***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: CONTEXT Selective serotonin reuptake inhibitors ( SSRIs ) are frequently prescribed to pregnant women , but knowledge about their unintended effects on child health is scarce . OBJECTIVE To examine the effects of maternal SSRI use during pregnancy on fetal growth and birth outcomes . DESIGN The study was embedded in the Generation R Study , a prospect i ve population -based study from fetal life onward . PARTICIPANTS Seven thous and six hundred ninety-six pregnant women were included .  Selective serotonin reuptake inhibitor use was assessed by question naires in each trimester and verified by pharmacy records . Using depressive symptom scores from the Brief Symptom Inventory , 7027 pregnant mothers ( 91.3 % ) had no or low depressive symptoms , 570 pregnant mothers ( 7.4 % ) had clinical ly relevant depressive symptoms and used no SSRIs , and 99 pregnant mothers ( 1.3 % ) used SSRIs .  MAIN OUTCOME MEASURES Fetal ultrasonography was performed in each trimester . We determined fetal body and head growth with repeated assessment s of body and head size . The birth outcomes studied were preterm birth , small for gestational age , and low birth weight . RESULTS Fetuses from mothers with prenatal depressive symptoms showed reduced body growth ( β=-4.4 g/wk ; 95 % CI : -6.3 to -2.4 ; P<.001 ) and head growth ( β=-0.08 mm/wk ; 95 % CI : -0.14 to -0.03 ; P=.003 ) . Mothers using SSRIs during pregnancy had fewer depressive symptoms than mothers in the clinical symptom range . Prenatal SSRI use was not associated with reduced body growth but was associated with reduced fetal head growth ( β=-0.18 mm/wk ; 95 % CI : -0.32 to -0.07 ; P=.003 ) . The SSRI-exposed children were at higher risk for preterm birth ( odds ratio=2.14 ; 95 % CI : 1.08 to 4.25 ; P=.03 ) . CONCLUSIONS Untreated maternal depression was associated with slower rates of fetal body and head growth . Pregnant mothers treated with SSRIs had fewer depressive symptoms and their fetuses had no delay in body growth but had delayed head growth and were at increased risk for preterm birth . Further research on the implication s of these findings is needed Background High rates of antenatal depression and preterm birth have been reported in Pakistan . Self reported maternal stress and depression have been associated with preterm birth ; however findings are inconsistent . Cortisol is a biological marker of stress and depression , and its measurement may assist in underst and ing the influence of self reported maternal stress and depression on preterm birth . Methods In a prospect i ve cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression respectively , and had a blood cortisol level drawn . Women were followed up after delivery to determine birth outcomes . Correlation coefficients and Wilcoxon rank sum test was used to assess relationship between preterm birth , stress , depression and cortisol . Logistic regression analysis was used to determine the key factors predictive of preterm birth . Results 132 pregnant women participated of whom 125 pregnant women had both question naire and cortisol level data and an additional seven had question naire data only . Almost 20 % of pregnant women ( 19·7 % , 95 % CI 13·3 - 27·5 ) experienced a high level of stress and nearly twice as many ( 40·9 % , 95 % CI 32·4 - 49·8 % ) experienced depressive symptoms . The median of cortisol level was 27·40 ug/dl ( IQR 22·5 - 34·2 ) . The preterm birth rate was 11·4 % ( 95 % CI 6·5 - 18 ) . There was no relationship between cortisol values and stress scale or depression . There was a significant positive relationship between maternal depression and stress . Preterm birth was associated with higher parity , past delivery of a male infant , and higher levels of paternal education . Insufficient numbers of preterm births were available to warrant the development of a multivariable logistic regression model . Conclusions Preterm birth was associated with higher parity , past delivery of a male infant , and higher levels of paternal education . There was no relationship between stress , and depression , cortisol and preterm birth . There were high rates of stress and depression among this sample suggesting that there are missed opportunities to address mental health needs in the prenatal period . Improved methods of measurement are required to better underst and the psychobiological basis of preterm birth The authors investigated a large number of stressors and measures of psychological distress in a multicenter , prospect i ve cohort study of spontaneous preterm birth among 5,337 Montreal (Canada)-area women who delivered from October 1999 to April 2004 . In addition , a nested case-control analysis ( 207 cases , 444 controls ) was used to explore potential biologic pathways by analyzing maternal plasma corticotrophin-releasing hormone ( CRH ) , placental histopathology , and ( in a subset ) maternal hair cortisol . Among the large number of stress and distress measures studied , only pregnancy-related anxiety was consistently and independently associated with spontaneous preterm birth ( for values above the median , adjusted odds ratio = 1.8 ( 95 % confidence interval : 1.3 , 2.4 ) ) , with a dose-response relation across quartiles . The maternal plasma CRH concentration was significantly higher in cases than in controls in crude analyses but not after adjustment ( for concentrations above the median , adjusted odds ratio = 1.1 ( 95 % confidence interval : 0.8 , 1.6 ) ) . In the subgroup ( n = 117 ) of participants with a sufficient maternal hair sample , hair cortisol was positively associated with gestational age . Neither maternal plasma CRH , hair cortisol , nor placental histopathologic features of infection/inflammation , infa rct ion , or maternal vasculopathy were significantly associated with pregnancy-related anxiety or any other stress or distress measure . The biologic pathways underlying stress-induced preterm birth remain poorly understood Background Few trials have evaluated the effectiveness of psychological treatment in improving depression by the end of pregnancy . This is the first pilot r and omised controlled trial ( RCT ) of individual cognitive behavioural therapy ( CBT ) looking at treating depression by the end of pregnancy . Our aim was to assess the feasibility of delivering a CBT intervention modified for antenatal depression during pregnancy . Methods Women in North Bristol , UK between 8–18 weeks pregnant were recruited through routine contact with midwives and r and omised to receive up to 12 sessions of individual CBT in addition to usual care or to continue with usual care only .  Women were eligible for r and omisation if they screened positive on a 3- question depression screen used routinely by midwives and met ICD-10 criteria for depression assessed using the clinical interview schedule – revised version ( CIS-R ) . Two CBT therapists delivered the intervention . Follow-up was at 15 and 33 weeks post-r and omisation when assessment s of mental health were made using measures which included the CIS-R. Results Of the 50 women assessed for the trial , 36 met ICD-10 depression criteria and were r and omised : 18 to the intervention and 18 to usual care . Thirteen of the 18 ( 72 % ) women who were allocated to receive the intervention completed 9 or more sessions of CBT before the end of pregnancy . Follow-up rates at 15 and 33 weeks post-r and omisation were higher in the group who received the intervention ( 89 % vs. 72 % at 15 weeks and 89 % vs. 61 % at 33 weeks post-r and omisation ) . At 15 weeks post-r and omisation ( the end of pregnancy ) , there were more women in the intervention group ( 11/16 ; 68.7 % ) who recovered ( i.e. no longer met ICD-10 criteria for depression ) , than those receiving only usual care ( 5/13 ; 38.5 % ) . Conclusions This pilot trial shows the feasibility of conducting a large RCT to assess the effectiveness of CBT for treating antenatal depression before the end of pregnancy . The intervention could be delivered during the antenatal period and there was some evidence to suggest that it could be effective . Trial registration IS RCT Background The prospect i ve cohort study design is ideal for examining diseases of public health importance , as its inherent temporal nature renders it advantageous for study ing early life influences on health outcomes and research questions of aetiological significance . This paper will describe the development and characteristics of the All Our Babies ( AOB ) study , a prospect i ve pregnancy cohort in Calgary , Alberta , Canada design ed to examine determinants of maternal , infant , and child outcomes and identify barriers and facilitators in health care utilization . Methods Women were recruited from health care offices , communities , and through Calgary Laboratory Services before 25 weeks gestation from May 2008 to December 2010 . Participants completed two question naires during pregnancy , a third at 4 months postpartum , and are currently being followed-up with question naires at 12 , 24 , and 36 months . Data was collected on pregnancy history , demographics , lifestyle , health care utilization , physical and mental health , parenting , and child developmental outcomes and milestones . In addition , biological/serological and genetic markers can be extracted from collected maternal and cord blood sample s. Results A total of 4011 pregnant women were eligible for recruitment into the AOB study . Of this , 3388 women completed at least one survey . The majority of participants were less than 35 years of age , Caucasian , Canadian born , married or in a common-law relationship , well-educated , and reported household incomes above the Calgary median . Women who discontinued after the first survey ( n=123 ) were typically younger , non-Caucasian , foreign-born , had lower education and household income levels , were less likely to be married or in a common-law relationship , and had poor psychosocial health in early pregnancy . In general , AOB participants reflect the pregnant and parenting population at local and provincial levels , and perinatal indicators from the study are comparable to perinatal surveillance data . Conclusions The extensive and rich data collected in the AOB cohort provides the opportunity to answer complex questions about the relationships between biology , early experiences , and developmental outcomes . This cohort will contribute to the underst and ing of the biologic mechanisms and social/environmental pathways underlying associations between early and later life outcomes , gene-environment interactions , and developmental trajectories among children This study investigates the relationship between adverse pregnancy outcomes in high-risk African American women in Washington , DC and sociodemographic risk factors , behavioral risk factors , and the most common and interrelated medical conditions occurring during pregnancy : diabetes , hypertension , preeclampsia , and Body Mass Index ( BMI ) . Data are from a r and omized controlled trial conducted in 6 prenatal clinics . Women in their 1st or 2nd trimester were screened for behavioral risks ( smoking , environmental tobacco smoke exposure , depression , and intimate partner violence ) and demographic eligibility . 1,044 were eligible , interviewed and followed through their pregnancies . Classification and Regression Trees ( CART ) methodology was used to : ( 1 ) explore the relationship between medical and behavioral risks ( reported at enrollment ) , sociodemographic factors and pregnancy outcomes ; ( 2 ) identify the relative importance of various predictors of adverse pregnancy outcomes ; and ( 3 ) characterize women at the highest risk of poor pregnancy outcomes . The strongest predictors of poor outcomes were prepregnancy BMI , preconceptional diabetes , employment status , intimate partner violence , and depression . In CART analysis , preeclampsia was the first splitter for low birthweight ; preconceptional diabetes was the first splitter for preterm birth ( PTB ) and neonatal intensive care admission ; BMI was the first splitter for very PTB , large for gestational age , Cesarean section and perinatal death ; employment was the first splitter for miscarriage . Preconceptional factors strongly influence pregnancy outcomes . For many of these women , the high risks they brought into pregnancy were more likely to impact their pregnancy outcomes than events during pregnancy Prenatal depression has been linked to adverse reproductive outcomes including preterm labor and delivery , and low birth weight . Social support also has been linked to birth outcomes , and may buffer infants from the adverse impact of maternal depression . In this prospect i ve study , 235 pregnant women completed question naires about depression and social support . Clinical interviews were administered to assess for DSM-IV axis I disorders . Following delivery , birth outcomes were obtained from medical records . Babies of depressed mothers weighed less , were born earlier and had lower Apgar scores than babies of nondepressed mothers . Depressed women had smaller social support networks and were less satisfied with support from social networks . We found no direct associations between perceived social support and birth weight . However , depressed women who rated their partners as less supportive had babies who were born earlier and had lower Apgar scores than depressed mothers with higher perceived partner support . Women ’s perception of partner support appears to buffer infants of depressed mothers from potential adverse outcomes . These results are notable in light of the low-risk nature of our sample and point to the need for continued depression screening in pregnant women and a broader view of risk for adverse birth outcomes . The results also suggest 
    Output:
    
When weighing method ological features , we determined that the effects of prenatal depression on LBW are more consistent than effects on length of gestation or PTB .