***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVES Pregnant women face considerable barriers to smoking cessation . The purpose of this study was to determine the prevalence of major depressive disorder ( MDD ) and post-traumatic stress disorder ( PTSD ) and response to  smoking cessation treatment  in pregnant smokers participating in a r and omized , placebo-controlled trial of nicotine gum .  METHODS Participants were 194 low-income , ethnically diverse pregnant smokers . RESULTS Utilizing a structured interview , 45 % and 18 % of the subjects met criteria for a lifetime diagnosis of MDD and PTSD , respectively . There was no difference in response to treatment , based on the presence of either of these psychiatric disorders . CONCLUSIONS Cumulatively , these findings provide evidence of the high degree of unmet mental health needs in pregnant smokers . SCIENTIFIC SIGNIFICANCE Pregnant women with a history of MDD and PTSD appear to be as likely to benefit from  smoking cessation treatment as those without such a history BACKGROUND Unexplained miscarriage is speculated to be due to a Th1/Th2 cytokine imbalance at the feto-maternal interface and immunological functions are known to be under the influence of various psychological factors . Indeed , the psycho-neuro-immuno-endocrine network has been proposed to contribute to miscarriage . To assess whether psychological disorders might induce spontaneous abortion we carried out a prospect i ve study to determine if any psychological parameter influenced risk in those patients with a history of recurrent miscarriages . METHODS A prospect i ve study was carried out on 61 patients with a history of two consecutive first-trimester miscarriages . A battery of self-report question naires including Symptom Checklist-90 Revised and the NEO Five Factor Index and semi-structured interviews were conducted before a subsequent pregnancy . We investigated whether or not these parameters predicted subsequent miscarriages . RESULTS Ten ( 22.2 % ) of the 45 patients who conceived miscarried again . Baseline depressive symptoms influenced subsequent miscarriage ( P = 0.004 ) . This statistically significant effect remained when we corrected with Bonfferoni adjustment ( P = 0.036 ) . CONCLUSIONS A high depression scale is associated with a high miscarriage rate in those patients suffering recurrent miscarriage BACKGROUND The impact of prenatal depression on pregnancy outcomes is largely unknown . METHODS We conducted a population -based prospect i ve cohort study among pregnant women of the Kaiser Permanente Medical Care Program to examine the impact of prenatal depression on the risk of preterm delivery . We interviewed pregnant women in their early pregnancy . Women 's depressive symptoms were ascertained using the st and ard Center for Epidemiological Studies Depression Scale ( CESD ) . The presence of significant prenatal depressive symptoms and severe depressive symptoms was determined by CESD scores > or = 16 and > or = 22 , respectively . RESULTS Among the 791 participants who answered CESD questions and delivered a live birth , after controlling for potential confounders using the Cox proportional hazard regression , women with CESD scores > or = 16 had almost twice the risk of preterm delivery compared with women without depressive symptoms : adjusted hazard ratio ( aHR ) = 1.9 , 95 % confidence interval ( CI ) 1.0 - 3.7 . The risk of preterm delivery increased with increasing severity of depression : aHR = 1.6 ( CI 0.7 - 3.6 ) for CESD 16 - 21 and aHR = 2.2 ( CI 1.1 - 4.7 ) for CESD > or = 22 . The risk of preterm delivery associated with prenatal depression appears to be exacerbated by low educational level , a history of fertility problems and the presence of obesity and stressful events . The observed associations were not confounded by the use of antidepressants , although some of the associations did not reach statistical significance . CONCLUSIONS Our findings show that pregnant women with depressive symptoms are at increased risk of preterm delivery and , in addition , provide preliminary evidence that social and reproductive risk factors as well as obesity and stressful events may exacerbate the effect Despite the well-established adverse birth and childhood health outcomes associated with maternal smoking , smoking rates among pregnant women remain high . Psychosocial health attributes , including anxiety , depression , perceived stress , self-efficacy , and personality characteristics , have especially important roles in smoking behavior . Underst and ing who smokes during pregnancy and what factors influence this behavior choice may be key to improving the effectiveness of smoking cessation intervention programs . We use data from a prospect i ve cohort study of pregnant women to underst and the psychosocial health profiles of women who choose to smoke during pregnancy compared to the profiles of women who do not smoke or successfully quit smoking during pregnancy .  Multinomial logistic regression analyses on 1518 non-Hispanic black and non-Hispanic white women assessed the association between smoking status and psychosocial health while controlling for demographic characteristics . Higher levels of perceived stress , depression , neuroticism , negative paternal support , and perceived racism among non-Hispanic blacks were associated with higher odds of being a smoker than a non-smoker ( p<0.05 ) . Higher levels of self-efficacy , extraversion , agreeableness , conscientiousness , interpersonal support , positive paternal support , and perceived social st and ing were associated with lower odds of being a smoker than a non-smoker ( p<0.05 ) . Our analysis indicates that women who smoked during pregnancy experienced a more negative constellation of psychosocial adversities than women who did not smoke . Given the psychosocial needs and personality profiles experienced by smokers , more attention to the psychosocial strengths and weaknesses of these women may allow for more tailored smoking cessation programs , enhancing both the short- and long-term effectiveness of such interventions Although heterogeneity in the timing and persistence of maternal depressive symptomatology has implication s for screening and treatment as well as associated maternal and child health outcomes , little is known about this variability . A prospect i ve observational study of 1,735 low-income , multiethnic , inner-city women recruited in pregnancy from 2000 to 2002 and followed prospect ively until 2004 ( 1 prenatal and 3 postpartum interviews )  was used to determine whether distinct trajectories of depressive symptomatology can be defined from pregnancy through 2 years postpartum . Analysis was carried out through general growth mixture modeling . A model with 5 trajectory classes characterized the heterogeneity seen in the timing and magnitude of depressive symptoms among the study participants from Philadelphia , Pennsylvania . These classes included the following : 1 ) always or chronic depressive symptomatology ( 7 % ) ; 2 ) antepartum only ( 6 % ) ; 3 ) postpartum , which resolves after the first year postpartum ( 9 % ) ; 4 ) late , present at 25 months postpartum ( 7 % ) ; and 5 ) never having depressive symptomatology ( 71 % ) . Women in these trajectory classes differed in demographic ( nativity , education , race , parity ) health , health behavior , and psychosocial characteristics ( ambivalence about pregnancy and high objective stress ) . This heterogeneity should be considered in maternal depression programs . Additional research is needed to determine the association of these trajectory classes with maternal and child health outcomes OBJECTIVE : To estimate the prevalence of major and minor depression , panic disorder , and suicidal ideation during pregnancy while also identifying factors independently associated with antenatal depressive disorders . METHODS : In this prospect i ve study , participants were 1,888 women receiving ongoing prenatal care at a university obstetric clinic from January 2004 through January 2009 .  Prevalence of psychiatric disorders was measured using the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) criteria based on the Patient Health Question naire . Multiple logistic regression identified factors associated with probable major depressive disorder and any depressive disorder . RESULTS : Antenatal depressive disorders were present in 9.9 % with 5.1 % ( 97 ) meeting criteria for probable major depression and 4.8 % ( 90 ) meeting criteria for probable minor depression . Panic disorder was present in 3.2 % ( 61 ) , and current suicidal ideation was reported by 2.6 % ( 49 ) . Among patients with probable major depression , 29.5 % ( 28 ) reported current suicidal ideation . Psychosocial stress ( odds ratio [ OR ] , 1.29 ; 95 % confidence interval [ CI ] , 1.21–1.36 ) , domestic violence ( OR 3.45 ; 95 % CI 1.46–8.12 ) , chronic medical conditions ( OR 3.05 ; 95 % CI 1.63–5.69 ) , and race ( Asian : OR 5.81 ; 95 % CI 2.55–13.23 ; or African American : OR 2.98 ; 95 % CI 1.24–7.18 ) each significantly increased the odds of probable antepartum major depressive disorder , whereas older age ( OR 0.92 ; 95 % CI 0.88–0.97 ) decreased the odds . Factors associated with odds of any depression were similar overall except that Hispanic ethnicity ( OR 2.50 ; 95 % CI 1.09–5.72 ) also independently increased the odds of any depression . CONCLUSION : Antenatal major and minor depressive disorders are common and significantly associated with clinical ly relevant and identifiable risk factors . By underst and ing the high point prevalence and associated factors , clinicians can potentially improve the diagnosis and treatment rates of serious depressive disorders in pregnant women . LEVEL OF EVIDENCE : Objective To examine whether depression and anxiety in early pregnancy are associated with  preeclampsia in an unselected nulliparous population . Methods In this prospect i ve population -based study during pregnancy at outpatient maternity clinics in the Helsinki metropolitan area , depression was assessed by a Finnish modification of the short form of the Beck Depression Inventory  and anxiety by one established question . Preeclampsia was defined as elevated blood pressure ( BP ) ( more than 140/100 mmHg ) and proteinuria ( 0.3 g during 24 hours or more ) . Age , smoking , alcohol consumption , marital status , socioeconomic status , and bacterial vaginosis were analyzed as potentially confounding factors in a multiple logistic regression analysis . Results Six hundred twenty-three consecutive nulliparous women with singleton pregnancies were studied at ten to 17 ( median 12 ) weeks ' gestation and at delivery . Of them , 28 ( 4.5 % ) women developed preeclampsia . Depression ( mean Beck score 4.5 , range 3–17 ) was observed in 185 ( 30 % ) , women and anxiety was observed in 99 ( 16 % ) in early pregnancy . In multivariate analysis , after adjustment for potentially confounding factors , depression was associated with increased risk ( odds ratio [ OR ] 2.5 ; 95 % confidence interval [ CI ] 1.1 , 5.4 ) for preeclampsia , as was anxiety ( OR 3.2 ; 95 % CI 1.4 , 7.4 ) . Either depression or anxiety , or both , were associated with increased risk ( OR 3.1 ; 95 % CI 1.4 , 6.9 ) for preeclampsia . Bacterial vaginosis together with depression was associated with increased risk ( OR 5.3 ; 95 % CI 1.8 , 15.0 ) for preeclampsia . Conclusion Depression and anxiety in early pregnancy are associated with risk for subsequent preeclampsia , a risk further increased by bacterial vaginosis OBJECTIVE : To estimate how social support and social conflict relate to prenatal depressive symptoms and to generate a brief clinical tool to identify women at increased psychosocial risk . METHODS : This is a prospect i ve study following 1,047 pregnant women receiving care at two university-affiliated clinics from early pregnancy through 1 year postpartum .  Structured interviews were conducted in the second trimester of pregnancy . Hierarchical and logistic regressions were used to examine potential direct and interactive effects of social support and conflict on prenatal depressive symptoms measured by the Center for Epidemiologic Studies -Depression Scale . RESULTS : Thirty-three percent of the sample reported elevated levels of depressive symptoms predicted from sociodemographic factors , social support , and social conflict . Social support and conflict had independent effects on depressive symptoms although social conflict was a stronger predictor . There was a “ dose – response , ” with each increase in interpersonal risk factor result ing in consequent risk for probable depression based on symptom reports ( Center for Epidemiologic Studies -Scale greater than or equal to 16 ) . A composite of one social support and three conflict items were identified to be used by clinicians to identify interpersonal risk factors for depression in pregnancy . Seventy-six percent of women with a composite score of three or more high-risk responses reported depressive symptoms . CONCLUSION : Increased assessment of social support and social conflict by clinicians during pregnancy can identify women who could benefit from group or individual interventions to enhance supportive and reduce negative social interactions . LEVEL OF EVIDENCE : Aims . To investigate the relationship between antenatal and postpartum depression and anxiety and to explore associated maternal characteristics . Methods . From a population ‐based sample of 1,555 women attending two obstetric clinics in Sweden , all women with an antenatal psychiatric diagn 
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Among employed women , higher depression scores were observed among NHBs , compared to NHWs ; while there was no racial difference among unemployed women .
In another study , higher parity , higher stress , and lower self-esteem were significant correlates of depression among NHBs , while less satisfaction with social support , and higher stress predicted higher depression scores among NHWs and Hispanics respectively .
Conclusions The findings of our review suggest that not only is antenatal depression a major public health issue that needs to be addressed , but different racial/ethnic groups seem to differ in their vulnerability and risk factors