital to decrease morbidity and mortality associated with LBW.  


- Johnson CF, Ali Nassr O, Harpur C, Kenicer D, Thom A, Akram G. Benzodiazepine and Z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community. Pharmacy Practice. 2018;16 (3):1256. DOI:

- Dowse E, Chan S, Ebert L, Wynne O, Thomas S, Jones D, et al. Impact of Perinatal Depression and Anxiety on Birth Outcomes: A Retrospective Data Analysis. Matern Child Health J 2020; 24:718–726. DOI:

- Raz Muhammed HamaSalih, Rebwar Ghareeb Hama. Electrocardiographic changes in patients with depression after using escitalopram for a short period. Al Mustansiriyah Journal of Pharmaceutical Sciences 2023; 22:23–30. doi:10.32947/ ajps. v22i4.950 DOI:

- Li X, Gao R, Dai X, Liu H, Zhang J, Liu X, et al. The association between symptoms of depression during pregnancy and low birth weight: a prospective study. BMC Pregnancy Childbirth 2020; 20:147. DOI:

- Van Ngo T, Gammeltoft T, Nguyen H T T, Meyrowitsch D W, Rasch V. Antenatal depressive symptoms and adverse birth outcomes in Hanoi, Vietnam. PLoS One 2018;13: e0206650. DOI:

- Dadi AF, Akalu T Y, Wolde H F, Baraki A G. Effect of perinatal depression on birth and infant health outcomes: a systematic review and meta-analysis of observational studies from Africa. Arch Public Health 2022; 80:34. DOI:

- Fekadu Dadi A, Miller E R, Woodman RJ, Azale T, Mwanri, L. Effect of antenatal depression on adverse birth outcomes in Gondar town, Ethiopia: A community-based cohort study. PLoS One 2020;15: e0234728. DOI:

- Iraq (IRQ) - Demographics, Health & Infant Mortality. UNICEF DATA. (Accessed 10-10-2022). Available from: https:// /country/iraq/.

- He Z, Bishwajit G, Yaya S, Cheng Z, Zou D, Zhou Y, et al. Prevalence of low birth weight and its association with maternal body weight status in selected countries in Africa: a cross-sectional study. BMJ Open 2018;8: e020410. DOI:

- Xi C, Luo M, Wang T, Wang Y, Wang S, Guo L, et al. Association between maternal lifestyle factors and low birth weight in preterm and term births: a case-control study. Reprod Health 2020; 17:93. DOI:

- Vilanova C S, Hirakata V N, Buriol V C, Nunes M, Goldani M Z, Silva C H. The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil. Popul Health Metr 2019; 17:15. DOI:

- Sabeeh H K, Ali S H, Al-Jawaldeh A. Iraq Is Moving Forward to Achieve Global Targets in Nutrition. Children 2022; 9:215. DOI:

- Taha Z, Ali Hassan A, Wikkeling-Scott L, Papandreou D. Factors Associated with Preterm Birth and Low Birth Weight in Abu Dhabi, the United Arab Emirates. Int J Environ Res Public Health 2020;17: E1382. DOI:

- Niran Kamel, Wasan Munim, Wasan Munim, Alaa Raheem Kareem, et al. Lipid profile changes in pregnant women with pre-eclampsia and their correlation with Severety of pre-eclampsia. Al Mustansiriyah Journal of Pharmaceutical Sciences 2020; 20:105–13. doi:10.32947/ajps. v20i3. 766 DOI:

- Ghimire U, Papabathini S S, Kawuki J, Obore N, Musa T H. Depression during pregnancy and the risk of low birth weight, preterm birth and intrauterine growth restriction- an updated meta-analysis. Early Hum Dev 2021; 152:105243. DOI:

- Al-Hashimi F J G, Kareem Alalaf S, Al Tawil N G. Screening for depression during pregnancy using the Kurdish version of the Edinburgh Postnatal Depression Scale in Erbil city. Health Care Women Int 2020; 41:240–254. DOI:

- Cox J L, Holden J M, Sagovsky A. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150:782-6. DOI:

- Ghubash R, Abou-Saleh M T, Daradkeh T K. The validity of the Arabic Edinburgh Postnatal Depression Scale. Soc Psychiatry Psychiatr Epidemiol 1997; 32:474–476. DOI:

- Spitzer R L, Kroenke K, Williams J B W, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166:1092–1097. DOI:

- AlHadi A N, AlAteeq D A, Al-Sharif E, Bawazeer H M, Alanazi H, AlShomrani A T. An arabic translation, reliability, and validation of Patient Health Questionnaire in a Saudi sample. Ann Gen Psychiatry 2017; 16:32. DOI:

- Sherin K M, Sinacore J M, Li X Q, Zitter R E, Shakil A. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med 1998; 30:508–512.

- Mohammad K I, Gamble J, Creedy D K. Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women. Midwifery 2011;27: e238-245. DOI:

- Nasreen H E, Pasi H B, Rifin S M, Md Aris M A, Ab Rahman J, Rus R M, et al. Impact of maternal antepartum depressive and anxiety symptoms on birth outcomes and mode of delivery: a prospective cohort study in east and west coasts of Malaysia. BMC Pregnancy Childbirth 2019; 19:201. DOI:

- Chandra P S, Bajaj A, Desai G, Satyanarayana V A, Sharp H M, Ganjekar S, et al. Anxiety and depressive symptoms in pregnancy predict low birth weight differentially in male and female infants—findings from an urban pregnancy cohort in India. Soc Psychiatry Psychiatr Epidemiol 2021;56: 2263–2274. DOI:

- Mostafa O, El-Rafie M, Al Sayed ET, Khalil MA, Zaki SM. Assessment of Antepartum Depression and its Effect on Pregnancy Outcome in Two Primary Health Care Units in Qaliobia Governorate, Egypt. Open Access Maced J Med Sci 2021; 9:447-54. DOI:

- Grigoriadis S, VonderPorten E H, Mamisashvili L, Tomlinson G, Dennis C, Koren G, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry 2013;74: e321-341. DOI:

- Fekadu Dadi A, Miller E R, Mwanri L. Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis. PLoS One 2020;15: e0227323. DOI:

- Nassr O A, Mohammed M M, Showman H A. Relationship between inflammatory biomarkers, vitamin D levels, and depressive symptoms in late pregnancy and during the postpartum period: a prospective, observational study. Middle East Curr Psychiatry 2022; 29:1-9. DOI:

- Mikolajczyk R T, Zhang J, Betran A P, Souza J P, Mori R, Gulmezoglu A M, et al. A global reference for fetal-weight and birthweight percentiles. Lancet 2011; 377:1855–1861. DOI:

- Al-Qaraghouli M, Fang Y M V. Effect of Fetal Sex on Maternal and Obstetric Outcomes. Front Pediatr 2017;5;144. DOI:

- Peelen M J C S, Kazemier B M, Ravelli A C J, Groot C J M D, Post J A M V D, Mol B W J, et al. Impact of fetal gender on the risk of preterm birth, a national cohort study. Acta Obstet Gynecol Scand 2016; 95:1034–1041. DOI:

- Kong L, Nilsson I Am K, Gissler M, Lavebratt C. Associations of Maternal Diabetes and Body Mass Index with Offspring Birth Weight and Prematurity. JAMA Pediatr 2019; 173:371–378. DOI:

- Ornoy A, Becker M, Weinstein-Fudim L, Ergaz Z. Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review. Int J Mol Sci 2021; 22:2965. DOI:

- Bérard A, Zhao J P, Sheehy O. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ Open 2017;7e013372. DOI:




How to Cite

Ola Ali Nassr, Mohammed Mahmood Mohammed, & Hind abdulkhaliq Showman. (2023). Impact of antenatal depressive and anxiety symptoms on adverse birth outcomes in Baghdad, Iraq: a prospective cohort study . Al Mustansiriyah Journal of Pharmaceutical Sciences, 23(1), 68–80.