Adolescent pregnancy and early gestation depressive symptoms in rural Bangladesh: Is there an association?

Abstract

Pregnancy during adolescence continues to pose a major public health concern in low-and middle-income countries, including Bangladesh. Suffering from depressive symptoms during pregnancy can lead to adverse maternal and fetal outcomes, and adolescent pregnancy may further complicate the risks. We aimed to estimate the prevalence of early-gestation depressive symptoms in pregnant adolescents in rural Bangladesh and investigate the potential association between the two. Data for this study were extracted from the screening dataset of a community-based randomized controlled trial among pregnant women in Matlab, Bangladesh. Screening was conducted for all eligible expectant women in the study area after pregnancy was confirmed by ultrasound between 5-16 weeks of gestation. This study analyzed data from 651 newly pregnant adolescents and adult women screened between January 2020 and January 2021. Depressive symptoms were evaluated using the seven-item Depression subscale of the Depression, Anxiety, and Stress Scales-21 (DASS-21). Depressive symptom scores were calculated as the sum of the responses to the seven items, and a binary outcome, depressive symptoms, was defined as a depressive symptom score of 5 or more. Multivariable linear and log-binomial regression models were fitted to determine the independent association of depressive symptom score and depressive symptoms with adolescent pregnancy, considering adult pregnancy as the reference. Of the pregnant women, 136 (20.9%) were adolescents (14-19 years), and 515 (79.1%) were adults (20-34 years). The prevalence of depressive symptoms in early gestation was found to be 11.0% among pregnant adolescent girls. In adjusted model, the mean depressive symptom score was higher among the adolescents compared to the adult pregnant women (β = 0.6, 95% CI: 0.1, 1.0; P = 0.010). In multivariable model, adolescents had higher prevalence ratio of depressive symptoms than their adult counterparts (PR = 2.0, 95% CI: 1.1, 3.6, P = 0.025). Our results suggest that adolescent pregnancy is associated with depressive symptoms in early gestation in rural Bangladesh. Furthermore, we found that more than one in ten pregnant adolescents experiences symptoms of depression in the early stages of pregnancy, underscoring a serious public health issue. Public health policies should aim at preventing adolescent marriage and pregnancy in the first place, and programs should be launched to mitigate depressive symptoms among pregnant adolescents.