Cyclothymic temperament and obstetric severity as independent correlates of antenatal depressive symptoms in high-risk pregnancy: A prospective cohort study.

BACKGROUND

Antenatal depression affects 12.5%-44.2% of women with high-risk pregnancies, yet risk stratification relies predominantly on obstetric factors. We examined whether cyclothymic temperament is independently linked to antenatal depression beyond obstetric severity.

METHODS

This prospective cohort enrolled 161 women with high-risk pregnancies at a tertiary center (April 2020-May 2021). The primary outcome was antenatal depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS] ≥10). Primary predictors were maternal-fetal intensive care unit (MFICU) admission and the cyclothymic subscale of the Korean-validated short Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). A pre-specified two-variable Firth's penalized logistic regression with bootstrap optimism correction was used; incremental value was assessed by the corrected area under the ROC curve (AUROC), calibration, and decision curve analysis.

RESULTS

Antenatal depression occurred in 52 of 161 participants (32.3%). Both MFICU admission (adjusted odds ratio [aOR], 3.27; 95% CI, 1.45-7.37) and cyclothymic score (aOR, 1.63 per unit; 95% CI, 1.37-1.95) were independently associated with antenatal depression. An exploratory cyclothymic threshold ≥4 yielded a negative predictive value of 87.5%; adding the cyclothymic score to the obstetric-only model improved the corrected AUROC from 0.629 to 0.821, with good calibration and higher net benefit. Symptoms persisted into the early postpartum period in 77.5% of affected women.

CONCLUSIONS

Cyclothymic temperament and MFICU admission were independently associated with antenatal depression in high-risk pregnancies. Because both were assessed concurrently the association is cross-sectional; pending validation, brief TEMPS-A cyclothymic assessment may help identify psychologically vulnerable women.