A study examining co-occurring alcohol use disorders and depression among pregnant and postpartum women concludes that comorbidity is more common than originally believed, according to the University of Buffalo -- State University of New York (SUNY).For the study, researchers from the Research Institute on Addictions at the University at Buffalo examined data collected from the Maternal Health Practices and Child Development Project (MHPCD), an ongoing, longitudinal study of pregnancy outcomes. The MHPCD recruited women in their fourth prenatal month from a large, urban prenatal clinic in Pittsburgh, Pa., between 1983 and 1985. The participants were assessed in their fourth and seventh prenatal month, at delivery, and then together with their children at eight months and 18 months, then three, six, 10, 14, 16, and 21 years later.
Five groups of prenatal variables -- psychological standing, substance use, social factors, obstetrical complications, and demographics -- were examined at the fourth and seventh month of pregnancy, delivery, and eight months postpartum for 595 women.
"We found that women who experience depressive symptoms, binge drink, or smoke at any point during their pregnancy may be at risk for depression and alcohol use during their first postpartum year," said Gregory Homish, research associate at the Research Institute on Addictions and author of the study. "The fact that these factors were not trimester-specific is important, as it suggests that women's mental health should be evaluated throughout their pregnancy and, for women identified as being at greater risk, into the postpartum period."
Rina Das Eiden, a senior scientist at the Research Institute on Addictions, said most people are unaware that alcohol-use disorders and depression can coexist and are common. "People generally think of these problems as being completely separate from each other. This is true for medical treatment of these problems as well; treatment of depression does not generally involve treatment for alcohol problems and vice-versa," said Eiden.
The researchers concurred that identifying women at risk for comorbidity and providing them with the necessary resources is essential for mother and child. "Given the challenges of the postpartum period due to the stresses of parenting and changes in hormone levels, which can themselves sometimes result in postpartum depression, treatment during pregnancy is vital," said Eiden.
Homish added, "Although we know about the harmful effects of alcohol use and depression on women and their children during pregnancy and the postpartum, routine obstetric care often does not identify these women. One of the goals of this study was to raise awareness for the general population that substance use and depression do occur in perinatal populations, screening should be used to identify women who may be at risk, and when warranted, treatment can be initiated sooner. Additionally, a clear understanding of early risk factors for postpartum alcohol use and depressive symptomatology can allow clinicians to more closely monitor these women for changes in their mental-health status during the first postpartum year."
The study's findings are published in the August 2004 issue of Alcoholism: Clinical & Experimental Research.
Homish, G., Cornelius, J., Richardson, G., & Day, N. (2004) Antenatal Risk Factors Associated With Postpartum Comorbid Alcohol Use and Depressive Symptomatology. Alcoholism: Clinical & Experimental Research, 28(8): 1242-1248.
Boston University School of Public Health 
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