Mothering Malnutrition: Moms’ depression weighs on infants in Pakistan

In southern Asia, where an estimated 75 million children qualify as malnourished, lack of food may only be part of the problem. A prospective study in rural Pakistan finds that mothers who became depressed shortly before or after giving birth had babies far more likely to experience stunted growth and bouts of diarrhea than were babies with psychologically healthy mothers.

Maternal depression critically contributes to high rates of malnutrition and failure to thrive among infants in this part of the world, conclude psychologist Atif Rahman of the University of Manchester in England and his colleagues. Most people living in southern Asia now have access to adequate food supplies, the researchers note.

In the new study, maternal depression exhibited a stronger link to poor infant health during the first year after birth than did other factors associated with slowed physical growth, including low birth weight and having poor, uneducated parents.

This finding raises particular concern, according to the scientists, because several other reports indicate that the depression rate of 10 to 15 percent among expectant and new mothers in Western nations nearly doubles in southern Asia.

“Attention to mothers’ psychological well-being could increase the effectiveness of child-health programs in many developing societies,” Rahman says. Such programs currently focus on improving mothers’ baby-feeding practices and providing medical services to infants.

The new findings appear in the September Archives of General Psychiatry.

Rahman’s group contacted 632 women, ages 17 to 40, who were in the third trimester of their pregnancies and lived in any of about two-dozen villages in rural Pakistan. In interviews, clinicians who spoke the volunteers’ native language identified 160 depressed women. Their symptoms consisted primarily of persistent sadness, loss of interest or pleasure in daily activities, unrelenting fatigue, guilty and suicidal thoughts, and disturbed sleep or appetite.

Another 160 women with no psychological symptoms also participated in the study. Infants of both groups of mothers were weighed and measured at birth and at 2, 6, and 12 months of age. The investigators also monitored other aspects of the babies’ physical health at each age.

Each mother’s mental condition was again evaluated when her baby reached 2, 6, and 12 months of age. Infants whose mothers remained depressed throughout the study weighed substantially less and experienced more diarrhea than did infants whose mothers were depressed for shorter periods or not at all.

In India and Pakistan, because of social pressures to produce boys, maternal depression occurs more often among women who give birth to girls. However, among babies of depressed mothers, boys and girls displayed comparably poor health during the first year of life, Rahman’s team found.

Rahman suspects that depression interferes with a mother’s capacity to care for an infant and to provide the baby with proper stimulation. These problems are magnified in developing countries, where mothers face daunting child-care challenges, he says. His team plans next year to test a form of psychotherapy for depressed mothers of infants in rural Pakistan.

Such an approach may prove beneficial, but social influences on Pakistani women’s depression also deserve attention, remarks Harvard Medical School anthropologist Alex Cohen. For instance, efforts to increase female literacy and to do away with arranged marriages might also yield mental-health gains, Cohen says.