Severe Depressive Symptoms during Pregnancy and Small-for-Gestational Age Infants: Does Confrontive Coping Style Moderate the Relationship

Background: Ways of coping (WOC) can moderate the relationship between antenatal depression and small-for-gestational age (SGA) births. We sought to examine how the use of confrontive coping influences the relationship between severe depressive symptoms (DS) during pregnancy and the rate of SGA. Methods: Data were obtained from a cohort of 1410 Black women in Metropolitan Detroit, Michigan (71% response rate; 14.5% SGA) using maternal interviews and medical record abstraction. The Center for Epidemiologic Studies Depression Scale was used to measure severe DS (score>23). Confrontive coping was assessed using the WOC questionnaire. Analyses were stratified by confrontive coping style; modified-Poisson regression models were used to calculate unadjusted and adjusted prevalence ratios (PR) with 95% confidence interval (CI). Results: Approximately 20% of women had severe DS. Unadjusted results showed severe DS among women that used confrontive coping (PR=1.4, 95% CI: 1.0-2.0) were significantly associated with SGA prevalence. No significant differences in the SGA prevalence were found (p=0.87) among women that used non-confrontive coping. After adjusting for demographics, parity, physical health and smoking during pregnancy, women with severe DS who employed confrontive coping were 1.4 times (95% CI: 0.98-2.13, p= 0.07) as likely to have a SGA infant.  Again no significant difference in SGA prevalence were found among women that employed non-confrontive coping (p=0.63). Significance/Recommendations: Our findings suggest confrontive coping moderates the relationship between severe DS and SGA. In addition to screening for DS during pregnancy clinicians may want to assess coping styles since coping styles drive women’s appraisal and response to stress.